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PubMed2002

[Ocular sarcoidosis. Retrospective study of 18 cases].

PURPOSE: To assess the clinical and epidemiological characteristics, diagnostic and therapeutic methods, and the final visual outcome of a group of patients with ocular sarcoidosis. METHODS: Retrospective study of 18 patients diagnosed of ocular sarcoidosis between March 1989 and May 1999. In every patient the following data were obtained: age, sex, bilaterality, initial and final visual outcome, systemic and ocular manifestations, stage of chest x-ray, serum markers, gallium scan, results of biopsy, medical and surgical treatment, and complications of treatment. RESULTS: The mean age at onset was 49.7 years (S.D. 19.9). Fourteen patients (77.8%) were female and 4 (22.2%) were male. The average follow-up time was 40.3 months (S.D. 28.7). Nine patients (50.0%) underwent a biopsy. The presence of non-caseating granulomata was observed in 7 (77.8%). Gallium scanning was positive in 16 cases (88.8%). The most frequent ocular manifestation was panuveitis (40.0%). Among the 30 eyes studied, conjunctival involvement was found in 10 (33.3%), secondary cataracts in 9 (30.0%), and secondary glaucoma in 6 (20.0%). Eleven patients (61.1%) were treated with oral corticosteroids and 10 (55,5%) with cyclosporine A. When sarcoidosis was diagnosed, 11 eyes (36.6%) had a visual acuity better than 0.6. At the end of the follow-up, the final visual outcome was better than 0.6 in 17 eyes (56.6%). CONCLUSIONS: An adequate control of ocular inflammation may improve the prognosis in patients with ocular sarcoidosis. Posterior segment involvement (posterior uveitis, macular edema or epiretinal membrane) may be associated with a worse visual prognosis.

Adolescent↗
PubMed2002

[Spontaneous reduction and absorption of cataracts in childhood].

The authors give an account on spontaneous reduction and absorption of cataracts in nine children. The initial symptom where leukocoria predominated was as a rule detected already in infant age. In one case the affection was bilateral and was manifested by partial pseudoaphakia. The observation comprised also classical secondary aphakia in a 4-year-old girl. Resorption of lenticular masses of cataracts into the shape of membranous discs or reduced masses of a fibrous character took on average 18 months on seven eyes and this process was associated with vascular activity in four lenses. In two of these patients during resorption panuveitis was observed with a hyperergic response in humoral and cellular immunity without obvious general antigenic action which caused atrophy of the optic nerve. Surgical solution of cataract was used in four eyes, PC IOL was implanted in one patient which had a favourable effect on visual function. Histological examination was successful of the extracted reduced lens only in one case. Inside the lenticular capsule was a mixture of the original fibrotically altered cataract masses with ingrowing vascular tissue.

Aphakia↗
PubMed2003

Endogenous uveitis: experiences in Kaohsiung Veterans General Hospital.

BACKGROUND: The distribution of uveitis varies in different parts of the world, which is attributed to geographic, alimentary or genetic factors. Epidemiological studies in uveitis may be extremely important in an effort to better understand the etiology of the disease and the classification of its subtypes. The purpose of this study was to determine the profile and characteristics of endogenous uveitis in southern Taiwan. METHODS: Retrospective chart review ofthe patients diagnosed and treated as endogenous uveitis in Kaohsiung Veterans General Hospital from January 1991 to December 2000 was performed. Demographic data, past history, ophthalmic examination and other laboratory tests were recorded and analyzed. RESULTS: One-hundred and sixty patients were collected, including 93 (58.1%) males and 67 (41.9%) female, with average age of 41.1 +/- 17.1 years (range 16-77), and mean follow-up period of 13.7 months. The diagnoses included 46 (28.8%) cases of acute anterior nongranulomatous uveitis (AAU), 26 (16.3%) cases of Vogt-Koyanagi-Harada (VKH) disease, 18 (11.3%) cases of intermediate uveitis, 14 (8.8%) cases of Behcet's disease, 26 (16.3%) cases of infectious origin, 7 (4.4%) cases of other diagnoses, and 23 (14.4%) undefined cases. Final visual acuity equal to or better than 0.5 was obtained in 78.2% of eyes of AAU, 65.4% of eyes of VKH disease, 48.1% of eyes of Behcet's disease, and 66.7% of eyes of intermediate uveitis. CONCLUSIONS: Acute anterior nongranulomatous uveitis was the most common endogenous uveitis, while VKH was the most common panuveitis in this series. As infectious origin contributes a significant proportion of endogenous uveitis, infectious etiology should be considered in any type of uveitis that responds poorly to conventional treatment.

