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PubMed2004

[Vitreoretinal traction syndrome in multiple sclerosis].

METHODS: From January to December 2001, 89 patients with multiple sclerosis (MS) were treated in our hospital; 24 of them were diagnosed for the first time. All patients underwent a complete ophthalmologic examination including a three-mirror contact lens examination when photopsias were found or the disease was diagnosed primarily. RESULTS: Two patients showed vitreoretinal tractions with signs of periphlebitis before clinical-neurological manifestation of multiple sclerosis. The third patient, in whom the disease had been known for years, showed distinct neovascularizations, vasculitis, and recurrent vitreous hemorrhages. High-dose steroid therapy resulted in stabilization of the retinal situation in one patient, but the tractions remained unchanged. Additional laser coagulation in the second patient achieved stabilization and reduction of the tractions. A pars plana vitrectomy led to stabilization of the retinal proliferation in the third patient. CONCLUSIONS: The vitreoretinal traction syndrome is associated with MS and can precede its clinical-neurological manifestation. The good results after argon laser coagulation and vitreoretinal surgery suggest a vascular pathogenesis of these tractions.

Adult↗

PubMed2005

Association of retinal vasculitis (Eales' disease) and Meniere-like vestibulocochlear symptoms.

The objective of this study was to present a previously unknown association of visual loss and Meniere-like vestibuloauditory symptoms in Eales' disease (idiopathic retinal vasculitis) and to give a survey of other conditions affecting both the retina and inner ear. A 32-year-old man diagnosed with Eales' disease presented with recurrent deteriorations of visual acuity and simultaneous recurrent vestibuloauditory symptoms strongly reminiscent of Meniere's disease. Both the recurrent low frequency hearing losses and the losses of visual acuity could be restituted repeatedly by high dose i.v. corticosteroids. A literature review reveals that in a number of other retinopathic diseases associated with Meniere-like symptoms, microvasculopathy is also the pathomechanism. A common pathogenetic cause, e.g., autoimmune-mediated microvasculitis of retinal periphlebitis and vestibulocochlear symptoms, in this case is suggested. The presented case adds new evidence to microvasculopathy being a pathogenetic factor in Meniere's disease. In cases of coincidence of vestibulocochlear symptoms and retinal perivasculitis, a therapeutic attempt with high-dose corticosteroids is advisable.

Adult↗

PubMed1982

Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome.

Among the prominent features of a newly described acquired cellular immunodeficiency syndrome that affects previously healthy male homosexuals are multiple opportunistic infections and Kaposi's sarcoma. Immunosuppression induced by cytomegalovirus infection may play a major role in the pathogenesis of this disorder. We have performed ophthalmic examinations on seven such patients and found ocular abnormalities in all cases. Six patients were examined during the course of their illness and one patient at autopsy only. Each patient had several cotton-wool spots in the affected eye. Other ocular findings included cytomegalovirus retinitis, severe retinal periphlebitis, and conjunctival Kaposi's sarcoma (one case each).

Candidiasis, Chronic Mucocutaneous↗

PubMed1982

Retinal phlebitis with chorioretinal emboli.

Emboli to the eye may cause retinal vascular occlusive disease with a wide range of clinicopathologic manifestations including arteriolar occlusion, retinal ischemia and infarction, and retinal neovascularization. Clinical observations of a progressive obliterative arteriolitis in patients with systemic embolic disease have led to the speculation that retinal vasculitis may be a feature of ocular embolic disease. A postmortem examination of the enucleated eyes of two elderly female patients disclosed gross and histopathologic features of retinal periphlebitis associated with many chorioretinal calcific emboli. These patients also had premortem and postmortem manifestations of systemic thromboembolic disease originating from the heart and great vessels. One patient had a progressive decrease in visual acuity, paracentral scotoma, and midperipheral perivascular sheathing. These findings suggest that ocular embolism may sometimes be a factor in the development of retinal phlebitis.

Adult↗

PubMedDate not supplied

Ocular tuberculosis.

In recent years tuberculosis has reemerged as a serious public health problem, raising the possibility that tuberculous eye disease may also become more prevalent. The predominant route by which tubercle bacilli reach the eye is through the bloodstream, after infecting the lungs. The pulmonary loci might not be evident clinically or radiographically. The most common manifestation of ocular tuberculosis in patients with pulmonary tuberculosis is choroiditis. Retinal periphlebitis is rarely caused by direct invasion of the retina by tubercle bacilli. Retinal tuberculosis is usually, but not always, secondary to an underlying choroiditis. Tuberculoprotein hypersensitivity may have a role in the pathogenesis of phlyctenulosis and Eales' disease. Both ocular and orbital tuberculosis are usually unilateral. Skin testing should be performed in selected patients based on the clinical presentation and/or a history of exposure to tuberculosis. The specificity of the PPD skin test for Mycobacterium tuberculosis increases with larger skin reactions and with a history of exposure to an active case of tuberculosis. Because of the potential for serious drug toxicities, empiric treatment with antituberculous chemotherapy should be reserved only for those cases that have an identifiable risk of tuberculous disease.

