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At least 343 records · Page 19Linked to original sources
PubMed1994

Vogt-Koyanagi-Harada disease in identical twins.

BACKGROUND: Certain aspects in the development of Vogt-Koyanagi-Harada (VKH) disease are documented, and immunogenetic studies have revealed a high relevance of some HLA types. Roles of possible environmental factors in disease onset are not fully understood, however. METHODS: Two cases involving monozygotic twin sisters who were diagnosed as having VKH disease and followed for more than 2 years are presented. RESULTS: Both patients showed the diffuse panuveitis that is characteristic of VKH disease and shared the same HLA typings. However, there was a 16-year time lag between onset of disease in the two patients, and many differences in their lifestyles before disease onset were noted. CONCLUSION: Although certain endogenous factors play an important role in the development of VKH disease, some exogenous factors may also affect the onset of the disease.

Adult↗
PubMed2000

Choroidal white lesions as an early manifestation of sarcoidosis.

PURPOSE: To describe the natural history of a series of patients with fine white choroidal lesions and uveitis of previously unknown cause. METHODS: A retrospective chart review of 11 patients with chronic uveitis and multiple, small (50-100 microm), peripheral white lesions of the choroid was performed using a standardized questionnaire form. RESULTS: Ten of 11 patients were white women with an average age of 62 years. Seven of 11 patients had panuveitis; 4 of 11 patients had vitritis; and 6 of 11 patients had cystoid macular edema. Choroidal white lesions were bilateral in all but one patient. Seven of 11 patients were followed up for more than 1 year. During a 12- to 173-month follow-up (mean, 94 months), these patients showed coalescence and atrophy of the white lesions. Initial systemic examination for the cause of the uveitis and white choroidal lesions was negative in all seven patients. With long-term follow-up, sarcoidosis was diagnosed in five of the seven patients followed for more than 1 year. CONCLUSIONS: The pattern of inflammatory white choroidal lesions distributed in the peripheral retina that atrophy and coalesce with time and that are associated with uveitis in middle-aged white women may represent an early form of sarcoidosis.

Adrenal Cortex Hormones↗
PubMed1996

Visual prognosis and sympathetic ophthalmia.

Sympathetic ophthalmia is probably the ocular disorder best known to practitioners outside of ophthalmology. It is characterized by a bilateral, nonnecrotizing granulomatous panuveitis that occurs after intentional or unintentional trauma to the exciting eye. So far, the identity of the inciting antigen has not been delineated with certainty. The sequelae from sympathetic ophthalmia have declined markedly in this century as a result of earlier diagnosis, use of corticosteroids, and better management of ocular injuries, in large part due to improved surgical techniques. Cases of sympathetic ophthalmia, however, still occur with their severe sight-threatening complications, which impose on ophthalmologists the importance of prompt diagnosis and aggressive treatment in order to achieve good visual outcome.

Humans↗
PubMed2002

Sequential or simultaneous cyclophotocoagulation and glaucoma drainage implant for refractory glaucoma.

PURPOSE: To describe the outcomes of combining cyclophotocoagulation and tube-shunt glaucoma drainage implants, either sequentially or simultaneously, for the control of refractory glaucomas. PATIENTS AND METHODS: A retrospective review was conducted of all patients that had been treated at our institute with both cyclophotocoagulation and a tube-shunt glaucoma drainage implant in the same eye between January 1996 and June 2000. Preoperative and postoperative intraocular pressure, number of glaucoma medications, vision, and complications data were collected for each eye. RESULTS: A total of 10 eyes of 9 patients met the study criteria. The minimum follow-up period after the last surgery was 15 months. Intraocular pressures were reduced from 28.5 +/- 7.2 mm Hg preoperatively to 13.9 +/- 5.4 mm Hg postoperatively at 15 months (P < 0.000, n = 9). Medications were reduced from 2.7 +/- 1.2 preoperatively to 0.3 +/- 0.5 postoperatively at 15 months (P < 0.000, n = 9). Of the eight eyes with measurable Snellen acuity, postoperative vision decreased two or more lines in five eyes (63%). Complications included transient hypotony (one eye), transient serous choroidal detachment (two eyes), cystoid macular edema (two eyes), corneal edema (three eyes), and panuveitis with chronic hypotony and traction retinal detachment (one eye). CONCLUSIONS: Combining cyclophotocoagulation with tube-shunt glaucoma drainage implants can effectively reduce intraocular pressure and number of glaucoma medications needed to achieve target intraocular pressure goals. Further study is needed to determine the safety of this combined approach compared with other available options to manage refractory glaucomas.