Adolescent↗
PubMed2003

Prognostic factors for Vogt-Koyanagi-Harada disease.

BACKGROUND: Vogt-Koyanagi-Harada disease is a chronic bilateral granulomatous panuveitis with involvement of the central nervous system, auditory and integumentary systems. The prognosis depends mostly on the development of complications or not. The purpose of this study was to identify the prognostic factors of Vogt-Koyanagi-Harada (VKH) disease. METHODS: Retrospective chart review of all the patients diagnosed with VKH disease between 1991 and 2000 was performed. Data recorded included age, sex, clinical features, systemic manifestations, recurrence, HLA typing, treatment, complications, and final visual acuity. Statistical analysis was performed using Statistical Products and Services Solutions. RESULTS: There were thirty-nine patients, the mean age at presentation was 39.82 +/- 12.38 years. The majority (46.2%) of patients were probable VKH disease, followed by incomplete type (43.5%), with only 10.3% complete type. Ten patients had at least one complication, including cataract in 19 eyes, glaucoma in 4 eyes and choroidal neovascularization in 3 eyes. Fifty eyes (64.1%) had final visual acuity of 6/12 or better. The interval between ocular symptom and treatment had significant effect on the development of complicaion (p = 0.022) and recurrence (p = 0.003), which were also significantly associated with the final visual acuity (p = 0.007). For patients who were diagnosed and treated within two weeks, the extent of exudative retinal detachment correlated significantly with final visual acuity (p = 0.001). CONCLUSIONS: The visual prognosis of VKH disease is generally favorable. The development of complications or recurrence was significantly associated with the visual outcome. Interval between development of ocular symptom and treatment seemed to be an important predictor in the early stage of VKH. It is important to start the treatment early even when the typical features of VKH disease have not completely appeared.

Adolescent↗
PubMed1992

Endogenous pneumococcal endophthalmitis after splenectomy: report of two cases.

Two cases of pneumococcal sepsis, meningitis and unilateral endophthalmitis after total splenectomy are described. The first patient, a 9-year-old girl, had severe panuveitis complicated by traction retinal detachment, eventually requiring vitrectomy. Due to large chorioretinal scars the visual recovery was poor. Minor residual neurological signs remained. The second patient, a 39-year-old man, showed endophthalmitis of the right eye. The recovery of the pneumococcal meningitis was complicated by severe neurological impairment. The right eye progressed to phthisis bulbi. The importance of early recognition of postsplenectomy sepsis (PSS) is emphasised since the survival rate is poor and the risk of visual loss high.

Adult↗
PubMed1992

[Endogenous uveitis in senior patients].

Forty-seven cases of endogenous uveitis aged 60 and above were analyzed in the retrospective study. The result shows males are more than females (1.2:1). Among the 47 cases, 28 cases (59.57%) are anterior uveitis, 18 cases (38.30%) are panuveitis. Only 1 case (2.13%) is posterior uveitis. Immediated-type uveitis is not found. Besides, 34 cases are non-granulomatosis type, more than the cases with granulomatosis type (13 cases). The major complications are secondary glaucoma (22 cases) and complicated cataract (16 cases). Immunological tests to the patients showed the unbalance of immune-regulation was mostly complicated by immune-related sickness. The cure rate was 40.58%. The invalid and deteriorative rate was 17.39%. 62.32% of the patients had the vision acuity lower than 0.3 after the treatment.

Aged↗
PubMed2003

[Diagnosis of toxoplasmosis and toxocariasis using fluid from the anterior ocular chamber].

The authors discuss methods of improvement of the etiologic diagnosis of the toxoplasma and toxocara associated posterior uveititis, by examining specific antibodies in the aqueous humor. Paired samples of aqueous humor and serum were analyzed in 23 patients. Chorioretinitis of infectious etiology was suspected in 15 patients, 3 patients were treated for panuveitis, 4 patients for intermediate uveitis, and in 1 patient the sample was obtained to rule out malignant melanoma. The local ocular antibody production was calculated according to Desmonts. Toxoplasma etiology was confirmed by local antibody production analysis in 1 patient, toxocara etiology in 5 patients. In 20 patients in the control group local specific antibody production was not demonstrated.

Adolescent↗
PubMedDate not supplied

Sarcoid-related uveitis occurring during etanercept therapy.