Antitubercular Agents↗

PubMed1981

Antibody-mediated enhancement of disease in feline infectious peritonitis: comparisons with dengue hemorrhagic fever.

Non-immune kittens passively immunized with feline serum containing high-titered antibodies reactive with feline infectious peritonitis virus (FIPV) developed a more rapid disease after FIPV challenge than did kittens pretreated with FIPV antibody-negative serum. Antibody-sensitized, FIPV challenged--kittens developed earlier clinical signs (including pyrexia, icterus, and thrombocytopenia) and died more rapidly than did non-sensitized, FIPV-challenged kittens. Mean survival time in sensitized kittens was significantly (P less than 0.05) reduced compared to non-sensitized kittens (mean +/- SEM, 10.0 +/- 0.6 days vs. 28.8 +/- 8.3 days, respectively). Lesions induced included fibrinous peritonitis, disseminated pyogranulomatous inflammation and necrotizing phlebitis and periphlebitis. FIPV antigen, immunoglobulin G, complement (C3) and fibrinogen were demonstrated in lesions by immunofluorescence microscopy. The pathogenesis of dengue hemorrhagic fever (DHF) in persons bears striking resemblance to that of FIP in experimental kittens. In both FIP and DHF, non-neutralizing antibody may promote acute disease by enhancement of virus infection in mononuclear phagocytes or by formation of immune complexes, activation of complement and secondary vascular disturbances.

Animals↗

PubMed2004

Fuchs heterochromic cyclitis: rubella virus antibodies and genome in aqueous humor.

PURPOSE: To characterize the polyspecific intraocular antibody synthesis in aqueous humor of patients with chronic inflammatory diseases of the eye and to detect the causative antigen in Fuchs heterochromic cyclitis (FHC). DESIGN: Retrospective case-control study. METHODS: Intraocular antibody synthesis is detected in aqueous humor with the Antibody Index [AI] (improved Goldmann-Witmer Index) and quantified as specific antibody fraction, F(s) (intraocular specific antibody concentration in percent of intraocular total immunoglobulin G in aqueous humor). Virus detection is by nested polymerase chain reaction. RESULTS: Fifty-two eyes of 52 patients with clinically defined FHC (aged 16-73 years) had an intraocular synthesis of rubella antibodies (AI > or =1.5). The rubella genome was detected in 5 (18%) of 28 aqueous humor samples investigated, or in 5 (56%) of 9 patients aged <40 years. Oligoclonal IgG was synthesized in 34 (87%) of 39 eyes. Unaffected fellow eyes (n = 3) or cerebrospinal fluid (n = 2) were normal. In FHC the median rubella AI = 20.6 (total range 1.5-309) was seven times higher than in multiple sclerosis (MS) patients (n = 15) with uveitis intermedia or periphlebitis retinae. In MS the intraocular rubella antibody synthesis (frequency 73%) is part of a polyspecific immune response (increased measles AI in 80%, varicella zoster virus AI in 47%, herpes simplex virus AI in 23%). The median rubella-F(s) = 2.6% in FHC (range = 0.14%-45.9%) was approximately 40 times higher than in MS, consistent with a virus-driven antibody response in FHC. Noninflammatory controls (50 senile cataracts) had neither an intraocular rubella antibody synthesis (normal AI < or =1.4) nor rubella antigen in aqueous humor. The rubella AI was normal in all patients with an intraocular toxoplasmosis (n = 24), anterior uveitis (n = 27), herpes simplex virus iritis (n = 25), and varicella zoster virus iritis (n = 14). CONCLUSIONS: Fuchs heterochromic cyclitis is a rubella virus-driven disease with persistence of the virus preferentially detected in the younger patients. The proposed laboratory supported diagnosis of FHC is based on the increased rubella Antibody Index. The virus etiology gives a rationale for omitting the ineffective corticosteroid therapy of FHC.

Adolescent↗

PubMed2005

[Ocular manifestation of Behçet disease (study of 50 patients consulting in dermatology department)].

