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PubMed1993

Pulmonary infiltrates recovered by FK506 in a patient with Behçet's disease.

Behçet's disease (BD) affects the lung as well as the intestine, central nervous system, kidney, and other organs. Pulmonary vasculitis is one of the most severe complications in BD because it can cause fatal bleeding. Corticosteroids and other immunosuppressive drugs have been used to treat pulmonary vasculitis, but the efficacy of these agents has not yet been established. We administered FK506, a novel immunosuppressive agent, as a treatment for BD. A 21-year-old woman presented definitive symptoms of BD, ie, repeated oral and genital ulcers, folliculitis, and panuveitis. The patient showed localized pulmonary infiltrates on her chest x-ray film that were histologically proved to be venulitis consistent with BD. These pulmonary infiltrates evanesced after the oral administration of FK506 for 8 weeks; in addition, the skin lesions and uveitis improved. This clinical observation indicates that FK506 is an effective agent in the treatment of pulmonary vasculitis associated with BD.

Adult↗
PubMed2006

Unilateral uveitis in a dog with uveodermatologic syndrome.

CASE DESCRIPTION: A 7-year-old Siberian Husky-type dog with heterochromia irides was evaluated because of signs of pain associated with the right eye. CLINICAL FINDINGS: Unilateral panuveitis, iris bombé, and secondary glaucoma were detected in the right eye. Tear production was low bilaterally. Facial and truncal poliosis and vitiligo were also evident; skin biopsy specimens were obtained from the nasal planum. Uveodermatologic syndrome was diagnosed on the basis of histopathologic findings of a lichenoid interface dermatitis and pigmentary incontinence within the dermis. Immunohistochemical analysis was performed on skin samples retrospectively, and findings were inconclusive. TREATMENT AND OUTCOME: Treatment involved topical (ocular) and oral administration of corticosteroids, oral administration of azathioprine, and topical (ocular) administration of a carbonic anhydrase inhibitor and a lacrimostimulant. The secondary glaucoma was refractory to treatment, and the right eye was enucleated. Uveodermatologic syndrome was confirmed via histologic examination of ocular tissues. The left eye remained free of inflammation 16 months after the initial diagnosis. The periocular skin and skin of the nose partially regained pigment, but the hair did not. CLINICAL RELEVANCE: Some breeds in which uveodermatologic syndrome has been reported (eg, Siberian Huskies, Old English Sheepdogs, Australian Shepherds, and Shetland Sheepdogs) often have heterochromia irides. This case highlights the fact that dogs with asymmetric uveal pigmentation may have unilateral ocular changes; therefore, uveodermatologic syndrome should not be excluded as a differential diagnosis on the basis of unilateral clinical signs.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Ocular fluorophotometric analysis.

Artifacts related to the wave-spreading phenomenon of fluorescent structures within the eye interfere with interpretation of vitreous fluorophotometric data. A standardized protocol which minimizes such artifacts is desirable in order to reveal actual changes in vitreous fluorescence. We have devised a protocol which reduces artifacts of crystalline lens autofluorescence and "tailing" from both lens and retina by the subtraction of preinjection data from measurements taken one hour after intravenous injection of fluorescein. A method of calculation is presented, performed automatically when programmed into a computerized fluorophotometer. Distinctions among healthy subjects and different kinds of ocular pathology are sharper when artifacts are reduced and the data are normalized to plasma fluorescein concentration. Examples of data from subjects with diabetes and no retinopathy, hypertension, cystoid macular edema, panuveitis and pars planitis are presented.

Diabetes Mellitus↗
PubMed1987

Humoral and cellular immune responsiveness to human S-antigen in uveitis.

