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PubMed2005

Ocular syphilis: the new epidemic.

AIM: To present the clinical presentation, diagnosis, and management of syphilitic uveitis in the context of an epidemic of syphilis in the UK. METHOD: Retrospective clinical case series. RESULTS: Six new cases of syphilitic uveitis presented to the Manchester Uveitis Clinic in 2004, after a 15-fold increase in the incidence of syphilis in the UK, including 615 cases in Greater Manchester in the 5 years to 2004. Four cases had secondary syphilis, two had latent disease, two had no rash, and two were HIV positive. Ocular involvement included anterior or panuveitis, retinitis, retinal vasculitis, and papillitis. All resolved on treatment including intramuscular procaine penicillin G with oral probenecid. CONCLUSIONS: Syphilis is much more common recently and syphilitic uveitis should be considered in all patients with rash and/or headache, where there is retinitis and/or retinal vasculitis, or in any uveitis of uncertain origin. Treatment is that of neurosyphilis.

Adult↗
PubMed2003

Combined cyclosporin-A /prednisone therapy of patients with active uveitis suppresses IFN-gamma production and the function of dendritic cells.

In this study, we assessed the Th1/Th2 polarization of the immune response and the involvement of dendritic cells (DC) and Th1 lymphocytes in the pathogenesis of uveitis. Thirty-seven patients with chronic idiopathic uveitis were enrolled: 21 of them had active uveitis and the remaining 16 were in complete remission. Patients with active uveitis were characterized as follows: 5 had intermediate uveitis, 5 panuveitis and the remaining 11 posterior uveitis. Thirteen healthy subjects were also studied as controls. Patients with active uveitis were treated with cyclosporin-A (CsA) associated to low doses of prednisone (PDS) and studied at baseline and after 6 months of therapy. Analysis of cytokine-producing CD3+ lymphocytes revealed a strong Th1 polarization of the immune response in patients with active uveitis. Th1 lymphocytes paralleled serum IL-12 levels and the response to therapy, which greatly reduced both IFN-gamma+/CD3+ lymphocytes and serum IL-12 levels, associated with a general clinical improvement. In vitro studies demonstrated that DC from untreated patients with active uveitis were mature and functionally active. In fact, they showed a higher ability to stimulate cell proliferation of allogeneic T cells in primary mixed lymphocyte reaction (MLR) and produced larger amounts of IL-12 than DC from CsA/PDS-treated patients and those in remission. These results demonstrate that CsA/PDS therapy impairs the capacity of mature DC to secrete IL-12 and inhibits their MLR activity.

Adult↗
PubMed2000

Intravenous pulse methylprednisolone in the treatment of uveitis associated with multiple sclerosis.

PURPOSE: To demonstrate the safety and effectiveness of intravenous methylprednisolone (IVMP) in the treatment of uveitis in association with multiple sclerosis (MS). METHODS: Uveitis is an unusual manifestation of MS that may be severe, chronic and require systemic immunosuppression therapy. High-dose IVMP has previously been shown to be effective in the treatment of inflammatory eye disease and MS. Eight episodes of uveitis in five patients with MS were treated over a 10-year period in an open, uncontrolled trial. Two patients had chronic anterior uveitis, one patient had bilateral panuveitis and two patients had intermediate uveitis. RESULTS: All patients responded to IVMP with evidence of a decrease in intraocular inflammatory activity and improved visual acuity (VA) within 2 weeks of commencing treatment. There were no severe ocular or systemic steroid side effects. CONCLUSIONS: Intravenous methylprednisolone is an effective, well-tolerated form of therapy for uveitis in patients with MS.

Adult↗
PubMed2003

Visual loss in sarcoid-related uveitis.

