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PubMed1992

[Uveitis and immune complexes].

The mean level of circulating immune complexes (CIC) in 24 uveitic patients determined by PEG deposition with the biochemical analyzor was found to be 28.458 +/- 7.796, in contrast to the value of 14.499 +/- 6.194 in the control group. The CIC level in acute iridocyclitis and panuveitis was significantly elevated compared with those in other types of uveitis. The results again demonstrated that most cases of uveitis, especially those of unknown origin, were related with immune complexes, and changes in the level of CIC could also be an indicator of therapeutic effects.

Adolescent↗
PubMed1992

Anti-toxoplasma serotitres in uveitis and ocular toxoplasmosis.

This study was based on anti-toxoplasma serotitres obtained from 80 normal healthy adults and 103 consecutive patients with anterior, posterior and panuveitis over a 42 month period. Twelve out of 80 (15%) normal healthy sera were found to have low titres (1:64 to 1:256), while 3 (3.8%) had high titres (1:1024 or higher). The distribution of serotitres in patients with clinical toxoplasmosis was significantly different from the population sample (p less than 0.001, chi-squared test). Similarly, the distribution of serotitres in patients with posterior uveitis (of which 28 out of 54 were clinically ocular toxoplasmosis) having serotitres of 1:1024 or greater, was found to be significantly different from the normal population (p less than 0.001, Chi-squared test), but not statistically different from those with clinical ocular toxoplasmosis. Hence, anti-toxoplasma serotitre is useful as a diagnostic screening tool only in patients with posterior uveitis. It is also useful in confirming cases of suspected clinically positive ocular toxoplasmosis in our local population.

Adolescent↗
PubMedDate not supplied

[Secondary syphilis with ocular involvement in a 77-year-old man].

A 77 year old man complained of vision loss and presented psoriasiform skin manifestations. A bilateral panuveitis was observed and after extensive investigation including vitrectomy the patient was diagnosed with secondary syphilis with ocular involvement. Syphilis has shown an increasing incidence in Sweden especially within the group of men who have sex with men. This case report reminds us of the diversity of symptoms which syphilis may present and the importance of PCR to demonstrate Treponema pallidum.

Aged↗
PubMedDate not supplied

Visual outcome of vitrectomy in seasonal hyperacute pan uveitis.

INTRODUCTION: Seasonal Hyper Acute Panuveitis (SHAPU) is a sight threatening condition often affecting children. Its management as yet is a challenge in ophthalmic practice. Most of the eyes even after treatment end up in pthisis bulbi. MATERIALS AND METHODS: A retrospective hospital based analysis of 18 patients with SHAPU managed with vitrectomy at Himalaya Eye Hospital (HEH) Pokhara over a period of two years was carried out. RESULTS: Out of 18 patients 10 were males. Majority of them were below the age of 15 years. Best corrected visual acuity (BCVA) at presentation was less then 3/60 in 72% of them. BCVA was better then 6/60 in 7 (50%) out of 14 patients, who underwent vitrectomy. CONCLUSION: Vitrectomy is a useful procedure in management of SHAPU.

Adolescent↗
PubMed1995

Intravitreal sustained-release dexamethasone device in the treatment of experimental uveitis.

PURPOSE: Uveitis often runs a chronic course requiring long-term therapy. Topical treatment results in poor intravitreal penetration, and systemic therapy is associated with significant side effects. The authors investigated whether an intravitreal sustained-release dexamethasone device was effective in the treatment of severe panuveitis in a rabbit model. METHODS: Twenty New Zealand white rabbits were immunized twice subcutaneously with 10 mg of Mycobacterium tuberculosis H37Ra antigen. Twelve days later, sustained-release dexamethasone devices were implanted into the vitreous of the right eye of 10 rabbits. Ten control rabbits received a sham device. One day later, rabbits were challenged with an intravitreal injection of 33 micrograms of antigen. Three animals in each group were sacrificed on post-challenge days 7 and 13 for aqueous white blood cell (WBC) count, protein determination, and histologic examination. To simulate chronic inflammation with exacerbations, the eight remaining eyes were rechallenged with intravitreal antigen on day 15 and were observed for 3 1/2 months. Inflammation was graded clinically by two masked observers. Retinal function was evaluated by electroretinography (ERG). Light microscopy was used to evaluate the eyes histopathologically. The amount of residual drug in the devices was measured on day 13 and at the end of the experiment. RESULTS: By all clinical criteria measured--anterior chamber cells, flare, and vitreous opacity--treated eyes had significantly less inflammation than untreated eyes (P < 0.05). Clinical examination correlated well with objective data. Both protein concentration (P < 0.05) and aqueous WBCs (P < 0.02) were approximately 10-fold higher, and ERGs were significantly depressed (P < 0.05) in untreated eyes compared to treated eyes. Histopathologic examination showed marked inflammation and tissue disorganization in the untreated compared to the treated eyes. After antigen rechallenge, inflammation in experimental eyes was still less than in control eyes. Late complications such as corneal neovascularization, cataract, and hypotony were also less in the treated eyes than in the untreated eyes. At the end of the experiment (99 days after device implantation), approximately 30% of drug remained in the devices. CONCLUSIONS: The intravitreal sustained-release dexamethasone device is highly effective in suppressing inflammation and preventing complications after two episodes of experimental uveitis in a rabbit model for at least 3 1/2 months. This device may be useful in the management of patients with severe chronic posterior uveitis who cannot tolerate systemic or periocular therapy.