Purified human retinal S-antigen (S-ag) was used to investigate the occurrence of humoral and cellular autoimmune reactions against S-ag in uveitis patients. With a sensitive ELISA method anti-S-ag antibodies could be detected in the sera of 28% of the uveitis patients. No difference was found between patients with posterior or panuveitis (31 out of 117 positive) and patients with anterior or intermediate uveitis (16 out of 52 positive). Similar frequencies and levels of anti-S-ag autoantibodies were also found among healthy controls (6/20) and patients who had undergone cataract surgery (6/17). Immunoblotting with purified S-ag and with whole human retinal extract confirmed the presence of anti-S-ag antibodies in uveitis and control sera. Moreover, antibodies against various other retinal proteins could also be demonstrated in patients and controls, without being particularly enhanced in uveitis. The cellular immune responsiveness was tested by measuring the production of migration inhibitory factor (MIF) during overnight culture of peripheral mononuclear cells with the antigen. None of 18 healthy controls responded, whereas 17 positive reactions were observed in the group of 44 uveitis patients. The highest frequencies were found in patients with posterior (5/12) or pan- (7/12) uveitis, while of the responders with anterior (2/8) or intermediate (3/12) uveitis, three had disorders affecting the retina. Thus, cellular autoimmune responsiveness to S-ag is apparently associated with posterior and pan-uveitis, and might also occur in non-uveitic retinal disorders, whereas the occurrence of anti-S-ag antibodies is probably not at all pathognomic for uveitis.

Adolescent↗
PubMed1990

Uveitis in northern Portugal.

During the past four years 450 patients (247 female - mean age 36 years and 203 male - mean age 34 years) with intraocular inflammation were evaluated using standard diagnostic criteria, to establish a uveitis survey profile. Patients were divided into four anatomic groups: anterior uveitis (270 cases = 60%), posterior uveitis (108 cases = 24%), panuveitis (54 cases = 12%) and intermediate uveitis (18 cases = 4%). A probable aetiological diagnosis was made in 232 cases (51.5%). Rheumatic diseases were diagnosed most commonly (55 cases = 12.2%), mainly ankylosing spondylitis, as is true for other European countries. Ocular toxoplasmosis was a frequent cause of uveitis, as in Brazil and West Africa, thus requiring a prompt diagnosis and treatment. Behçet's syndrome was associated with HLA B5 (65%) as in Japanese and Mediterranean populations. In our area AIDS retinitis is becoming an important differential diagnosis.

Adolescent↗
PubMedDate not supplied

Clinical results of phacoemulsification in patients with uveitis.

BACKGROUND AND OBJECTIVE: To evaluate the results of phacoemulsification and posterior chamber intraocular lens (IOL) implantation in patients with uveitis. PATIENTS AND METHODS: Review of records of 37 eyes of 31 patients with uveitis (14 men and 17 women; mean age, 49.8 years; age range, 26 to 71 years) who underwent phacoemulsification with IOL implantation. The data recorded were age, gender, IOL type, treatment modalities, final visual outcome, and complications. RESULTS: Panuveitis, anterior uveitis, posterior uveitis, and intermediate uveitis were detected in 16 (51.6%), 9 (29.0%), 5 (16.1%), and 1 (3.3%) of the patients, respectively. At 6 months postoperatively, 32 (86.5%) eyes had achieved a best-corrected visual acuity of 20/40 or better, and 22 (59.5%) eyes had a visual acuity of 20/20. Five (13.5%) eyes showed limited improvement in postoperative visual acuity due to posterior segment problems. Postoperative recurrence of inflammation occurred in 12 eyes (32.4%) of 10 patients and was treated and controlled with medical therapy. CONCLUSION: When inflammation in uveitic eyes is under complete control, phacoemulsification and implantation of a foldable acrylic IOL in the posterior chamber is safe, effective, and tolerated well. To minimize vision-limiting complications, these patients must be observed closely after surgery, and must be treated aggressively if the inflammation recurs.

Adult↗
PubMedDate not supplied

Traditional couching for cataract treatment: a cause of visual impairment.