INTRODUCTION: Behçet disease is a multisystemic vascularitis. Ocular affection is one of the major criteria of this disease. The aim of this study is to specify the clinical, therapeutical characteristics and the prognosis factors of the ocular affection in patients having BD and admitted to the dermatology department. PATIENTS AND METHODS: It is a retrospective investigation carried out in the dermatology department of Ibn Rochd university hospital center of Casablanca, Morroco, from Jannuary 1990 until December 2003. Two patient groups have been distinguished. The first one involved 50 patients (44,2%) having BD with ocular affection, and the second group involved 63 patients having BD without ocular affection. RESULTS: The mean age was 29 +/- 8 years in the first group VS 30 +/- 7,9 years in the 2(nd) group. The ocular affection was more frequent in males than in females (P < 0.05). The ocular manifestations were marked by uveitis and retinal periphlebitis. The frequency of the cutaneomucosal and joint manifestations was similar in both groups, whereas neurologic and vascular with ocular affections. The choice of the treatment depended on the type of ocular affection. Evolution was marked by blindness in 6 patients (12%). DISCUSSION: The ocular affection comes second after the cutanous mucuous affection. Males are more clearly affected than females. This allows saying that there is a marked effect of the sexual hormones on the ocular affection. Age is not predictive of this ocular affection. The ocular affection was severe in our series and was dominated by uveitis and vascularitis. We insist on the severity of ocular Behçet and its evolution? Risk toward blindness especially concerning young man. Currently, the treatment is not codified; however, the encouraging outcome obtained with some immunosuppressive therapies would be better if this treatment was set up early. CONCLUSION: This study enebed us to re-examine the ocular manifestations of the Behçet disease in the Maroccan population by the means of a consultation of Dermatology. Il should be noted that it is worse forecast because on the one hand of its frequent association to vascular and neurological affections and other share of the delay of consultation noted at the majority of our patients.

Adolescent↗

PubMed2006

Opportunistic posterior uveal infections in renal transplant patients.

AIMS: To describe the cases of opportunistic posterior uveal infection diagnosed in renal transplant recipients at a single center over a 10-year period. METHODS: The study involved 1156 patients who underwent renal transplantation. Five of the recipients were diagnosed with posterior uveal infection. The specific diagnoses were acute retinal necrosis (two cases), cytomegalovirus retinitis (one case), nocardial chorioretinitis (one case), or tuberculoid granuloma (one case). RESULTS: The five patients were aged 27 to 55 years, and the interval from renal transplantation to uveal infection ranged from 7 months to 16 years. All patients were receiving immunosuppressive treatment at the time of the posterior uveal infection. Acute retinal necrosis was diagnosed in cases I and II at 2 and 3 years after transplantation, respectively. In both cases, fundus examination revealed moderate vitritis and yellow-white lesions representing confluent retinitis. In case III (cytomegalovirus retinitis), 7 months after transplantation the patient developed extensive hemorrhage and confluent white exudates, periphlebitis, and perivascular sheathing in the right eye. In case IV, culture of a fine-needle aspirate from a well-demarcated, white-yellow, elevated choroidal lesion in the superotemporal region of the macula revealed nocardial infection. Fundus examination of the right eye of case V revealed a small, hypopigmented choroidal lesion superior to the optic disc. The lesion was identified as a choroidal tuberculoid granuloma. CONCLUSIONS: Opportunistic chorioretinal infections can occur at any time after renal transplantation. So it is important that every kidney recipient undergo regular ophthalmic examinations throughout his or her lifetime.

Adult↗

PubMed2001

A case of multiple sclerosis with granulomatous uveitis in Japan--use of the antilipoarabinomannan (LAM)-B test in differential diagnosis.

PURPOSE: To report a patient with multiple sclerosis and associated with granulomatous uveitis, and how anti-lipoarabinomannan (LAM)-B antibody can play a key role in differential diagnosis. METHODS: Case report. RESULTS: A 35-year-old Japanese woman with multiple sclerosis, diagnosed 3 years ago, presented with blurred vision in her left eye. Ophthalmological examinations revealed granulomatous iridocyclitis in her left eye and retinal periphlebitis in both eyes. The diagnosis of tuberculosis was suspected because of a positive tuberculin skin test. However, a further examination by an anti-LAM-B antibody test excluded active tuberculosis. Her clinical findings were thought most likely to be caused by multiple sclerosis and treated with corticosteroids. CONCLUSION: We should consider the possibility of multiple sclerosis as the underlying origin in patients with granulomatous uveitis. A measurement of anti-LAM-B antibody titer may be useful in the differential diagnosis of granulomatous uveitis.

Administration, Topical↗

PubMed1997

The association of HLA-DR15 and intermediate uveitis.

