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At least 127 records · Page 7Linked to original sources

Prevalence of uveitis: a retrospective study.

BACKGROUND: Uveitis is commonly seen in optometric practice, and anterior uveitis accounts for more than 75% of all uveitis. Uveitis may be the initial manifestation of an associated systemic disease process; and, with proper testing and diagnosis, the patient's ocular and systemic condition may be more effectively treated. METHODS: Retrospectively, 194 charts from a referral practice with a general diagnosis of uveitis, retinitis, or chorioretinal scar were reviewed to determine medical history, clinical findings, tests performed, and specific diagnoses obtained. RESULTS: The majority of cases, 87.6%, were anterior uveitis with more than half, 54.7%, presenting with undetermined etiology. Trauma was the cause of the next most common group of anterior uveitis patients, 21.8%, and accounted for 19.1% of all uveitis cases. Glaucomatocyclitic crisis was seen in 8 cases, 4.1%, while there were 7 patients with sarcoid disease, and 5 with ankylosing spondylitis or systemic lupus erythematosus. Posterior uveitis was the principle finding in 12.4% of cases with ocular histoplasmosis being most common. There were 4 cases of toxoplasmosis and 3 cases of pars planitis. CONCLUSIONS: Utilization of laboratory testing proved to be most valuable in the treatment and management of uveitis. Although there were fewer cases of pars planitis reported in our study in comparison to previous reports, the mix of cases of uveitis in our study was comparable to the work of others in the field. Accurate diagnosis of these cases is quite important since the treatment and prognosis for recovery is variable and different with its associated diseases.

Adolescent↗

Inadvertent injection of corticosteroid into the choroidal vasculature.

A 21-year-old woman with pars planitis was treated with a subtenon's depot corticosteroid injection that was complicated by the appearance of the corticosteroid suspension within the choroidal vasculature. White, flocculent material was observed in the anterior chamber and 24 hours later this settled on the iris surface. Similar material was located in the major choroidal vessels. Two months after the incident, the choroid was normal appearing but the pars planitis was unchanged.

Adult↗

[Evaluation and monitoring of selected inflammation patterns in uveitis using laser tyndallometry].

AIM: The purpose of the present study was to evaluate the degree of inflammation and to monitor the dynamics of the blood-aqueous barrier disruption in selected cases of uveitis using laser tyndalometry. MATERIAL AND METHOD: Measurements with the use of laser tyndalometer (Kowa FM-500) were performed in 72 patients (90 eyes) with various types of uveitis. They were divided into four groups: anterior uveitis (28 eyes), intermediate uveitis (pars planitis) (28 eyes), posterior uveitis (26 eyes) and panuveitis (8 eyes). Aqueous flare values were expressed as photon counts per millisecond. RESULTS: Tyndalometric mean values in control eyes were 4.8 +/- 1.0 ph/msec. Mean initial flare was pronounced in multifocal choroiditis and panuveitis--196.0 ph/msec, HLA-B27 positive acute anterior uveitis--145.4 ph/msec, and in acute herpes zoster anterior uveitis--52.4 ph/msec. It was mild to moderate in Fuchs uveitis syndrome--7.8 ph/msec, pars planitis--15.7 ph/msec, posterior uveitis in toxoplasmosis--6.8 ph/msec and toxocariasis--17.5 ph/msec. The potential of laser flare-meter for precise follow-up and adjustment of therapy was demonstrated in selected cases. CONCLUSIONS: Laser tyndalometry has been proved to be a useful tool for the objective and quantitative evaluation of anterior chamber flare in uveitis and for monitoring the effectiveness of the treatment, thus improving therapeutic efficacy of uveitis.

Adolescent↗

Vitrectomy for nondiabetic vitreous hemorrhage. Retinal and choroidal vascular disorders.

