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PubMed1994

The treatment and follow up of adult chlamydial ophthalmia.

Sixty two patients diagnosed as having adult chlamydial ophthalmia were treated with oral doxycycline and roxithromycin in association and tetracycline eye wash for 2 weeks. Chlamydial ophthalmia was diagnosed by laboratory detection of the micro-organism in ocular specimens using direct immunofluorescent monoclonal antibody staining for Chlamydia trachomatis, chlamydial culture in cycloheximide treated McCoy cells, and Giemsa staining. An immunoenzymatic method for detection of specific IgG and IgA in patients' serum was used as an additional test to confirm the diagnosis. All patients were reexamined 3 weeks after completing their course of antibiotics and in the case of persistent infection a further course of treatment was given. With this treatment regimen 48 out of 62 patients (77.4%) were cured after three courses. Because of the risks of an inadequate response to therapy, we recommend a proper post-treatment follow up in all patients with chlamydial eye infections.

Administration, Oral↗
PubMed1986

[Larrey and Egyptian ophthalmia].

During the napoleonic expedition to Egypt (1798-1801), a new ophthalmic disease, the "egyptian ophthalmia", was discovered by the french physicians. We analysed a contemporary study published by the surgeon Jean-Dominique Larrey. The accuracy of the clinical description enables us to suggest hypotheses upon the origin if the egyptian ophthalmia: Weeks' conjunctivitis, gonorrheal conjunctivitis, trachoma. Treatments are also reviewed. Larrey is to be seen as a symbol of the transition from the old medical vision to modern clinical medicine.

Egypt↗
PubMed1995

A comparative microbiological study of clinically healthy eyes and those affected by ophthalmia in cattle and the association of noctuid eye-frequenting moths.

The eyes of clinically healthy Simmentaler cattle and those affected by ophthalmia were sampled once a month over a continuous period of 12 months for bacterial, mycoplasmal and ureaplasmal infections. In total 478 eyes, representing from a clinical viewpoint 414 healthy and 64 affected eyes, were swabbed. Bacteria were isolated from 201 (48.6%) healthy eyes and 56 (87.5%) affected eyes. No bacteria were isolated from the remaining eyes. Eleven genera of bacteria were isolated from healthy eyes and 8 genera from affected eyes. The majority of isolates were classified in the genera Moraxella, Neisseria and Staphylococcus. Mycoplasmas were isolated from 247 (50.7%) healthy eyes and 27 (42.2%) affected eyes. No mycoplasmas were isolated from the remaining eyes. Ureaplasmas were not isolated from any animal. Eye-frequenting moths were collected on 3 occasions during the investigation and bacterial and mycoplasmal isolation techniques were performed on a total of 21 moths. Twelve different genera of bacteria, mostly Nocardia, Corynebacterium, Staphylococcus, Moraxella, and mycoplasmas were isolated from various eye-frequenting moths. Scanning electron microscopical studies of the proboscis of the moths showed it to contain various sensillae and short triangular denticles that could possibly cause damage to the mucous membranes of the eyes and predispose to ophthalmia in cattle.

Animals↗
PubMed1978

Sympathetic ophthalmia. A long-term follow-up.

Seventeen cases of sympathetic ophthalmia have been followed up for as long as 23 years (average 10.6 years). Sixty-five percent of those patients treated with corticosteroids retained a visual acuity of 20/60 or better. Complications were frequent and included secondary glaucoma, cataract, exudative retinal detachment, and choroidal scarring. Uneventful cataract extraction was difficult to manage, requiring frequent changes in the steroid dosage, and in one patient two glaucoma procedures. The duration of steroid therapy was quite variable and ranged from a few months to six years or longer. Relapses were common and several occurred many years after the initial episode had resolved. If the histopathologic picture were moderate or severe, the clinical course most often would be difficult and protracted.

Adolescent↗
PubMed1983

The role of the penetrating wound in the development of sympathetic ophthalmia experimental observations.