We report the case of a 7-year-old boy who was initially diagnosed as having polyarticular juvenile idiopathic arthritis. Clinical and laboratory features of overt sarcoidosis became evident early during etanercept therapy when he developed acute panuveitis, papular skin rash and elevated levels of angiotensin-converting enzyme. Non-caseating granulomas were present in the liver. Uveitis resolved upon discontinuation of etanercept and systemic administration of corticosteroids. In rare cases expression of autoimmune disorders or expanded clinical features of these disorders may occur during etanercept treatment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

[Experimental autoimmune uveitis--a clinical and pathological study].

Experimental autoimmune uveitis (EAU) was induced in 95% of guinea pigs after immunization by a single intradermal injection of homologous retinal tissue in Freund's complete adjuvant and subcutaneous injection of dead pertussis bacilli. The clinical features were circumcorneal injection, cells and flare in the anterior chamber, vasodilation in the iris, and marked cellular exudate in the vitreous. The pathological changes were characterized by diffuse proliferative granulomatous panuveitis, consisting of lymphocytes, macrophages, and epithelioid cells. The outer layers of the retina were disrupted or missing in areas where the pigment epithelium was damaged.

Animals↗
PubMed2004

Pattern of uveitis in a referral eye clinic in north India.

PURPOSE: To report the pattern of uveitis in a north Indian tertiary eye center. METHODS: A retrospective study was done to identify the pattern of uveitis in a uveitis clinic population of a major referral center in north India from January 1996 to June 2001. A standard clinical protocol, the "naming and meshing" approach with tailored laboratory investigations, was used for the final diagnosis. RESULTS: 1233 patients were included in the study; 641 (51.98%) were males and 592 (48.01%) females ranging in age from 1.5 to 75 years. The anterior uveitis was seen in 607 patients (49.23%) followed by posterior uveitis (247 patients, 20.23 %), intermediate uveitis (198 patients, 16.06%) and panuveitis (181 patients, 14.68%). A specific diagnosis could be established in 602 patients (48.82%). The infective aetiology was seen in 179 patients, of which tuberculosis was the commonest cause in 125 patients followed by toxoplasmosis (21 patients, 11.7%). Non-infectious aetiology was seen in 423 patients, of which ankylosing spondylitis was the commonest cause in 80 patients followed by sepigionous choroidopathy (62 patients, 14.65%). CONCLUSION: Tuberculosis and toxoplasmosis were the commonest form of infective uveitis, while ankylosing spondylitis and serpiginous choroidopathy were commonly seen as the non-infective causes of uveitis in North India.

Adolescent↗
PubMed1997

[Sympathetic ophthalmia, one missing disease?].

Between 1992-1996 were treated ten cases with sympathetic ophthalmia, representing 0.16% from all hospitalized patients, in Ophthalmological Clinic from Craiova. The disease appeared after corneo-scleral penetrating wounds with membranes hernia at four cases; three from them was complications after cataract surgery and required long treatments; other two patients had glaucoma with closed angle in irreversible stages; another one presented herpetic cornea perforated ulceration with uveitis. Since ocular trauma until appearance of sympathetic ophthalmia, the time was two months at eight cases and two years at two cases. Under clinical aspect seven cases evolved like an anterior uveitis, two cases like a panuveitis and one like a uveopapillitis. Pathologic exam on the removed eye was not specific for sympathetic ophthalmia and only the clinical examination established the diagnosis. Under corticotherapy and immunomodulator therapy, sympathetic ophthalmia evolves this days benign. The disease should not be underestimated. It is not a disappeared disease..

Adrenal Cortex Hormones↗
PubMedDate not supplied

Infliximab for the treatment of posterior uveitis with retinal neovascularization in Behçet disease.

PURPOSE: To report a case of posterior uveitis with retinal neovascularization in a patient with Behçet disease treated with infliximab. METHODS: A 50-year-old man with a history of recurrent relapses of ocular inflammation despite immunosuppressive therapy developed retinal neovascularization near the optic disk. The patient was treated with infliximab and followed up for 12 months. RESULTS: Retinal neovascularization regressed 8 months after the first anti-tumor necrosis factor (TNF) treatment and with six infusions of infliximab. The ocular inflammation resolved almost completely. CONCLUSIONS: The result suggests that anti-TNF therapy may be effective in the treatment of retinal neovascularization caused by panuveitis in Behçet disease.

Adult↗
PubMed2004

[Incidence of endogenous uveitis at Kyushu University Hospital].