PURPOSE: To evaluate the association between human leukocyte antigen (HLA-DR15) specificity and intermediate uveitis. METHODS: Eighteen patients diagnosed with intermediate uveitis underwent HLA-DR15 serotyping. Additionally, DNA-based phenotyping for a specific HLA-DR15 allele was performed in four patients. The clinical features of HLA-DR15-positive intermediate uveitis were compared with those of HLA-DR15-negative intermediate uveitis. RESULTS: Thirteen of 18 patients (72%) were positive for HLA-DR15. The frequency of the HLA-DR15 specificity in intermediate uveitis patients was significantly higher than in the control subjects (relative risk, 6.36; P < .001). Each of four patients tested carried the specific allele, DR beta 1*1501, which has been associated with multiple sclerosis. In the HLA-DR15-positive group were four patients (31%) with coexisting multiple sclerosis or optic neuritis, one patient with coexisting narcolepsy, and three patients (23%) with a family history of multiple sclerosis. Retinal periphlebitis, especially if bilateral, was a frequent ophthalmoscopic finding in HLA-DR15-positive intermediate uveitis. CONCLUSIONS: This study identifies a significant association between intermediate uveitis and the HLA-DR15 specificity. Patients who are HLA-DR15-positive and have intermediate uveitis may have systemic findings of another HLA-DR15-related disorder. Intermediate uveitis may belong to a constellation of HLA-DR15-related disorders, which includes multiple sclerosis, optic neuritis, and narcolepsy.

Adolescent↗

PubMed1997

Uveitis associated with an epidemic outbreak of leptospirosis.

PURPOSE: To define uveitis associated with leptospirosis in a clinical setting. METHODS: We present the clinical features of 73 consecutive cases of uveitis linked clinically to an outbreak of systemic leptospirosis in patients with antibodies to Leptospira species who were examined from January to September 1994. RESULTS: In 73 patients, the pattern of ocular involvement was unilateral in 35 and bilateral in 38. Panuveitis was seen in 106 eyes (95.5%), retinal periphlebitis in 57 eyes (51.4%), and hypopyon in 14 eyes (12.6%). Anterior uveitis alone without hypopyon was observed in three eyes (2.7%), whereas vitreous inflammatory reaction alone was seen in two eyes (1.8%). Sixty of 73 patients (82.2%) or 91 of 111 eyes (82.0%) were followed up for 8 months. Final visual acuity was 6/6 (20/20) in 47 eyes (52%) and improved during treatment, although not up to 6/6, in 15 eyes (16%). Twenty-eight eyes (31%) maintained same vision, and one eye showed deterioration of vision. CONCLUSION: Uveitis associated with leptospirosis may manifest as unilateral or bilateral uveitis, anterior uveitis, or panuveitis. The prognosis is generally good in this entity, even when the inflammation is severe. Awareness of this disease in endemic areas is important in order to differentiate it from other uveitic entities, especially in young male patients in whom other immunologic uveitides are also common.

Adult↗

PubMed1998

Intraocular inflammation and the diffuse infiltrative lymphocytosis syndrome.

PURPOSE: To report a case of bilateral panuveitis associated with diffuse infiltrative lymphocytosis syndrome (DILS). METHODS: Case report. A 35-year-old woman with known human immunodeficiency virus (HIV) infection developed bilateral uveitis with retinal periphlebitis in association with diffuse infiltrative lymphocytosis syndrome. RESULTS: Detailed comprehensive examination and investigations were performed and recognized causes of panuveitis excluded. CONCLUSION: To the best of our knowledge, we report the first case of retinal findings associated with diffuse infiltrative lymphocytosis syndrome.

Adult↗

PubMedDate not supplied

Eales disease--an update.

Eales disease, first described by Henry Eales in 1880, remains an enigma. The disease, observed more commonly in the Indian subcontinent than in the rest of the world, occurs in young healthy adult males, initially presenting as retinal periphlebitis and later as retinal ischemia that may lead to vascular alterations and neovascularization. Recurrent vitreous hemorrhage with or without retinal detachment is the common sequelae. In recent years, immunological, molecular biological, and biochemical studies have indicated the role of human leukocyte antigen, retinal autoimmunity, mycobacterium tuberculosis genome, and free radical mediated damage in the etiopathogenesis of this disease. However, its etiology appears to be multifactorial. The management depends on the stage of the disease and consists of medical treatment with oral corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages. The results of vitreoretinal surgery have been found to be satisfactory in case of vitreous hemorrhage with or without retinal detachment.

Diagnosis, Differential↗

PubMed1997

Neuroma of the sural nerve as a complication of stripping of the small saphenous vein.