Clinical observations have established that sympathetic ophthalmia (SO) develops after a penetrating wound but not subsequent to often more severe intraocular disturbances such as extensive photocoagulation. A feature of the penetrating wound that appears important in the pathogenesis of SO is the access it provides for intraocular antigens to reach regional lymph nodes. The intraocular compartment has no lymphatic drainage and appears to function like a number of alymphatic biologic sites. In an experimental model of SO, subconjunctival injection of retinal S antigen in one eye induced a bilateral sympathetic uveitis, whereas intraocular injection in one eye was ineffective in inducing sympathetic disease.

Animals↗
PubMed1988

Neonatal ophthalmia in the developing world. Epidemiology, etiology, management and control.

In the 19th century, the incidence of neonatal conjunctivitis varied between 1 and 14% in Europe, and the disease was a main cause of blindness at that time. Since then the epidemiology of ophthalmia neonatorum (ON) has changed and Chlamydia trachomatis is more frequent than Neisseria gonorrhoeae. Both are still very common causes of ON in the developing world. ON can not be differentiated clinically as to the etiology, but Intracellular Gram Negative Diplococci (IGND) on a Gram stain of an eye smear has an excellent validity and further differentiation can be made using microbiological cultures. All cases of presumed gonococcal conjunctivitis must be treated with effective systemic antibiotics. Systemic treatment with penicillin can still be used in areas where the percentage of beta-lactamase producing strains of gonococci is very low. For other areas a single dose of ceftriaxone intramuscular combined with saline eye washes is the treatment of choice. Chlamydial ON necessitates also systemic treatment with erythromycin. Parents of infants with gonococcal or chlamydia ON also need to be examined and treated. Prevention of gonococcal and chlamydial disease can be done following 3 strategies: antenatal diagnosis and treatment of maternal infections or disinfection of the infants eyes at birth or adequate treatment of infants and parents as soon as a ON has been diagnosed. Crédé's eye prophylaxis with silver nitrate has become a controversial issue, because of concern about the occurrence of chemical conjunctivitis and its ineffectiveness against infections with C. trachomatis.(ABSTRACT TRUNCATED AT 250 WORDS)

Chlamydia Infections↗
PubMed1982

Atypical histopathologic features in sympathetic ophthalmia. A study of a hundred cases.

One hundred cases of clinically acceptable sympathetic ophthalmia (SO) were evaluated histologically to determine the incidence of atypical features and correlate them with the severity of choroidal inflammation. The inflammatory response in the choroid varied from a focal non-granulomatous to a diffuse non-necrotizing granulomatous process. The choriocapillaris was focally involved rather frequently (in 40% of the cases). This was associated with severe inflammation. Chorioretinal adhesions were noted in 7% of the cases. Retinal detachment was observed in 50% of the cases, and this was associated with severe uveal inflammation. Fifty percent of the cases showed retinal perivasculitis and 18% a mild inflammatory infiltrate of the retina. Involvement of the meninges (a finding present in 22% of the cases) and severe inflammation in the scleral canals were both related to the severity of choroidal inflammation. Lens-induced endophthalmitis was observed in 14 cases and was not associated with the severity of the choroidal inflammation. Our observations indicate that the changes interpreted as atypical in SO are usually associated with severe choroidal inflammation, suggesting that these features may be the response to high doses of antigenic agent. The classical histopathologic description of SO may represent only one manifestation of the pathologic response of this disease.

Adolescent↗
PubMed1990

Prevention of sympathetic ophthalmia. State of the art 1989.

Ophthalmologists are daily confronted with intraocular inflammation following trauma and/or intraocular surgery. In rare cases, this may lead to the loss of visual function in both eyes, i.e. sympathetic ophthalmia (SO). In order to reduce the scope of responsible action between enucleation of the exciting eye (EE), which still has good vision, and progressive inflammation of the second eye (SE) resulting in blindness if action is delayed, a score system was established based on all SO symptoms which had become known from the literature and personal communications up the end of 1988. The score system developed by HANNE et al. allows causal differentiation between SO or uveitis of other genesis in the partner eye taking into account the prior history and findings in the EE and the occurrence of symptoms after the last accident/operation and findings in the SE. If the last eye is involved, the presence of SO should be assumed in every case where there are signs of intraocular inflammation in order to allow immediate commencement of anti-inflammatory therapy, the more so since it is known that corticosteroids and cytostatics (this also applies to cyclosporin A) can only arrest the immunopathologic processes in the initial phase of the disease.