PURPOSE: We performed a clinical statistical study on recent patients with endogenous uveitis at the clinic of the Department of Ophthalmology, Kyushu University Hospital. SUBJECTS: We studied 616 patients with endogenous uveitis who first visited the clinic of the Department of Ophthalmology, Kyushu University Hospital, between January 1996 and December 2001. RESULTS AND CONCLUSION: The most frequent clinical entity was sarcoidosis (8.6%), followed by Behçet's disease (8.4%), Vogt-Koyanagi-Harada syndrome (6.5%), human T-lymphotropic virus type I (HTLV-1) uveitis (3.9%), and toxoplasmosis (2.6%). Unclassified uveitis comprised 58.1% in our study. Next we classified the subjects into four age groups; adolescent (0-19 years old), young (20-39 years old), middle-aged (40-59 years old), and elderly (60-years old). We also classified the disease into four groups: uveitis pan, anterior, intermediate, and posterior uveitis, according to the site of inflammation. The most frequent clinical entity was Behçet's disease in the young group, and sarcoidosis in the elderly group. The frequency of unclassified uveitis was high in the adolescent and the elderly groups. As to the anatomic diagnosis of uveitis, panuveitis was most frequent, followed by anterior, posterior, and intermediate uveitis. Finally we investigated the frequency of secondary glaucoma. The frequency in all 616 patients was 19.7%. Secondary glaucoma was more frequent in male patients and more frequent in the middle-aged and the elderly groups.

Adolescent↗
PubMed1992

Acquired ocular syphilis: diagnosis and treatment.

We present our findings in 14 patients with a serologically verified diagnosis of ocular syphilis. Although most patients had iridocyclitis, other ocular findings included episcleritis, scleritis, vitritis, retinitis, papillitis, panuveitis, cystoid macular edema, and retinal detachment. Most patients had only ocular manifestations of syphilis with no other definitive symptoms. Without the use of specific treponemal serologic tests, the diagnosis of ocular syphilis would have been missed in at least 20% of patients. Furthermore, 80% of patients were negative for antibody to syphilis in the cerebrospinal fluid, and therefore, this test should not be used to determine treatment for ocular syphilis. Currently, the most effective therapy for ocular syphilis is the same as that for neurosyphilis (i.e., high-dose intravenous penicillin G 12 to 24 million units/day for ten to 14 days). Human immunodeficiency virus-positive patients should receive a full 14 days of high-dose intravenous penicillin G plus intramuscular benzathine penicillin 2.4 million units weekly for three weeks because their immune defenses are likely to be impaired.

Adult↗
PubMed2005

[The clinical feature, diagnosis and treatment of uveitis associated with juvenile chronic arthritis].

OBJECTIVE: To investigate the clinical features, diagnosis and treatment of uveitis associated with juvenile chronic arthritis (JCA). METHODS: A retrospective study was performed on the clinical data of 26 patients with uveitis associated with JCA, referred to Zhongshan Ophthalmic Center from 1996 to 2002. Taking of history, examination with slit-lamp microscope and ophthalmoscope were carefully performed in all of these patients. Laboratory tests including antinuclear antibodies, erythrocyte sedimentation rate, rheumatoid factor, C reactive protein and antistreptolysin O were used to disclose possible causes. Human leukocyte antigen B 27 and X-ray examination of sacroiliac joints and spine were carried out if necessary. Data about the treatment, visual outcome and complications were analyzed. RESULTS: Twenty-six patients, 11 males and 15 females, were included in the present studies. Age of onset of JCA and uveitis averaged 8 years and 9 years, respectively. Twenty-one patients had chronic anterior uveitis. Acute anterior uveitis and chronic panuveitis were noted in 3 and 2 patients, respectively. Twenty-two patients had bilateral uveitis, the other 4 had unilateral involvement. The ophthalmologic examination revealed that 33 of the 48 affected eyes showed mild aqueous humor flare, 24 had few cells in the anterior chamber. Complicated cataract, band keratopathy and secondary glaucoma were noted in 30, 20 and 12 eyes, respectively. The laboratory examination revealed positive antinuclear antibodies in 18 cases and rheumatoid factor positive in one case. In acute episode, patients were treated with extensive topical cycloplegic agents and corticosteroids eyedrops. In the 6 cases with severe uveitis, 3 patients were treated with cyclosporine A (5 mg.kg(-1).d(-1)) and the other 3 were treated with chlorambucil (0.1 mg.kg(-1).d(-1)). The intraocular inflammation in all of these patients was satisfactorily controlled with these treatments. Visual acuity improvement was noted in 32 affected eyes but not in the other 16 eyes which had already serious complications before the treatment. CONCLUSIONS: Uveitis associated with JCA is characterized by a chronic and recurred iridocyclitis, which usually developed within 5 year after JCA onset. Although the intraocular inflammation associated with JCA is usually white uveitis, complications such as cataract, secondary glaucoma and keratopathy occur frequently in these patients. The diagnosis is mainly based on typical clinical manifestations, the history of arthritis and positive antinuclear antibodies. Adequate application of cycloplegic agents, corticosteroids eyedrops, immunosupressives and the regular follow-up should be kept in mind in the treatment of these patients.