BACKGROUND: Cataract is the most common cause of blindness both in Nigeria and in the world over. Couching as an ancient method of treatment usually practiced by traditional healer is discouraged and has been abandoned as a result of the attendant complications and also because of the availability of better techniques in the treatment of cataract. STUDY DESIGN: Records of 9 eyes of 6 patients (4 males, 2 females) who presented at the eye clinic of the University of Ilorin Teaching Hospital following traditional treatment of cataract known as couching between April 1999 and December 2001 were reviewed retrospectively. RESULT: The male: female ratio was 2:1. The age range was from 43 years to 80 years. The period between couching and presentation was between 3 months and 10 years. All the patients presented as a result of poor vision in the couched eyes. The complications recorded include glaucoma, optic atrophy and panuveitis. None had previous spectacle correction. Couching was done biocularly in 3 patients and uniocularly in 3 patients. The visual acuity at presentation was less than 3/60 in 8(88.8%) eyes. The patients received treatment, ranging from surgical, medical to optical as indicated. Their visual acuity improved to between 6/36 and 6/18 in 6 (66.6%) eyes, while the remaining 3 (33.3%) eyes remained blind. CONCLUSION: Scientifically proven atrocities performed by those who practice medicine without any medical knowledge often referred to as "traditional doctors" as shown here are reasons enough to discourage such practices as they exist at present.

Adult↗
PubMed2004

[Ocular Behçet disease. Retrospective study].

OBJECTIVE: To study clinical features, visual prognosis and response to immunosuppressive drugs in patients with ocular Behçet Disease (BD). PATIENTS AND METHODS: clinical data of 17 patients (33 eyes) were retrospectively reviewed from May 1996 to May 2003. RESULTS: The male/female ratio was 12/5. The commonest manifestations were oral ulceration (100%) and skin lesions (88%). Anterior uveitis was present in 59%, posterior uveitis was in 76% and panuveitis was in 88.1%. Visual acuity improved in 11 (33.3%) eyes, remind stable in 18 (54.5%) eyes and four (12.1%) eyes lost two or more lines. Main drug therapy consisted of colchicine and cyclosporine (59%). Seven patients had received three drugs simultaneously. CONCLUSIONS: BD can lead to an irreversible visual loss; however, the visual prognosis is good (85%) if immunosuppressor treatment is implemented.

Adolescent↗
PubMedDate not supplied

Heart failure caused by toxoplasmosis in a fennec fox (Fennecus zerda).

A male fennec fox (Fennecus zerda) kit was examined for lethargy, inappetence, and weight loss. Clinical findings included respiratory distress, a gallop rhythm, and retinochoroiditis. Radiography indicated pleural effusion and cardiomegaly. Echocardiographic findings included left ventricular dilatation, low left ventricular ejection fraction, and atrioventricular valvular regurgitation. Necropsy findings were compatible with a diagnosis of congestive heart failure caused by myocarditis. Histopathology showed a disseminated infection with Toxoplasma gondii causing myocarditis, skeletal polymyositis, gastrointestinal myositis, and panuveitis. Toxoplasma-induced myocarditis should be included in the differential diagnosis of heart failure and retinochoroiditis in the fennec fox.

Animals↗
PubMed1987

Delayed onset sympathetic ophthalmia.

Three cases of sympathetic ophthalmia that occurred up to 62 years after an ocular injury are reported. Sympathetic ophthalmia occurred spontaneously in the first case, 62 years after a shot-gun pellet had penetrated one eye. In the other two cases, further surgery had been performed on previously-injured eyes. This was followed by a bilateral granulomatous panuveitis that developed within a week in one case and after seven years in the other case. The risk of elective surgery in eyes that are already at risk of sympathetic ophthalmia and the practical aspects of patient counselling are discussed.

Aged↗
PubMed2005

Primary intraocular T-cell-rich large B-cell lymphoma.

We report a primary intraocular T-cell-rich large B-cell lymphoma in a 57-year-old woman who underwent 3 diagnostic vitrectomies for a presumed diagnosis of panuveitis. She developed no light perception in the left eye and underwent enucleation. Histopathologic and immunohistochemical studies on the enucleated globe disclosed a primary intraocular large B-cell lymphoma involving the choroid, vitreous, and retina. A large population of T cells was identified among the neoplastic B-cell population. B-cell immunoglobulin gene rearrangement and T-cell receptor gene rearrangement studies using the polymerase chain reaction method indicated that a monoclonal immunoglobulin kappa light chain population was present and that the T-cell population was not monoclonal. This case highlights the importance of interpreting cytologic features in vitreous aspirates in the context of the clinical situation.