Adolescent↗
PubMed2004

Incidence of glaucoma in patients with uveitis.

PURPOSE: To evaluate the incidence of glaucoma and elevation of intraocular pressure (IOP) in patients with inflammatory eye disease. METHODS: Retrospective review of medical records of 391 consecutive patients with uveitis attending a uveitis clinic of an academic Department of Ophthalmology from January 1999 to August 2002. Demographic, ocular and systemic variables were recorded. The diagnosis and treatment of uveitis were recorded. Uveitis was classified according to standard anatomic, etiological and clinical criteria. "Glaucoma" was defined as elevated IOP (>21 mm Hg) or glaucomatous optic nerve damage requiring medical and/or surgical anti-glaucoma treatment. Kaplan-Maier analysis and log-rank tests were used to evaluate and compare the incidence of glaucoma. RESULTS: The incidence of glaucoma as defined above at 3 and 12 months after acute uveitis was 7.6%. In patients with chronic uveitis (n = 337), the incidence of glaucoma at 1 and 5 years was 6.5% and 11.1%, respectively. There was no statistically significant difference in the incidence of glaucoma between different types of uveitis, idiopathic versus non-idiopathic, and among anterior, intermediate, posterior and panuveitis. Visual loss occurred more frequently in patients with glaucoma than in patients without glaucoma. CONCLUSION: In patients with chronic inflammatory eye disease, the presence of glaucoma was associated with an increasing risk of visual loss. The incidence of glaucoma increased with time and was similar among the different types of uveitis.

Acute Disease↗
PubMed2006

Interdisciplinary treatment and ophthalmological findings in Parry-Romberg syndrome.

Parry-Romberg syndrome is a rare pathologic process, characterized by progressive hemifacial atrophy. A case of Parry-Romberg syndrome with ocular involvement is reported. A 27-year-old male patient with Parry-Romberg syndrome was interdisciplinary investigated and treated. For reconstruction of hemifacial soft tissues a free vascular parascapular graft was performed. Opthalmological findings included an evident enophthalmos and an eyelid lag with keratopathy and epiphora. Furthermore pupillary disturbances and endothelial precipitates were detectable. Complete fundus examination showed a unilateral optic disc swelling, central vitreous opacities and peripheral pigmentary disturbances. In the presented case of Parry-Romberg syndrome a rare association to ophthalmological involvement could be found. Beside the enophthalmos and eyelid alterations, also a panuveitis with papillitis should be treated by steroid therapy.

Adult↗
PubMed2005

Update on uveomeningoencephalitides.

PURPOSE OF REVIEW: Uveomeningoencephalitides, commonly known as Vogt-Koyanagi-Harada (VKH) disease, are characterized by chronic bilateral granulomatous panuveitis involving the central nervous, auditory and integumentary systems. Visual prognosis is generally favourable, but outcomes in patients with VKH disease may vary. Also, the treatment of choice differs in different parts of the world. This review addresses the literature on the possible pathogenesis, diagnosis and treatment of this disorder. RECENT FINDINGS: Atypical presentations of VKH disease, as well as those associated with interferon-alpha therapy, have been reported. Most reports suggest an association with autoimmunity. The diagnostic criteria were revised by the International Workshop on VKH in 1999, allowing for the presence of different ocular findings in the early and late stages of the disease. New techniques have also been developed to aid in the rapid diagnosis of VKH disease and evaluation of treatment. Different routes of administration of corticosteroid and adjuvant therapy were tried, with positive results. SUMMARY: Although the pathogenesis of VKH disease is uncertain and antigen-specific treatment strategies have not yet been developed, reports increasingly suggest an autoimmune nature for uveomeningoencephalitides. Currently, systemic corticosteroid therapy remains the standard initial treatment. Different routes of administration are used to reduce the frequency of side effects of systemic corticosteroids, and there are various adjuvant therapies. With the aid of modern equipment, early diagnosis and prompt and appropriate treatment, resulting in better visual outcomes, can be anticipated. A large-scale, multinational, prospective study is warranted to determine the optimal initial therapy.

Humans↗
PubMed1992

Circulating immune complexes may play a regulatory and pathogenic role in experimental autoimmune uveoretinitis.