PURPOSE: To assess the visual acuity outcome after treatment, in patients with differing types of uveitis associated with sarcoidosis, and to determine the types of sight-threatening complications. METHODS: This was an retrospective, non-comparative, interventional study of patients who had uveitis with a confirmed diagnosis of sarcoidosis and a minimum follow-up duration of 6 months from presentation. The worst affected eye at presentation was selected for the study. Complications causing impaired vision were documented, changes in visual acuity after completion of treatment were measured, and the risk of 'poor outcome' (visual acuity 6/12 and less) was compared in the various types of uveitis, using 'exact' multiple logistic regression to control confounding by other prognostic factors. RESULTS: Seventy-five patients were studied. The spectrum of ocular inflammation in sarcoidosis is wide. Presentation may be acute and non-granulomatous or chronic and granulomatous with posterior segment involvement being varied. Poor visual outcome was significantly more frequent in multifocal choroiditis (5/7, 71.4%), and in panuveitis without multifocal choroiditis (13/28, 46.4%), compared to only 3/24 (12.5%) patients with anterior uveitis. The excess risks remained significant after adjustment for confounding effects of other prognostic factors including age, sex and manifest systemic sarcoidosis. Causes of visual loss were cataract, glaucoma, macular oedema, vitreous haemorrhage and retinal detachment. CONCLUSION: Multifocal choroiditis is a less common manifestation of uveitis associated with sarcoidosis but appears to be associated with a worse visual prognosis despite immunosuppressive therapy.

Adult↗
PubMed2003

Long-term efficacy of mycophenolate mofetil in the control of severe intraocular inflammation.

PURPOSE: To assess whether the previously demonstrated short-term efficacy of the immunosuppressant mycophenolate mofetil (MMF; CellCept, Roche) is maintained in the long-term management of refractory uveitis. METHODS: The study was an open-label, non-comparative retrospective series of 14 patients with refractory uveitis and treated with MMF for a mean of >33 months. Mycophenolate mofetil was given at a dosage of 1 g (oral) twice daily. Indications included prednisolone reduction, additive agent with cyclosporin, or replacement therapy (azathioprine or methotrexate). The intraocular inflammatory response, side-effects, and toxicity were monitored. RESULTS: Intraocular inflammation remained under control in 10 patients, unchanged in three and deteriorated in one patient. Transient side-effects included tiredness, headache and dizziness (one patient each, lasting less than 2 weeks from the time of MMF introduction). Mycophenolate mofetil was stopped in one patient because of absence of prolonged clinical improvement. Vision improved in 25% (7 eyes), did not change in 50% (14 eyes), but was reduced in 25% (7 eyes). CONCLUSIONS: Mycophenolate mofetil is safe for long-term usage and is recommended for treatment of refractory panuveitis or posterior uveitis with uncontrolled inflammation despite high prednisolone maintenance dosage (>15 mg/day) or toxicity or lack of efficacy of other immuno-suppressive agents. However, MMF is less effective for refractory uveitis unresponsive to azathioprine.

Adult↗
PubMed2002

Tubulointerstitial nephritis and uveitis syndrome in Southern Spain.

OBJECTIVE: To examine immunogenetic and clinical features in a series of patients with the idiopathic tubulointerstitial nephritis and uveitis (TINU) syndrome diagnosed at the single referral hospital for a defined population in Southern Spain. PATIENTS AND METHODS: Retrospective study of the case records of all patients diagnosed with the TINU syndrome in the Departments of Ophthalmology and Medicine of the Valme University Hospital (Seville, Spain) from January 1996 through October 2000. Patients were included in this study if they had a renal biopsy showing interstitial edema and infiltration by lymphocytes, plasma cells, macrophages, eosinophils, and neutrophils. In these cases fibrosis was occasionally seen, but no glomerular changes were found. In addition, a diagnosis of uveitis by expert ophthalmologists was always required. Underlying diseases, which might be responsible for the renal or ocular manifestations, were excluded. Patients were HLA-DRB1 genotyped from DNA by using molecular-based methods. RESULTS: Six patients (4 females) fulfilled the definitions described above. Four were younger than 18 years. In addition to tubulointerstitial nephritis, non-granulomatous uveitis (anterior or panuveitis) associated with low visual acuity was present at the time of diagnosis. Leukocytosis and increase of acute phase reactants were also commonly observed at the time of diagnosis. Topical and oral corticosteroids were prescribed to all the patients. Cyclosporine A therapy was required in 2 cases. After a 2.5-year median follow-up, visual acuity had improved in all cases. Of note, 4 of 6 patients carried the HLA-DRB1*01 allele. CONCLUSION: The TINU syndrome should be considered in the differential diagnosis of patients presenting with visual and renal manifestations. The presence of renal dysfunction in patients with uveitis may be of some help, as a warning sign, for the recognition of patients who require a rapid diagnosis and therapy. In Southern Spain, the TINU syndrome appears to be associated with HLA-DRB1*01 allele.