The results and complications of pars plana vitrectomy for nondiabetic vitreous hemorrhage due to retinal and choroidal vascular disorders were studied in 68 eyes of 66 patients. Diagnoses included: retinal branch vein obstruction (34 eyes), choroidal neovascularization (15 eyes), central retinal vein occlusion (5 eyes), Eales' disease (10 eyes), pars planitis (3 eyes), and hemoglobin S-C retinopathy (1 eye). The duration of the vitreous hemorrhage was 6 months or more in 48 eyes (71%), and averaged 17.8 months. Preoperative visual acuity was less than 5/200 in 57 eyes (84%). Best postoperative visual acuity was 5/200 or better in 55 patients (81%), and vision improved two or more lines after vitrectomy in 54 eyes (80%). Patients with retinal branch vein obstruction, Eales' disease, or pars planitis had the best prognosis. Those with central retinal vein obstruction or choroidal neovascularization had the worst prognosis.

Adolescent↗

Tacrolimus (FK506) in the treatment of posterior uveitis refractory to cyclosporine.

OBJECTIVE: To assess the efficacy and side effects of tacrolimus, a potent immunosuppressive macrolide antibiotic, in the treatment of sight-threatening uveitis. DESIGN: A clinical study of tacrolimus in patients who required systemic immunosuppression for control of uveitis, but were refractory to cyclosporine. PARTICIPANTS: Six patients with uveitis were treated: three had Behçet disease, one had microscopic polyangiitis, one had pars planitis, and one had idiopathic retinal vasculitis. INTERVENTION: Patients with sight-threatening uveitis refractory to cyclosporine were treated with tacrolimus. MAIN OUTCOME MEASURES: Intraocular inflammation, visual acuity (VA), neovascularization. Adverse effects of tacrolimus were documented. RESULTS: The posterior uveitis remained controlled in all patients while they were taking tacrolimus. Five of the six patients showed improvement, defined as improvement of two or more lines of Snellen acuity or a decrease in the binocular indirect ophthalmoscopy score (P < 0.05, Sign test). One patient with Behçet disease showed a marked improvement in best-corrected VA from 1/60 to 6/24. Two patients with Behçet disease showed a modest improvement in VA in the affected eye and had no disease activity in the other eye. The patient with microscopic polyangiitis was symptomatically improved, and there was no progression of the posterior uveitis. The patient with pars planitis had an improvement in VA from 6/18 to 6/9. The patient with retinal vasculitis showed partial regression of neovascularization on tacrolimus. Side effects were less troublesome than with cyclosporine. CONCLUSIONS: Tacrolimus (FK506) has a useful role as an immunosuppressive agent for the treatment of sight-threatening uveitis in patients who did not respond to cyclosporine either because of lack of therapeutic effect or unacceptable adverse effects.

Adolescent↗

[Ocular changes in demyelinating diseases].

To synthetize the main ocular changes in the demyelinating diseases of CNS. The most important changes in this diseases are the neuro-ophthalmological ones: retrobulbar optic neuritis, papillitis, oculomotor nerves palsies. Also the demyelinating diseases can have an ophthalmological involvement represented by: retinal periphlebitis, pars planitis.

Demyelinating Diseases↗

[Lyme disease in Switzerland: ocular involvement].

Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi, which is transmitted by a tick (Ixodes Ricinus). Lyme disease is divided into three stages (infection, dissemination and immunological reactions). Ocular manifestations are rare except for conjunctivitis and facial nerve palsy. Switzerland is an endemic zone for Lyme disease; the presence of an atypical pars planitis should prompt a search for Lyme disease.

Adult↗

Lower eyelid herniation of orbital fat may complicate periocular corticosteroid injection.

PURPOSE: To report a case of lower eyelid herniation of orbital fat occurring after periocular corticosteroid injection. DESIGN: Interventional case report. METHODS: A 44-year-old man with asymmetrical pars planitis complicated by right cystoid macular edema was treated with multiple right orbital floor injections of triamcinolone through the lower eyelid. RESULTS: Right lower eyelid orbital fat herniation occurred during the course of the treatment. CONCLUSION: A herniation of orbital fat may complicate the injection of corticosteroid through the lower eyelid.