We compared the time course of changes in serum levels of circulating immune complexes (CICs) and of IgG antibody after sensitization of albino Lewis and pigmented Lister strain rats with uveitogenic (retinal S-antigen) and non-uveitogenic (ovalbumin) protein antigens of comparable molecular weight. Normal levels of CICs were far lower in Lewis rats in which experimental autoimmune uveoretinitis (EAU) takes the form of a severe panuveitis, than in Lister rats, in which the disease is mild, focal, confined to the posterior segment, and of lower incidence. After sensitization with either S-antigen or ovalbumin, polyethylene-glycol-precipitable CIC (PEG-CIC) peaked and fell as IgG antibody levels rose in both rat strains. However, peak levels of PEG-CIC were lower and subsequent IgG antibody levels were higher in the Lewis strain than in the less susceptible Lister strain. In both strains of rat these linked PEG-CIC/IgG antibody responses occurred earlier after sensitization with uveitogenic (S-) antigen than with ovalbumin, whether or not individual S-antigen-sensitized Lister rats developed EAU. In contrast, complement-binding CIC rose substantially only in those rats of both strains displaying EAU in response to S-antigen and not in response to ovalbumin. We suggest that immune complex (idiotypic) regulation of IgG antibody responses may be more readily perturbed by a pathogenic autoantigen (S-antigen) than by a bland antigen (ovalbumin). We also suggest that differences between the balance of regulatory and pathogenic CIC responses to uveitogenic retinal antigen may underlie or reflect strain differences in susceptibility to and severity of EAU.

Animals↗
PubMed1987

Uveitis: a strategy for diagnosis.

Uveitis may be the first presentation of a wide variety of underlying ocular and systemic diseases. It is important for the ophthalmologist to make a specific diagnosis in order to instigate specific therapy and give an accurate prognosis. The ability to recognise the clinical patterns of uveitis and to initiate appropriate investigations should form the basis of the ophthalmologist's management of the condition. To this end, we have considered uveitis under four major patterns of presentation--anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis--with subclasses within each of these four groups. We have outlined both the investigations which facilitate diagnosis of the possible underlying causes of inflammation and the interpretation of the results of such investigations.

Capillaries↗
PubMed2004

Paediatric uveitis: a Sydney clinic experience.

PURPOSE: The aim of this study was to retrospectively review uveitis cases at The Children's Hospital at Westmead, Sydney, since its inception in 1997 to 2001, including patients presenting at the Camperdown, Sydney, campus between 1989 and 1997 attending Westmead for further care. Comparison is made with international centres. METHODS: Information was obtained from medical records. RESULTS: Forty patients (53 eyes) presented, of whom 23 (57.5%) were female and 17 (42.5%) were male (mean age 6.7 years). Of 53 eyes, 35 (66%) had anterior uveitis, three (5.7%) intermediate uveitis, seven (13.2%) posterior uveitis and eight (15.1%) panuveitis. Twenty-seven (67.5%) patients had disease unilaterally and 13 (32.5%) bilaterally. Twenty-four (60%) cases were idiopathic. Seven (17.5%) cases were associated with juvenile rheumatoid arthritis, three (7.5%) with herpes zoster, two (5%) with herpes simplex, two (5%) with toxocara, one (2.5%) with toxoplasma, and one (2.5%) with ulcerative colitis. Complications included cataract in 14 (26.4%) eyes; band keratopathy in four (7.5%) eyes; macular scarring in three (5.7%) eyes; and glaucoma in four (7.5%) eyes. Last measured acuity was 6/6 for 19 (35.8%) eyes, < or =6/18 for 15 (28.3%) eyes and <6/60 for eight (15.1%) eyes. CONCLUSIONS: Despite small numbers, the comparisons of this study with some international studies, and its contrasts with other studies, are due to similarities and differences amongst these studies with respect to factors of referral bias, and the aetiological basis of disease.

Child↗
PubMed2004

Changing trends in sympathetic ophthalmia.

Sympathetic ophthalmia is a rare and potentially visually devastating bilateral panuveitis, typically following non-surgical penetrating injury to one eye. Three patients are presented where sympathetic ophthalmia developed after repeated vitreoretinal surgery. Prompt and effective management with systemic immunosuppressive agents permitted control of their disease and retention of good visual acuity in their remaining eye. Vitreoretinal surgery is an important risk factor in sympathetic ophthalmia. Informed consent for vitreoretinal surgery (especially in the re-operation setting) should now include the risk of sympathetic ophthalmia (approximately 1 in 800). Diverse clinical presentations are possible in sympathetic ophthalmia and any bilateral uveitis following vitreoretinal surgery should alert the surgeon to the possibility of sympathetic ophthalmia. Modern immunosuppressive therapy with systemic steroids and steroid-sparing agents such as cyclosporin A and azathioprine have improved the prognosis. This is particularly so in cases where early diagnosis is made and prompt and suitable immunotherapy is commenced.

Aged↗
PubMedDate not supplied

Mycotic endophthalmitis in a dog caused by Candida albicans.