Administration, Oral↗
PubMed2004

Endoscopic laser coagulation of the ciliary processes in patients with severe chronic glaucoma.

BACKGROUND: To investigate the effect of endoscopic laser coagulation on the ciliary processes in order to control intraocular pressure (IOP) in patients with severe chronic glaucoma. PATIENTS AND METHODS: 6 eyes (5 pseudophakic, 1 phakic) of 5 patients (mean age 60 years, range 46 - 70) were treated. Glaucoma was related to previous detachment surgery (patients 1), panuveitis (patient 2), iris dystrophy (patient 3), or neovascularization (patient 4: central venous occlusion; patient 5: proliferative diabetic retinopathy). Preoperatively, all patients had not responded to intensive glaucomatous topical and systemic treatment (mean 4.2 drugs, range 3 - 5). Trabeculectomy has been unsuccessfully performed in patients 2 and 3. After pars plana vitrectomy, the ciliary processes were coagulated under endoscopic view over 180 - 270 degrees using endolaser (argon green with spots of 300 - 500 mW for 0.4 - 0.5 s). Patient 5 was treated in both eyes. RESULTS: The mean preoperative IOP was 39 mm Hg (range 32 - 47). The mean postoperative follow-up was 339 days (range 125 - 485). The postoperative IOP was over 1 year under 21 mm Hg in patient 1 with one topical drug, and in patients 2 and 3 without any further treatment. Patient 4 needed trabeculectomy and one topical drug to control IOP. The IOP was not controlled in patient 5 with the shortest follow-up despite additional topical treatment. No serious treatment-related complication was noted. CONCLUSIONS: Endoscopic laser coagulation allows a precise destruction of the ciliary processes, and permits a better control of IOP in certain cases of severe chronic glaucoma. Further investigations are necessary to better evaluate this therapy.

Aged↗
PubMed2005

[Uveitis in childhood sarcoidosis].

BACKGROUND: Sarcoidosis is a rare cause of uveitis in childhood. Differentiation from other rheumatic diseases may be difficult. We report on five children with uveitis in childhood sarcoidosis and review the previous literature. RESULTS: Children were aged between seven month and 13 years at the time of diagnosis of uveitis. Four of the five patients had panuveitis, the fifth one had intermediate uveitis. In addition, three children had systemic disease with skin, joint and central nervous system involvement. The two children younger than 5 years showed the clinical triad of eye, joint and skin disease. Uveitic complications included corneal band keratopathy, cataract, posterior synechiae, macular scars and choroidal neovascularisation. Vision-limiting complications were found in six of nine eyes at the first visit. CONCLUSION: In childhood sarcoidosis two clinical courses can be differentiated. Younger children aged up to five years express a clinical triad of arthritis, skin lesions and uveitis. In the older group of patients, the clinical course is more similar to that of adults. Rapid diagnosis and quiescence of disease are of particular importance to improve the long-term visual prognosis.

Adolescent↗
PubMed2006

[Histological and immunohistological investigations in human epiretinal membranes].