Animals↗
PubMed1993

Vitrectomy in multifocal chorioretinitis.

In nine patients suffering from multifocal chorioretinitis with panuveitis, we obtained no impressive therapeutic benefit from vitrectomy. Seven women and two men ranging in age from 63 to 86 years underwent pars plana vitrectomy at 3-28 months after the first signs of uveitis had appeared. Previous medical treatment had always been unsuccessful. Vitrectomy was performed in one eye of eight patients and in both eyes of one patient. In addition, in two patients a cataract was removed by phacoemulsification and an intraocular lens was implanted. A visual improvement of one or two lines was achieved postoperatively in most cases, but the visual acuity decreased to preoperative values or less within 6 months. The surgical treatment showed no obvious effect on the intensity or frequency of uveitis relapse. In all cases, vitrectomy specimens were serologically negative for herpes-group viruses. Histologically, no malignancy was detectable. Immunohistochemistry studies revealed that a large number of the vitreous cells bore T-lymphocyte markers (mostly CD2-, CD3-, and CD4-positive); about one-third of the vitreous cells were macrophages, and B-lymphocytes were only rarely detected. In conclusion, pars plana vitrectomy in multifocal chorioretinitis achieved no positive long-term result. There was no diagnostic hint as to whether the cause of the uveitis might have been of a viral, malignant, or autoimmune origin. Therefore, multifocal chorioretinitis remains poorly understood in terms of its etiology and adequate treatment.

Aged↗
PubMed1995

Intraocular tuberculosis. Clinicopathologic study of five cases.

BACKGROUND: Intraocular tuberculosis is a rare disease. Only approximately 18 cases of microbiologically or histopathologically proven cases of intraocular tuberculosis have been reported. METHODS: Between 1984 and 1994, five cases of intraocular tuberculosis were confirmed microbiologically and histopathologically from intraocular specimens in the authors' uveitis clinic. Systemic antitubercular treatment was instituted, along with the treatment for the ocular inflammation. RESULTS: Clinical presentation included subretinal abscess (two cases), granulomatous anterior uveitis with scleral perforation, an exudative mass in the anterior chamber, and choroidal mass with panuveitis (one case each). Aqueous aspirate in three patients and eviscerated material in the other two showed presence of acid fast bacilli. One globe that required enucleation revealed granulomatous inflammation with caseation necrosis. Two patients showed a significant response to antitubercular therapy, whereas the other three patients eventually required evisceration or enucleation. CONCLUSIONS: Intraocular tuberculosis can have protean manifestations and variable response to systemic antitubercular therapy.

Abscess↗
PubMed1996

Leptospiral antibodies in patients with recurrent ophthalmic involvement.

Leptospiral antibodies could be demonstrated by microscopic agglutination test in 14 of 15 (93%) patients with acute panuveitis and retinal vasculitis in a preliminary study undertaken during the postmonsoon period at Madurai in Tamilnadu, India. The predominant serogroup was Pomona followed by Autumnalis, Australis and Javanica, the titres being between 1:160 and 1:10240. Titres in the normal controls were 1:20 to 1:80 in 8 of 20 mostly to the endemic serogroup Autumnalis. The involvement of leptospires particularly Pomona as a cause of ophthalmic complications in the patients studied is likely.