Biomarkers, Tumor↗
PubMed1998

Acute retinal necrosis--early manifestation and successful treatment with steroid and acyclovir: case report.

A healthy 19-year-old woman suffering from pain, redness, and blurred vision of her left eye came to our emergency unit for help. Initial examination revealed no light-perception, tenderness and marked inflammation of the left eye. There was severe inflammation both in the anterior chamber and vitreous cavity. Total retinal detachment accompanied by diffuse thickening of choroid was demonstrated using echography. Under the impression of panuveitis, oral steroids were given. The response of the left eye was dramatic but the patient complained of blurred vision of her right eye 2 days after steroid therapy. There was only mild reaction in the right eye; however, multiple granule-appearing white dots were found on the inferior two-thirds of the peripheral retina. The nummular white lesions increased in size and number and finally became confluent in the following days. The diagnosis was shifted to acute retinal necrosis and intravenous acyclovir was started while continuing systemic steroid therapy. The retinal necrosis began to consolidate four days after the administration of acyclovir and gradually regressed. We tapered the systemic steroids when the intra-venous acyclovir was shifted to oral form. The vitreous of the right eye remained clear during the follow-up period. The antiviral agent still suppressed the disease process even though steroids had been used beforehand. Furthermore, the systemic steroids seemed to ameliorate the vitritis and secondary complications in the right eye compared with the fulminant, disastrous course of the left eye.

Acyclovir↗
PubMed1999

[Primary ocular lymphoma manifesting as anterior uveitis. Apropos of a case].

We report the case of a primitive ocular lymphoma occurring in a 48 year old patient. Non-Hodgkin's lymphomas are usually found in ocular localizations, and are often associated with a lymphomatous cerebral affection. The most frequent mode of presentation of these rare intra ocular tumors is usually posterior uveitis with chorioretinal lesions, and must be suspected for every long-standing chronic uveitis, especially posterior ones. The diagnosis can only be based on histological or cytological analysis. Our patient presented a primary ocular lymphoma which was initially revealed by an anterior uveitis and had evolved into a panuveitis that was resistant to treatment. The initial checkup of this uveitis remained negative and did not allow for an etiological diagnosis. The eye came less operational, hypertonic crisis became more frequent and controlled less and less by the treatment, therefore the patient had to be enucleated in order to establish a diagnosis and for therapeutic reasons. The histology revealed the existence of a NK lymphoma.

Chronic Disease↗
PubMedDate not supplied

[Cytomegalovirus infection in children with endogenous uveitis].

A total of 405 children aged 3 months to 15 years with uveitis of different origin and localization and 50 mothers of children with intrauterine uveitis were tested for cytomegaloviruses (CMV). Chronic CMV infection was detected in 79% children and 88% mothers. Active CMV infection was diagnosed in 7.1% children with various clinical forms of uveitis; it was somewhat more frequent in cases with grave posterior uveitis and panuveitis complicated by detachment of the retina and vitreous fibrosis. Anti-CMV IgG antibodies indicate an infection, but their detection is insufficient for identifying the etiology of uveitis. Active CMV infection can be a cause of uveitis or aggravate uveitis of another etiology and favor the development of postoperative complications. In many cases active CMV infection was detected in children during remission without clinical signs of uveitis activity. Individual analysis of clinical laboratory data is needed for each patient in order to evaluate the etiological and pathogenetic role of active CMV infection.

Adolescent↗
PubMed2000

[Vogt-Koyanagi-Harada's disease: 3 cases].