A case of mycotic endophthalmitis in the dog caused by Candida albicans is presented. The 3-year-old dog had a history of bloody diarrhea 3 months previously. The dog presented with acute signs of unilateral panuveitis. Aqueocentesis, vitreocentesis, and routine blood tests were performed but did not contribute to the diagnosis. The posterior segment could not be visualized because of flare and fibrin. On day 7 ultrasonography showed retinal separation which progressed to vitreous compartmentalization and abscessation by day 14. Three weeks after onset, glaucoma developed and enucleation was performed. Histology revealed the yeast Candida to be the causative agent. Post-enucleation serum Candida antibody titer was 1 : 640 (human threshold 1 : 120), as determined by agglutination test. A relapse of enteric signs 3 months later led to the diagnosis of chronic lymphocytic enteritis. An hematogenous route of infection is suspected.

Animals↗
PubMedDate not supplied

Therapy of ocular and visceral leishmaniasis in a cat.

An 8-year-old, spayed female Domestic Short-haired cat was referred for further evaluation of chronic lymphocytic-plasmacytic stomatitis and bilateral ocular disease. The cat had been treated with systemic glucocorticoids for several months. Initial ophthalmic examination revealed bilateral deep stromal corneal ulcers, exudative panuveitis and secondary glaucoma. Mature mild neutrophilia and monocytosis were detected on complete blood cell count. Abnormalities in the serum profile were hyperglycemia, mild azotemia, hyperglobulinemia and moderate polyclonal gammapathy. Urinalysis revealed glucosuria without ketonuria. Diabetes mellitus was diagnosed and treatment with long-acting insulin was started. An enzyme-linked immunosorbent assay was highly positive for leishmaniasis, and treatment with allopurinol was started. Although specific topical treatment was applied, melting ulcers progressed to corneal perforation and both eyes were enucleated. Ocular histology showed large numbers of intracellular organisms compatible with amastigotes of the genus Leishmania located in the uveal tract, cornea, sclera and retina. Results of inmunohistochemistry staining on ocular samples were positive for Leishmania. Bone marrow cytology demonstrated numerous macrophages with intracytoplasmatic Leishmania. Polymerase chain reaction results on bone marrow for Leishmania were positive. Three weeks later, hypoglycemic episodes permitted withdrawal of the insulin therapy. To the authors' knowledge this is the first case of ocular and visceral leishmaniasis diagnosed in vivo and under systemic treatment in a cat.

Allopurinol↗
PubMedDate not supplied

Ocular signs of canine monocytic ehrlichiosis: a retrospective study in dogs from Barcelona, Spain.

Canine monocytic ehrlichiosis (CME) is a tick-borne disease caused by the rickettsia Ehrlichia canis. Ocular lesions are a common feature of the disease and can be present in all stages. The purpose of this retrospective study was to determine the prevalence, type and response to treatment of ocular lesions associated with monocytic ehrlichiosis in 46 affected dogs presented to the Autonomous University of Barcelona-Veterinary Teaching Hospital (UAB-VTH) from January 2000 to December 2002. Dogs were included in the study only if they had a positive serologic test for E. canis and information about the clinical outcome was available. Eighteen breeds were represented, with the German Shepherd dog (n = 6) being the most common. There were 25 intact and three castrated males, and 16 intact and two neutered females. Twenty dogs (43.4%) were between 5 and 10 years old. Seventeen dogs (37% of all cases of monocytic ehrlichiosis diagnosed during the study period) had ocular signs, and 11 dogs (64.7% of the ocular cases) had only ocular lesions without apparent systemic signs. Exudative retinal detachment was the most common ocular manifestation; other prevalent findings included anterior exudative uveitis and optic neuritis. Five of the 17 cases with ocular lesions (29.4%) had ocular bleeding disorders (hyphema or retinal hemorrhages). All the dogs with ocular disease presented with bilateral signs. Dogs with posterior segment disease had titers against E. canis that were > or = 1 : 320, while lower titers were noted in dogs with anterior exudative uveitis. Two dogs presented with chronic autoimmune panuveitis after ehrlichiosis treatment. Canine ehrlichiosis should be considered in the differential diagnosis of exudative retinal detachment and anterior uveal inflammatory lesions.

Animals↗
PubMedDate not supplied

An immunohistochemical study of uveodermatologic syndrome in two Japanese Akita dogs.