Adipose Tissue↗

Chronic Propionibacterium acnes endophthalmitis as a cause of intermediate uveitis.

Although the pathogenesis in most cases of intermediate uveitis is unknown, a small minority of cases is associated with a variety of specific inflammatory etiologies: sarcoidosis; multiple sclerosis; Lyme disease; syphilis; ocular lymphoma; and as a rare manifestation of Behçet's disease and AIDS. A 61-year-old woman developed pars planitis after cataract surgery. A vitrectomy was performed after ten months when a white capsular plaque and an hypopyon developed. Propionibacterium acnes was isolated. The intermediate uveitis was not controlled until later removal of the intraocular lens and capsular remnants. Chronic propionibacterial endophthalmitis may be a cause of intermediate uveitis.

Cataract Extraction↗

Serum levels of interleukin-2 receptor in ocular Behçet's disease.

Serum interleukin-2 receptor levels were evaluated in 69 patients who had chronic bilateral uveitis and in 22 control subjects. Fifty-one of the 69 patients with uveitis had the ocular type of Behçet's disease and 18 had pars planitis (intermediate uveitis). The mean serum interleukin-2 receptor level was 412.6 +/- 94.6 U/ml for the control group, 465.0 +/- 96.6 U/ml for the patients with intermediate uveitis, and 810.9 +/- 369.3 U/ml for those with ocular Behçet's disease. The serum interleukin-2 receptor levels of patients with ocular Behçet's disease were significantly different from the levels of both the control and the intermediate uveitis groups (P < .001). The differences in serum levels of patients with intermediate uveitis and the levels of the control subjects were not statistically significant. Treatment of patients with ocular Behçet's disease for four to six weeks with either cyclosporine, methylprednisolone, or a combination of both, decreased the intraocular inflammation in nearly all cases. The influence of treatment on the level of serum interleukin-2 receptor, however, was variable.

Behcet Syndrome↗

[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↗

[Mesangial glomerulonephritis and intermediate uveitis].

Uveitis in children are less frequent than in adults. Their prognosis is variable because it may be found as an isolated and idiophatic condition or in association with definite clinical entities. The associated noninfectious diseases with predominantly renal involvement are tubulointerstitial nephritis and uveitis syndrome (TINU syndrome), mesangial glomerulonephritis isolated or in association with Behçet's disease. A case of 14-years-old girl with intermediate uveitis (pars planitis) and mesangial glomerulonephritis is presented. The ocular symptoms was eye redness and ocular pain and she has snow-banks in pars plana. She showed microscopic hematuria and intermitent proteinuria that increased during the ocular clinical exacerbation. Renal biopsy revealed both mild mesangial matrix increase and mesangial celullarity with normal tubulointerstitial structure and mesangial deposition of IgA and IgG immunoglobulins. This case is de first pediatric patient report in the literature with intermediate uveitis and mesangial glomerulonephritis with immune deposition. Mesangial glomerulonephritis were observed in patients whit Behçet disease, known etiological cause of uveitis in adults and children. These findings may suggest that uveitis and glomerulonephritis have common immunological pathogenesis including circulatory immune complexes. In uveitis patients, screening for associated extra-ocular and renal manifestations is mandatory and should have careful long-term follow-up with regular systemic evaluation.

Adolescent↗

Vitrectomy and juvenile epiretinal membrane.

The cases of two children who had idiopathic epiretinal membranes are reported. Causes for juvenile epiretinal membranes, including trauma, pars planitis, toxocariasis, Coats' disease, or combined hamartomas, were not present. Both patients previously had documented normal vision in the affected eye. Observation revealed deterioration of vision, and a pars plana vitrectomy and a membranectomy were performed. The 5-year -old girl's vision improved from counting fingers at 5 feet to 20/80. The 12-year-old boy's vision improved from 20/200 to 20/80. Selected cases of juvenile epiretinal membranes may benefit from surgical excision.