Adult↗
PubMed1996

Experimental autoimmune uveoretinitis induced by the gamma-subunit of cyclic guanosine monophosphate phosphodiesterase in rats.

PURPOSE: To investigate the capacity of the recombinant gamma-subunit (P gamma) of cyclic guanosine monophosphate phosphodiesterase to induce experimental autoimmune uveoretinitis in Lewis rats. METHODS: Bovine P gamma was expressed in Escherichia coli cells and purified by fast protein liquid chromatography. Lewis rats were immunized by a single footpad injection of P gamma emulsified in complete Freund's adjuvant. Clinical and histopathologic changes in the eye and pineal gland were examined. Lymphocytes were prepared from the lymph nodes of rats with uveitis and transferred by intraperitoneal injection to naive recipient rats. RESULTS: Immunization of rats with P gamma induced panuveitis and pinealitis with clinical and histopathologic changes similar to those induced by S-antigen. Lymphocytes from the lymph nodes of diseased rats transferred uveitis to naive recipients. CONCLUSIONS: P gamma, a retina-specific protein of molecular weight less than 10,000 kDa, is capable of inducing uveoretinitis in Lewis rats. The disease can be transferred adoptively to naive rats by injection of lymphocytes from donor rats with experimental autoimmune uveoretinitis. Inflammation of the pineal gland of immunized rats suggests that P gamma is not only localized to the retina but also to the pineal gland.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMedDate not supplied

[A case of syphilitic uveitis].

A 43-year-old woman with alcoholism developed hearing loss, dizziness, unsteady walking, frequent urination, memory disorders, and later a manifest drop of bilateral vision. The patient denied syphilis. Examinations revealed bilateral panuveitis, bilateral neurosensory amblyacusia, vestibulopathy, and imperative urges to urination. Serological tests were positive with both Treponema and other than Treponema antigens. The cerebrospinal fluid was normal. Ampicillin therapy was ineffective. The clinical picture, diagnosis, and treatment of syphilitic uveitis are discussed; the authors point out that it is often associated with neurosyphilis. The condition is extremely rare nowadays.

Adult↗
PubMed1998

Chronic uveitis in Kinshasa (D R Congo).

PURPOSE: To determine frequencies of different types of chronic uveitis and the possible associated conditions. METHODS: In the retrospective study a review is made of all 336 consecutive patients with chronic uveitis seen during 1983 through 1993. All patients were evaluated ophthalmologically and most of them medically. Traumatic uveitis was excluded from this study. RESULTS: There were 171 (51%) males and 165 (49%) females. Of 336 patients with chronic uveitis, 194 (58%) had anterior uveitis, 76 (23%) had isolated posterior uveitis, 38 (11%) had panuveitis and 28 (8%) intermediate uveitis. Associated conditions were found in 151 (46%) of 336 patients. AIDS, Herpes Zoster Ophthalmicus, toxoplasmosis, tuberculosis, rheumatoid arthritis and onchocerciasis were the most common associated disease respectively in 12.5%, 6.4%, 6%, 6%, 6% and 4% of cases. CONCLUSION: The findings of this study were different from those of other studies published in Europe and the United States.

Acquired Immunodeficiency Syndrome↗
PubMed1975

Retinal periarteritis secondary to syphilis.

A 43-year-old black woman showed ophthalmoscopic evidence of retinal arteriolitis two weeks after being treated for uniocular panuveitis. Angiographic examination suggested that these deposits were not intraluminal or endothelial atherosclerotic emboli or plaques, but were deposits in the outer walls of retinal arterioles. Sequential ophthalmoscopic and angiographic examinations at one-month intervals for 12 months showed no progression or change in location of these deposits. Results of clinical and laboratory investigations suggested the diagnosis of syphilis. We believe it is rare for syphilitic infection to be implicated in the diagnosis of isolated retinal arteriolitis without periphlebitis.

Adult↗
PubMed1982

Bilateral acute retinal necrosis. Clinical and ultrastructural study.

In a 28-year-old man with bilateral acute retinal necrosis, a severe, bilateral panuveitis, necrotizing retinitis, and retinal vasculitis developed. Severe vitreous traction on atrophic retina resulted in bilateral giant retinal tears with an inoperable retinal detachment in the right eye. A retinal detachment developed in the left eye that was reattached after a pars plana vitrectomy and two scleral buckling procedures, but ultimately became inoperable. Large numbers of lymphocytes in the vitreous aspirate and depressed serum complement levels may indicate that an immune mechanism was involved in the necrotizing retinitis. We present the first electron microscopic evidence, to our knowledge, that preretinal membranes occurring in rhegmatogenous retinal detachment due to bilateral acute retinal necrosis arise from retinal pigment epithelium.