MATERIALS: Ocular and cutaneous tissues from two Japanese Akita dogs with uveodermatologic syndrome (UVD) were subjected to immunohistochemical analysis. RESULTS: Light microscopic examination of the globes confirmed the presence of panuveitis of different severity in each case. The infiltrate was primarily granulomatous with prominent perivascular lymphoid aggregates. Melanophages were present throughout the affected areas, and there were scattered plasma cells. Immunohistochemistry using CD79a, CD3, MAC387 and MHC class II markers indicated that there were relatively few T lymphocytes and that most lymphocytes were of the B-cell lineage. The two skin biopsies examined also appeared to represent different stages of cutaneous pathology. The biopsy from one case was consistent with the reported features of skin lesions of canine UVD syndrome, including granulomatous dermatitis with extensive T-cell infiltration extending into the epidermis. In contrast, the skin lesion from the second case showed less inflammation, more pigmentary incontinence and evidence of dermal fibrosis. There was no immunoglobulin or complement deposition at any level within the cutaneous or ocular lesions. CONCLUSIONS: The findings of these two cases suggest that the skin lesions of these two dogs with UVD syndrome were mediated by T cells and macrophages (Th1 immunity), whereas the ocular lesions were more consistent with a B cell and macrophage response (Th2 immunity). This is, however, a preliminary investigation and these features may not be the same for all cases of UVD syndrome.

Animals↗
PubMed1995

Epidemiology of endogenous uveitis in south-western Finland.

We studied the case records of 1122 patients with endogenous uveitis including 418 new cases treated at the University Eye Clinic in Turku during the years 1980-1982 and 1988. The mean annual incidence and prevalence rates of anterior uveitis were, respectively, 21.3 and 68.7 per 100,000, of posterior uveitis 0.8 and 4.6 per 100,000, of panuveitis 0.2 and 0.8 per 100 000, and of all uveitis cases 22.6 and 75.4 per 100,000 population. The incidence of uveitis was higher in the age group 20-69 years than in the age groups 0-19 years (p < 0.001) and 70 years or over (p = 0.049). The incidence rates were not different between sexes in any age group (p = 0.2). The incidence of uveitis was higher in lower socio-economic groups than in higher socio-economic groups (p < 0.001). There were no significant differences in the incidence of uveitis between sexes in different socio-economic groups (p = 0.1).

Adolescent↗
PubMed2006

Post-streptococcal uveitis.

PURPOSE: To describe the clinical features of post-streptococcal uveitis (PSU) and examine management strategies in the treatment of this under-recognized condition. METHODS: Patients were identified from the world literature using the Pubmed search engine. We examined two new cases of post-streptococcal intermediate uveitis. The epidemiology, immune mechanisms, clinical features, investigations, treatments and visual outcomes were examined and recorded. RESULTS: We reviewed 11 patients including our own two cases. There was a statistically significant seasonal difference in antistreptolysin-O titres (ASOT), and age-related ASOT was identified. Of the 11 patients, eight (72.7%) had anterior uveitis, two (18.2%) had intermediate uveitis and one (9.1%) had panuveitis. Their ages ranged from 5 to 56 years (mean 17 years). The majority of cases had significantly elevated ASOT; most patients were treated with topical steroids and oral antibiotics and four cases underwent adenotonsillectomy. The visual prognosis was good in most cases. CONCLUSIONS: Uveitis may be the sole presenting clinical feature, or it may occur in combination with other features of post-streptococcal infection. Ophthalmologists should be aware of the clinical features of PSU and maintain a high level of suspicion, particularly in childhood uveitis.

Adolescent↗
PubMed1994

Uveitis survey at the University Eye Clinic in Turku.

We conducted a retrospective analysis of 1122 patients with endogenous uveitis treated at the University Eye Clinic in Turku during the years 1980-1982 and 1988. Of the 1122 patients 568 were men and 554 women; 1034 (92.2%) had anterior uveitis, 15 (1.3%) intermediate uveitis, 64 (5.7%) posterior uveitis and 9(0.8%) panuveitis; 867 (77.3%) were unilateral and 255 bilateral; 789 of 1067 cases (73.9%) were of sudden onset and 278 of insidious onset; 808 of 1102 cases (73.3%) were of short duration and 294 of long duration; and 519 (46.3%) single and 603 repeated. In this study uveitis occurred significantly more often (44.2%) in the age group 20-39 years than in other age groups (p < 0.00001). Anterior and posterior uveitis were more often unilateral than bilateral (p < 0.0005) and of sudden onset than of insidious onset (p < 0.00008). Acute anterior uveitis was the most common uveitic entity and accounted for 745 cases (66.4%). Acute anterior uveitis associated with ankylosing spondylitis was the single most frequently seen diagnostic group including 144 cases (12.8%) with a statistically significant male predominance (p < 0.00001).

Acute Disease↗