BACKGROUND: Vogt-Koyanagi-Harada's disease is a bilateral chronic panuveitis sometimes associated with signs of meningo-encephalic, auditory and skin and nail involvement. We report 3 cases. CASE REPORTS: The first case was a 30-year-old woman who consulted for a red eye, low visual acuity, poliosis, and diffuse alopecia which had developed over 9 months. The ophthalmology examination disclosed anterior uveitis with retinal detachment. The second patient was a 9-year-old child who developed poliosis, canities, and achromic lesions over a 2 month period. The ophthalmology examination disclosed low visual acuity, irido-corneal synechiae and pigmented deposits on the anterior lens. The third patient was a 20-year-old man who consulted for alopecia, diffuse canities, and white body hair. The ophthalmology examination disclosed low visual acuity, anterior uveitis, and a serous chorio-retinal detachment. All three patients were given general corticosteroid therapy (1 mg/kg/d). The clinical course was favorable in all cases with however one case of recurrent ocular involvement and one case of pigmentation disorders. DISCUSSION: The diagnosis of Vogt-Koyanagi-Harada's disease was established in these three cases on the basis of the ocular and skin and nail signs. This rare disease usually occurs in young, often female, patients. The pathogenesis remains unknown. Among the three signs observed, ocular involvement is the most serious. Skin and nail signs are seen in two-thirds of cases. For rapid diagnosis and early treatment, this disease requires a multidisiplinary management associating the dermatologist and the ophthalmologist.

Adult↗
PubMed2000

Undiagnosed spondyloarthropathy in patients presenting with anterior uveitis.

OBJECTIVE: To investigate patients with formerly undiagnosed underlying spondyloarthropathy (SpA) in a series of anterior uveitis (AU) cases and to describe the rheumatologic and ophthalmologic characteristics of these patients. METHODS: Patients with anterior uveitis referred to the Uveitis Clinic between January 1992 and December 1998 who had a final diagnosis of SpA were included in the study group. The diagnosis of SpA was based on current diagnostic criteria. Patients were classified into 2 groups: formerly diagnosed, or undiagnosed SpA before attendance at the uveitis clinic. Demographic features, clinical symptoms, ophthalmologic characteristics, and laboratory tests were collected prospectively in each patient. A regression logistic model was applied. RESULTS: We evaluated 514 patients with anterior uveitis; 117 (22.7%) had some type of SpA. Ankylosing spondylitis was the most frequent diagnosis (64.1%). More than half the patients (53%) were diagnosed with SpA after an episode of uveitis; the percentage was up to 90.9% in undifferentiated SpA. Clinically, the formerly diagnosed and undiagnosed groups were quite similar, inflammatory low back pain being the most frequent symptom in both groups. Radiological sacroiliitis was less common and with a lower grade in the formerly undiagnosed group. Acute recurrent unilateral anterior uveitis was the most frequent clinical pattern in the group as a whole (68.3%), observed in all subgroups, except for inflammatory bowel disease related SpA, which presented panuveitis as the most frequent pattern. CONCLUSION: SpA was the most frequent systemic disease related to anterior uveitis, seen in more than 50% of our SpA cases diagnosed after an episode of uveitis. The undiagnosed SpA patient is generally an atypical case, with a shorter clinical evolution and less radiological damage.

Adult↗
PubMed2001

[Intravitreal injection of triamcinolone acetonide in non infectious uveitis].

PURPOSE: Systemic immunosuppressants take more than two weeks before showing activity. Therefore corticosteroids remain the mainstay in the treatment of non infectious uveitis. The goal of this study is to assess results of the use of intravitreal triamcinolone acetonide in acute sight-threatening non-infectious uveitis. METHOD: Ten patients (4 idiopathic retinal vasculitis, 1 idiopathic panuveitis, 1 pars planitis and 4 Behçet disease) were treated. Triamcinolone acetonide 4 mg/0.1 ml was injected through pars plana. RESULTS: Pre-treatment visual acuity<0.1 and post-treatment visual acuity >0.6 after less than a week. Inflammation resolved completely in all cases. The only complications observed were transient ocular hypertension which was successfully treated in two patients with topical betablockers and a catact in one case. CONCLUSIONS: Intravitreal triamcinolone acetonide is effective in rapidly decreasing inflammation in acute sight threatening non infectious uveitis.

Adolescent↗