Blindness↗
PubMed2005

Sympathetic ophthalmia in Singapore: new trends in an old disease.

BACKGROUND: Sympathetic ophthalmia (SO) is an uncommon uveitic condition that occurs after injury to the uvea of one eye and may occur after accidental ocular trauma or ocular surgery. We sought to investigate the common causes of SO in Singapore and the demographic profile as well as the final visual acuity after treatment in these patients. METHODS: This was a retrospective, non-comparative case series in which patients with SO were identified from the Singapore National Eye Centre uveitis database in the period between 1993 and 2003. The patients' case records were examined for a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO or histopathological evidence of SO in enucleated eyes. The medical records of these patients were reviewed for details of the inciting event, presentation, treatment, and visual acuity. RESULTS: A total of ten patients (six men and four women) were diagnosed with SO in the period of study. SO occurred after accidental trauma in three patients and following ocular surgery in seven. Vitreoretinal surgery was responsible for four of these cases, and diode laser cyclophotoablation for another two, whereas neodymium:yttrium-aluminium-garnet (Nd:YAG) laser cyclotherapy was the cause in the last patient. Overall, six of ten patients underwent at least one vitreoretinal procedure. Four of the patients had a final visual acuity of 6/15 or better, whereas five had a visual acuity of 6/30 or worse. Good final visual acuity appeared to be associated with early initiation of immunosuppressive therapy. CONCLUSION: In this series, ocular surgery, especially vitreoretinal surgery, had overtaken non-surgical trauma as the major cause of SO. A good outcome was possible in most cases if an early diagnosis was made and immunosuppressive treatment started promptly.

Adult↗
PubMedDate not supplied

A historical review of sympathetic ophthalmia and its epidemiology.

Sympathetic ophthalmia was given its complete clinical description by William Mackenzic in 1840, and fully described in terms of its histopathology by Ernst Fuchs in 1905. A review of epidemiologic data from the 19th and 20th centuries reveals that acceptable statistical studies have yet to be carried out, but suggests that the disease has always been of extremely low incidence. Further, there does not appear to be a markedly decreased incidence in the "modern era." The etiology of the disease remains elusive, although the pathogenesis appears to be due to delayed hypersensitivity (cell-mediated immunity), possibly directed at a surface membrane antigen that is shared by photoreceptors, retinal pigment epithelium and choroidal melanocytes. The only effective therapy remains preventive enucleation of the injured eye, despite modern usage of immunosuppressive agents. Studies have suggested that early enucleation of a blind exciting eye can improve the prognosis for the sympathizing eye.

Antigens, Surface↗
PubMed2004

Immunopathology of progressive subretinal fibrosis: a variant of sympathetic ophthalmia.

PURPOSE: We report the immunopathology of progressive subretinal fibrosis, a variant of sympathetic ophthalmia. DESIGN: Brief case report. METHOD: Review of medical record and immunopathology of a chorioretinal biopsy of a 40-year-old man who presented with left total retinal detachment (RD) following multiple vitrectomies in the right eye for RD. Small peripherally retinal holes, snow banks, and inflammatory nodules along the ora serrata were observed during left vitrectomy. Both eyes deteriorated rapidly to blindness with progressive subretinal fibrosis and inflammation over 3 months, and the patient was unresponsive to systemic prednisolone and azathioprine. RESULT: Immunopathology of the chorioretinal biopsy of the right eye revealed aggregates of CD20+ B cells, surrounded by CD3+ T cells. CD68+ macrophages were scattered throughout. CONCLUSION: The rapid clinical course described in this case may be related to the unique immunopathology of rapidly forming peudogerminal centers in the choroids and retina.