Acute Disease↗
PubMed1987

Ocular involvement associated with chronic Epstein-Barr virus disease.

Ocular involvement with acute Epstein-Barr virus infection is usually limited to a transient follicular conjunctivitis, although other lesions have been reported. Chronic Epstein-Barr virus infection has recently gained attention, but ocular manifestations have not been emphasized. We describe three patients with chronic infection with prominent ocular involvement. Bilateral uveitis was noted in all patients, ranging from an anterior uveitis that was responsive to steroids to a severe panuveitis with vitritis, cataract, optic disc swelling, and macular edema. In one patient, topical acyclovir ointment resulted in a substantial decrease in the inflammatory reaction when added to systemic acyclovir therapy. Another patient displayed a keratitis that resolved with topical steroid therapy. Cataract and vitreous surgery were also beneficial in the management of these patients.

Acyclovir↗
PubMed1989

Granulomatous uveitis in Crohn's disease. A clinicopathologic case report.

Recurrent episodes of uveitis occurred in a young male patient with clinical as well as radiologic and histologic evidence of Crohn's ileocolitis. His left eye became blind and painful, and was enucleated. Histopathologic examination of the eye revealed a panuveitis with evidence of granuloma formation in the choroid. While granulomatous inflammation has previously been demonstrated in extraintestinal sites, to our knowledge, this is the first histopathologic evidence of granuloma formation within the eye in Crohn's disease.

Adult↗
PubMed1990

Echographic features of the Vogt-Koyanagi-Harada syndrome.

Vogt-Koyanagi-Harada (VKH) syndrome represents a spectrum of bilateral panuveitis with associated central nervous system and dermatologic manifestations. The diagnosis is based on clinical and angiographic findings, but some of the characteristic features may be either absent or difficult to visualize in the presence of opaque media. With the use of standardized echography (standardized A-scan and contact B-scan echography), we examined nine patients with clear media and clinical evidence of VKH syndrome. Consistent echographic findings included (1) diffuse, low to medium reflective thickening of the choroid posteriorly; (2) serous retinal detachment, located inferiorly or in the posterior pole; (3) mild vitreous opacities with no posterior vitreous detachment; and (4) thickening of the sclera and/or episclera posteriorly. Resolution of these findings occurred with systemic corticosteroid therapy. Standardized echography should be considered an important diagnostic tool in VKH syndrome, especially when visualization of the fundus is poor or when clinical presentation is atypical.

Adolescent↗
PubMed1991

Retinal artery obstruction and atheromas associated with non-Hodgkin's large cell lymphoma (reticulum cell sarcoma).

A 71-year-old woman developed branch retinal artery obstruction as the presenting manifestation of a large cell non-Hodgkin's lymphoma. Multifocal chorioretinal scars were present in the same eye. She experienced progressive visual loss accompanied by development of multiple yellow retinal arterial wall plaques, extension of retinal opacification into other quadrants, and increasing vitreous cellular infiltration. Clinical diagnoses included branch retinal arterial obstruction caused by toxoplasmosis retinitis, multifocal choroiditis and panuveitis simulating the presumed ocular histoplasmosis syndrome, vitiliginous chorioretinitis, and the acute retinal necrosis syndrome. Four months after onset, the right eye was blind and was enucleated. Histopathologic examination revealed extensive lymphomatous infiltration and necrosis of the retina and optic nerve. The retinal arteries were partly obstructed by lymphomatous infiltration and atheromas. Subsequently, the left eye and central nervous system were involved by lymphoma.

Aged↗
PubMed1986

Sixteen cases of uveitis associated with sarcoidosis.

In 210 cases of uveitis sixteen were associated with sarcoidosis. All patients had bilateral involvement and thirteen patients had a panuveitis. Ophthalmic and systemic findings in these patients are described and compared with the literature. Nine patients were not known to have sarcoidosis previously; seven of these presented with the typical signs for sarcoidosis, such as periphlebitis with 'candle wax' exudates and/or small chorioretinal lesions.

Adult↗