Child↗

High-resolution ultrasound biomicroscopy of the pars plana and peripheral retina.

OBJECTIVE: This study aimed to evaluate the ability and role of ultrasound biomicroscopy in imaging the peripheral retina, pars plana, and anterior choroid. DESIGN: The study design was a case series. PARTICIPANTS: Seventeen eyes of 17 patients with a variety of clinical diagnoses involving the anterior portion of the posterior segment were studied. INTERVENTION: High-frequency (50 MHz), high-resolution (50 microns) ultrasound biomicroscopy was performed. RESULTS: Ultrasound biomicroscopy was capable of imaging the peripheral retina, pars plana, and anterior choroid. Images had features consistent with known histopathology. Retinoschisis consisted of one thin hyper-reflective echo and could be differentiated from a retinal detachment, which was thicker and formed a bilayered echo. A choroidal effusion could be identified as an echolucent space within the suprachoroidea, whereas a choroidal hemorrhage was moderately echodense. Inflammatory diseases, such as a sarcoid granuloma, pars planitis, and Harada's disease, were characterized by different forms of uveal thickening. A ciliochoroidal nevus was internally hyporeflective and could be measured accurately and localized. CONCLUSIONS: Imaging of the peripheral retina, pars plana, and anterior choroid is possible with ultrasound biomicroscopy and may aid in the diagnosis and management of pathology involving this region.

Adolescent↗

Combined 50- and 20-MHz frequency ultrasound imaging in intermediate uveitis.

PURPOSE: To evaluate the information provided by multifrequency ultrasound examination in patients with intermediate uveitis. DESIGN: Prospective observational case series. METHOD: High-resolution ultrasonography with 50- and 20-MHz frequency immersion probes was performed in seven eyes of five young patients with clinical diagnosis of intermediate uveitis. RESULTS: Exudative material over the inferior pars plana and peripheral retina (snowbank) was found in all eyes with 50- and 20-MHz probe, although resolution of the latter was poorer. The 50-MHz imaging was superior for visualization of angle structures and details of pars planitis; the anterior vitreous involvement and cyclitic bands were better shown with the 20-MHz probe, which could also evidence cystoid macular edema. CONCLUSIONS: Ultrasound examination with both 50- and 20-MHz frequency probes can detect the typical snowbank in intermediate uveitis and be useful in eyes with small pupil, dense vitreitis, or both, especially before pars plana vitrectomy or cataract surgery.

Adolescent↗

[Intermediate uveitis].

Intermediate uveitis defines the group of diseases formerly called pars planitis or chronic cyclitis. Its frequency amounts to 10-20% of all uveitis cases. The anamnesis is vague. The clinical symptoms mainly involve the vitreous. The visual acuity is variable, depending of the involvement of the retina. A slight inflammation of the anterior chamber is possible, but no synechiae are present. The vitreous shows a positive Tyndall and cells, snow balls, eventual plaques on the pars plana. Serious cases are complicated by a retinal vasculitis, which often leads to cystic macular edema and papillary edema. Schisis and retinal holes are more seldom. A complicated cataract can develop. The most valuable complementary tests are fluorescein angiography and electroretinography, useful to detect retinal damage. Aetiological investigations give mostly poor results and are not very useful. Differential diagnosis has to be made, among others, from Fuchs' heterochromic cyclitis and from acute cellular infiltration of the vitreous in case of retinochoroiditis or candida endophthalmitis. Treatment of intermediate uveitis can be only local and discrete when only the vitreous is involved. If the retina is damaged, systemic steroids or immunodepressive cytostatic drugs might be indicated. Despite the duration of the disease, its prognosis remains rather good. Only about 15% of the cases end up with visual impairment to 1/10 or less, while more than half of the cases maintain a visual acuity higher than 0.6, even after three years of disease progress.