Adolescent↗
PubMedDate not supplied

[Sympathetic ophthalmia. Clinical and morphological study in 6 cases after penetrating injury and subsequent repeated vitreoretinal operations].

The paper outlines the clinical and morphological picture of 6 sympathizing eyes enucleated in 1996 to 2003 after vitrectomy and other endovitreal interventions into early injured or operated eyes. Resurgery was attempted early after wounds or a primary operation on the average following 20 days. Sympathetic ophthalmia (SO) generally occurred in the posterior uveal tract as panuveitis or posterior uveitis and diagnosed in the late periods. Specific granulomatous inflammation in the uveal tract was observed in all eyes and the morphological feature of sympathizing eyes was the spread of an inflammatory process to the retina with the development of the latter's epithelioid-cell granulomas and adhesive chorioretinitis. The authors also discuss the possibility of additional antigenic stimulation accompanied by a progressive autoimmune process in the eye and by the generalization of a granulomatous inflammation, as well as the role of retinal minor lesions in this process as a source of additional autoantigens during repeated vitreoretinal operations. The latter, as the authors believe, are a risk factor of SO. In this connection, when repeated vutreoretinal interventions should be made in the presence of an uncompleted wound process in the eye and when they should be conducted under the conditions of active immunosuppressive therapy gain in great importance.

Adult↗
PubMedDate not supplied

Ocular manifestations of leptospirosis.

Leptospiral uveitis is a common entity in tropical countries. Ocular manifestations are noted in the second phase of illness, but these remain under-diagnosed mainly because of the prolonged symptom-free period that separates the systemic manifestations from detection of ocular manifestations. Varying ophthalmic presentations and the intrinsic nature of different types of uveitis to mimic one another also challenge the accuracy of the diagnosis. Of the individual ocular signs, the combination of acute, non-granulomatous, panuveitis, hypopyon, vasculitis, optic disc edema, membranous vitreous opacities and absence of choroiditis or retinitis have high predictive value for the clinical diagnosis of leptospiral uveitis. Geographic location of the patient, occupation, socio-economic status, risk factors related to exposure, past history of fever or jaundice also aid in diagnosis. Steroids are the mainstay of treatment for leptospiral uveitis. Depending upon the severity and anatomical location of inflammatory lesion, topical, peri-ocular and/or systemic steroids are given. The prognosis is generally good, even when the inflammation is severe.

Eye Diseases↗
PubMed2005

[The Vogt-Koyanagi-Harada syndrome in 11-year-old girl].

PURPOSE: The Vogt-Koyanagi-Harada syndrome is an idiopathic, multisystem disorder which typically affects pigmented individuals between 20-50 years old. The typical symptoms include granulomatous panuveitis with characteristic extraocular dermato-neurological manifestations. The case of VKH syndrome affecting Polish girl is very rare. CASE REPORT: A 11-year-old girl had an important decrease of visual acuity in both eyes (RE 0.1 and LE 0.2), with the presence of bullous serous retinal detachment in both eyes. Besides, in right eye some keratic precipitates were noted. The routine laboratory evaluation failed to provide a diagnosis. The patient was treated with an intravenous bolus of corticosteroid therapy and then, high dose of oral prednisone. RESULTS: After administered therapy the visual acuity improved rapidly in both eyes (RE 1.0 and LR 0.9), and the exudative retinal detachment resolved. After 5 months, the patient's examination showed a sunset glow fundus with several whitish rounded lesions in peripheral fundus, which is typical for the VKH syndrome. CONCLUSIONS: The VKH syndrome rarely affects young children, so the diagnosis may be difficult in the absence of the typical extraocular manifestations. In such atypical cases the diagnosis is based on the clinical evolution of the disease.

Anti-Inflammatory Agents↗