BACKGROUND: The exact mechanisms involved in the development of epiretinal membranes are still poorly understood. This study aimed to investigate human epiretinal membranes with the help of different histological and immunohistological methods in order to find new concepts for the development of these membranes. METHODS: 79 epiretinal membranes of patients (28 male, 51 female) undergoing a pars plana vitrectomy were included in this study. The mean age of the patients was 67.3 +/- 12.1 years. Preoperative diagnosis was diabetic retinopathy (n = 57), panuveitis (n = 4), PVR-ablatio (n = 16) and Coats disease (n = 2). All epiretinal membranes were histological and immunohistological investigated (aquaporin and with smooth muscle actin [SMA]). RESULTS: Within the investigated membranes very different cell and tissue structures were found. They varied from extracellular matrix-rich membranes to membranes with high cell density and proliferative activity (fibroblasts). In immunohistological studies highly differentiated vessel structures were identified (aquaporin-endothelial cells). A typical characterisation and comparison to clinical findings is demonstrated with the help of selected samples. CONCLUSIONS: Human epiretinal membranes vary in their histological structure according to their underlying disease. Histological and immunohistological investigations may help to characterise these membranes and to understand the complex origin mechanism of these structures. This provides the basis for further studies with potential antiangiogenic drugs.

Aged↗
PubMed1998

[Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis].

BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.

Borrelia burgdorferi Group↗
PubMed1995

[Ocular tuberculosis in systemic lupus erythematosus and immunosuppressive therapy].

BACKGROUND: A marked reduction in eye disease attributed to tuberculosis has occurred over the past several decades. In recent years, however, tuberculosis has reemerged as a serious public health problem. We report a case of a severe ocular tuberculosis in a patient with systemic lupus erythematosus and immunosuppressive therapy. PATIENT: The 36-years-old woman underwent an immunosuppressive therapy because of a systemic lupus erythematosus detected two years earlier. After holidays on the Philippines Mycobacterium tuberculosis was found in a bronchial lavage. Two months later fundoscopy showed severe subretinal exsudation with overlying serous retinal detachment. Within several months these findings progressed to a panuveitis with spontaneous perforation. Histopathologically a granulomatous panophthalmitis could be found with giant cells. Two months later acid-fast bacilli were detected in orbital lesions. CONCLUSION: In immunosuppressed patients there is still an increased risk for severe ocular tuberculosis. Therefore it is important to think of this almost forgotten disease in those cases.

Adult↗
PubMed1994

[Uveitis in the elderly].

BACKGROUND: There is only scarce information available in the literature on uveitis of older patients. The aim of this study was to study this age group in greater detail. PATIENTS AND METHODS: 435 patients were seen in the uveitis clinic of the University Eye Hospital Jules Gonin from January 1990 to March 1993. We analysed here the 94 (21.8%) patients that presented a first episode of uveitis after the age of sixty. RESULTS: This collective was characterised by an increased frequency of the anatomic diagnosis of panuveitis (p < 0.0001), and of the specific diagnosis of zoster uveitis (p < 0.0001), sarcoidosis (p < 0.0001), uveitis associated with scleritis (p < 0.05) and granulomatous anterior uveitis (p < 0.01). The frequency of diagnosis of intermediate uveitis was significantly reduced (p < 0.034) as were the specific diagnosis of HLA-B27 positive acute anterior uveitis (p < 0.001), pars planitis (p < 0.08) and non granulomatous anterior uveitis (p < 0.01). Reiter's uveitis, Possner-Schlossmann Syndrome, Behçet's uveitis, Vogt-Koyanagi-Harada disease and Toxoplasmosis retinochoroiditis were never diagnosed in this group of elderly patients. The proportion of defined specific diagnosis (75.5%) was comparable to the group of patients of less than 60 years old. CONCLUSION: As can be seen from our data, epidemiological characteristics of old age uveitis differ markedly from younger patients which should influence the diagnostic approach in these patients.

Aged↗
PubMed1991

[Endogenous candida endophthalmitis: a new therapy].

A thirty-year-old patient underwent an extensive abdominal surgery because of a precancerosis due to a colitis ulcerosa. An accompanying smoldering panuveitis led under immunosuppressive therapy to the loss of sight of one eye. Only an increasing vitritis of the second eye allowed the diagnosis of an endogenous Candida endophthalmitis (ECE) following a vitrectomy. A systemic administration of the common antifungal medications was impossible because of the patient's pathological blood-picture and a severe cholestasis. We report the successful use of Fluconazol (Diflucan), an antimycotic agent we never used before in this connection.

Adult↗
PubMed1990

[Retinal vasculitis with multifocal chorioretinitis].