BACKGROUND: Two cases of neuroma of the sural nerve after stripping of the small saphenous vein are reported. PATIENTS: This 39-year-old woman and this 52-year-old man complained of paresthesia and burning pain, which worsened with walking, in the area of the sural nerve, about 1 month after saphenectomy of the small saphenous vein. RESULTS: Exploratory surgery in both cases led to the identification of the spindle neuroma-in-continuity of the sural nerve confirmed histologically. The nerve was sectioned and the proximal stump implanted under the deep fascia. This resulted in complete remission of the symptoms in one case, and partial in the other. CONCLUSION: It is likely that the nerve was lacerated during stripping, as a process of periphlebitis might cause adhesion of the vein to the nerve, and then the spindle neuroma developed. The authors underline the necessity of including neuroma of the sural nerve among the possible, albeit rare, complications of stripping of the small saphenous vein.

Adult↗

PubMed2004

Demographic-related variations in posterior segment ocular sarcoidosis.

OBJECTIVE: To compare the frequency of posterior segment involvement (PSI), the prevalence of specific posterior segment signs, and visual acuity in ocular sarcoidosis by patient race, sex, and age. DESIGN: Retrospective, cross-sectional observational study. PARTICIPANTS: Seventy-six consecutive patients with biopsy-proven or presumed ocular sarcoidosis seen at the Duke University Eye Center between 1989 and 2001. METHODS: Medical record review. MAIN OUTCOME MEASURES: Patient demographics, presence and laterality of specific posterior segment signs, and visual acuity at initial examination. RESULTS: Of the 76 patients, 68% were black (34 female and 18 male) and 32% were white (18 female and 6 male). A total of 68 patients (89%) had PSI: black patients had 85% and white patients had 100% (P = 0.05). For patients with PSI, white females had the highest mean age at initial examination (58 years compared with 37 years for all others; P = 0.005). The most common findings among the 68 patients with posterior segment disease were vitritis (69%); choroidal "punched-out" lesions (56%); "snowball" lesions (46%); cystoid macular edema (CME; 31%); and periphlebitis, vitreous opacity, and posterior vitreous detachment (29% each). There was a significantly higher prevalence of "punched-out" lesions and CME in whites (79% and 54%, respectively) compared with blacks (43% and 18%, respectively; P = 0.005 each). Additionally, the prevalence of CME was highest in white females (61%) compared with all others (20%; P = 0.002). Patients with vitreous hemorrhage were more likely to be in the youngest age group (P = 0.02). Female patients with posterior segment disease had a significantly lower visual acuity compared with males in both the better (P<0.001) and worse (P = 0.002) eye. CONCLUSIONS: We have identified variations based on patient race, sex, and age in PSI, specific posterior segment signs, and visual acuity in cases of ocular sarcoidosis.

Adolescent↗

PubMed1983

Acquired immune deficiency syndrome. Ocular manifestations.

The acquired immune deficiency syndrome (AIDS) is a recently described disorder of cellular immunity in homosexuals, intravenous drug abusers, and Haitians. Manifestations include Kaposi's sarcoma, Pneumocystis carinii pneumonia, and other opportunistic infections. Ophthalmic and autopsy examinations of 30 patients at UCLA revealed frequent ocular abnormalities. Findings included cotton-wool spots (16 patients), cytomegalovirus retinitis (eight patients), conjunctivitis and keratitis (four patients), conjunctival Kaposi's sarcoma (three patients), Mycobacterium avium intracellulare choroidal granulomas (one patient), and retinal periphlebitis (one patient). We feel that the presence of cotton-wool spots in patients with this syndrome indicates a poor prognosis. Immunologic and electronmicroscopic studies of cotton-wool spots revealed no infectious agents or immunoglobulin deposition. Cytomegalovirus retinitis always was associated with a fatal outcome. The retinitis was characterized by an acute inflammatory reaction in 50% of patients. Ophthalmologists should be aware of the syndrome and its ocular manifestations.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Immunopathologic features of retinal lesions in multiple sclerosis.

To further characterize the nature of retinal periphlebitis and retinitis in multiple sclerosis, immunoperoxidase studies were performed on retinal tissue from multiple sclerosis patients at autopsy. Antibodies against myelin basic protein stained the optic nerve but not the retina. Both normal and multiple sclerosis retinas showed staining of Müller cells with Leu-7 (a monoclonal antibody that cross-reacts with myelin associated glycoprotein and natural killer cells). Nerve fiber bundles of the optic nerve in cases with multiple sclerosis and controls also showed staining with Leu-7 antibody. Tissue-bound IgG was demonstrated on retinal ganglion cells in six of seven multiple sclerosis cases but not in controls.

Antibodies, Monoclonal↗