Diagnosis, Differential↗

Phakic patients with cystoid macular edema, retinal periphlebitis, and vitreous inflammation.

OBJECTIVE: To characterize a group of phakic patients with idiopathic intermediate uveitis as defined by vitritis, cystoid macular edema, and retinal periphlebitis. DESIGN: Cross-sectional study. PARTICIPANTS: Nineteen phakic patients (35 eyes) with vitreous inflammation, cystoid macular edema, and/or retinal periphlebitis of unknown cause. INTERVENTION: None. MAIN OUTCOME MEASURES: Best-corrected final visual acuities, standardized clinical examinations, photographic and fluorescein angiographic evaluations, and class I and II HLA analysis on all 19 patients. RESULTS: Fifteen of the 19 patients were women. The mean age was 38 years, the mean follow-up was 104 months, and the mean duration of symptoms was 154 months. All 35 affected eyes had significant vitritis; 21 eyes (60%) had cystoid macular edema, 21 eyes (60%) had retinal periphlebitis. The median initial visual acuity was 20/30. The median final visual acuity was 20/20 with 32 (91%) of 35 eyes having 20/40 or better visual acuity at the final visit. No patient developed "snow-banks" or evidence of systemic disease, including multiple sclerosis or sarcoidosis, during the follow-up period. There were no statistically significant HLA associations in these patients compared with controls from another study from Iowa, but the Iowa phakic patients with cystoid macular edema did differ from the Iowa patients with pars-planitis at loci HLA-B8, HLA-B51, and HLA-DR2. CONCLUSIONS: We describe a disease entity of idiopathic intermediate uveitis that affects primarily young to middle-aged women and usually causes bilateral vitritis, cystoid macular edema, and retinal periphlebitis. Most patients retained good vision over a prolonged follow-up period. Multiple sequential examinations and HLA associations suggest that these conditions are distinct from other syndromes of intermediate uveitis, particularly parsplanitis.

Adolescent↗

Human T-cell lymphotropic virus type 1 infection and ocular manifestations in São Paulo, Brazil.

OBJECTIVES: Although human T-cell lymphotropic virus type 1 (HTLV-1)-associated uveitis has been well recognized in Japan, related studies in Brazil are scarce. We performed a serologic survey for HTLV-1 infection among patients with uveitis and investigated the ocular findings in HTLV-1-asymptomatic carriers. METHODS: One hundred ninety serum samples from patients with uveitis of determined (n = 137) and undetermined origins (n = 53) being examined at the Uveitis Service, University of São Paulo, São Paulo, Brazil, underwent testing using HTLV enzyme-linked immunosorbent assay and discriminatory Western blots. One hundred five asymptomatic blood donors and/or their relatives who were seropositive for HTLV-1 (carrier group) and 105 age- and sex-paired blood donors who were seronegative for HTLV-1 (control group) underwent ocular evaluation. For the statistical analysis, chi2 test was used. RESULTS: Only 1 patient with uveitis was seropositive for HTLV- 1, and she belonged to the group with uveitis of undetermined origin. Results of tear films were evaluated in 52 carriers. The prevalence of a decreased tear break-up time was significantly higher in the carrier compared with the control group (P = .02). Two carriers had keratoconjunctivitis sicca. Three of the 105 carriers exhibited mild uveitis (cells in the vitreous, retinal and choroidal infiltrates, retinal vasculitis, and bilateral pars planitis). Retinal pigmentary changes were found in both groups (no statistical difference). CONCLUSIONS: Early tear abnormalities may be present in asymptomatic carriers, and mild uveitis may be found among them. The relatively low seroprevalence of HTLV-1 in the Brazilian population made it difficult to establish the real importance of HTLV-1-associated uveitis among our patients with uveitis.

Adolescent↗