Multifocal retinochoroiditis was diagnosed in 16 patients (13 female, 3 male). The patients also had cells in the vitreous, and in some cases pronounced retinal vasculitis, cystoid macular edema and papilledema. The patients' ages ranged from 62 to 77 years. There was anterior segment involvement in 13 cases. One patient had subretinal neovascularization in both eyes. Fluorescein angiograms revealed leaks from the retinal vessels, papilledema, and macular edema. So far, the authors have not succeeded in classifying the changes described as belonging to a known disease entity. The findings most closely resembled a disease described by Dreyer and Gass in 1984 as "multifocal choroiditis and panuveitis". Similar changes were seen by Tiedemann in 1987, in patients with Epstein-Barr viral antibodies.

Aged↗
PubMed1989

[Sense and nonsense of examinations in hematogenous and exogenous intra-ocular infections].

Diagnosis of intraocular inflammations can be difficult, particularly if the patient is suffering from immunodeficiency. Among the endogenous inflammations this applies mainly to cases of hyaloretinitis caused by Candida or other fungi, often presenting as an acute hyalitis with sudden onset; the various ocular complications of AIDS, especially those due to toxoplasmosis (rare) and cytomegalovirus, and lyme disease, which can occasionally cause chronic panuveitis. Among the exogenous cases it applies to postoperative and posttraumatic endophthalmitis. In all these cases the diagnosis has to be established clinically if possible, since, as a consequence of the immunodeficiency, serology is hardly helpful, and only biopsy (of the vitreous) may provide additional information. Rapid diagnosis is very important because of the urgent need for therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Bromocriptine: a new therapy concept in the treatment of chronic recurrent uveitis?].

Chronic recurrent uveitis still responds unsatisfactorily to therapy. Prolactin, a pituitary hormone that attains high blood levels physiologically in stress situations, has an immune modulating effect. The prolactin antagonist bromocriptine (2 x 2.5 mg/day) was administered prophylactically to prevent recurrence in seven patients with chronic iritis/iridocyclitis or panuveitis (Group A). On this therapy two patients suffered a mild recurrence (in one case in the first month). Another patient developed rebound uveitis after discontinuing bromocriptine medication. Tolerance appears to vary considerably, and in three patients the therapy had to be discontinued because of arterial hypotension and congestive rhinopathy, respectively. The three patients in Group B (with iritis, sympathetic ophthalmia, and intermediate uveitis) received bromocriptine in addition to cyclosporin A after plasmapheresis. This combination resulted in an elevated cyclosporin A plasma level, and the dosage was reduced by 30-50% (plasma level 70-120 ng/ml). With this lower dosage of cyclosporin A, the creatinine level of one of the patients returned to normal. Viewed on the basis of these initial results bromocriptine would appear to reduce the number of recurrences of chronic uveitis. Moreover, the synergism with cyclosporin A, described both theoretically and in an animal model in the literature, appears attainable in therapy.

Adult↗
PubMed1988

[The nervous system and uveitis].

This paper presents a short review of some inflammatory diseases which involve both the nervous system and the uvea, and of some forms of uveitis whose onset could be neurogenic. Multiple sclerosis and reticulum cell sarcoma are examples of systemic neurologic diseases which can be accompanied by uveitis or pseudo-uveitis. Syndromes such as Behçet's or Vogt-Koyanagi-Harada are characterized not only by a highly severe panuveitis but also by the participation of optic nerve, meningeal, and brain tissues in the inflammatory process. The occurrence of sympathetic ophthalmia and herpetic uveitis could to a certain extent be due to a neurogenic transmission of the antigen. For Fuchs' heterochromic cyclitis, however, the old theory of sympathetic nerve dysfunction at its origin is no longer widely accepted.

Animals↗
PubMed1984

[Importance of vitrectomy in the treatment of posterior uveitis].

In 30 cases of panuveitis which did not respond to treatment with drugs (corticosteroids and/or immunosuppressors), pars plana vitrectomy was performed with good functional results. There were no further recurrences and it was possible to discontinue anti-inflammatory or respectively immunosuppressive treatment after surgery.

Adult↗