Adult↗
PubMed2006

Sympathetic ophthalmia following postoperative bacterial endophthalmitis: a clinicopathologic study.

PURPOSE: Clinical and histopathologic documentation of sympathetic ophthalmia (SO) development in eyes with postoperative bacterial endophthalmitis. DESIGN: Observational case series; retrospective clinicopathologic study. METHODS: All patients who presented with a clinical diagnosis of SO during 2002 to 2004 were included in the study. The diagnosis of SO was made on the basis of history of penetrating ocular injury, followed by development of bilateral intraocular inflammation, ultrasonographic detection of bilateral diffuse thickening of the choroid, or both. Patients presenting with the additional finding of hypopyon underwent an anterior chamber tap and vitreous aspirate for microbiologic detection of bacteria and fungi. Eight exciting eyes were enucleated and submitted for histologic examination. RESULTS: Of a total of 26 patients with a clinical diagnosis of SO, four also had bacterial endophthalmitis. Of these, histologic examination of three exciting eyes revealed vitreous abscess and typical features of SO. Of the five remaining enucleated globes, histologic examination showed that two eyes had phacoanaphylactic endophthalmitis, and two others revealed features of SO; the one remaining eye had nongranulomatous diffuse choroiditis. CONCLUSIONS: Bacterial endophthalmitis cannot prevent the development of SO. Early diagnosis of coexistent mixed infectious and inflammatory processes, and initiation of antimicrobial treatment directed at the infection followed by immunomodulatory agents to address the autoimmune component may improve the prognosis in such cases.

Abscess↗
PubMed1983

Effect of corticosteroid treatment and enucleation on the visual prognosis of sympathetic ophthalmia.

A retrospective clinicopathologic study, conducted to determine the course of disease in 30 cases of sympathetic ophthalmia with clinical follow-up of at least six months (average, 12.7 years), showed that 21 of 30 patients retained visual acuities of 20/50 or better in the sympathizing eye. The severity of inflammation graded histologically in the exciting eye did not correlate with the clinical course of final visual acuity in the sympathizing eye. Enucleation of the exciting eye within two weeks of the onset of symptoms was associated with a relatively benign clinical course (P = .008). Corticosteroid treatment in patients who underwent enucleation more than two weeks after the onset of symptoms was associated with a good visual outcome (P = .009). Early enucleation of a blind exciting eye and corticosteroid treatment appear to be important variables that influence the visual prognosis in the sympathizing eye.

Adolescent↗
PubMed1984

Single-dose kanamycin therapy of gonococcal ophthalmia neonatorum.

117 infants with gonococcal ophthalmia neonatorum, including 27 with infections due to penicillinase-producing Neisseria gonorrhoeae, were treated as outpatients with five different regimens of single-dose intramuscular kanamycin (75 mg or 150 mg) with saline eye washes, gentamicin eye ointment, or chloramphenicol eye drops. There were no treatment failures among 68 patients treated with 75 mg or 150 mg kanamycin and gentamicin eye ointment (for 3 days). However, the minimum and maximum cumulative probabilities of cure of single-dose kanamycin with saline eye washes (for 3 days) were only 60% and 89%. 1 patient of 15 treated with 150 mg kanamycin plus chloramphenicol eye drops did not respond to treatment. Postgonococcal conjunctivitis developed in 14 (12%) infants, of whom 13 had positive cultures for Chlamydia trachomatis. Nasopharyngeal infection with N gonorrhoeae was eradicated in 9 of 11 infants colonised.

Administration, Topical↗
PubMed1980

Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913--1978).

A retrospective clinicopathologic review of 105 cases of sympathetic ophthalmia showed histologic features of prognostic significance and evaluated the role of therapy. Classic descriptions omit retinal changes, but 58.0% of our cases had retinal detachment and 42.2% showed intraretinal inflammation. The optic nerve and/or meninges were inflamed in 51%. Optic atrophy was seen in 54.4%. Plasma cells are said to be characteristically absent, but 65.0% of steroid-treated and 85.7% of cases before the steroid era showed plasma cell infiltration. Severity of inflammation pathologically correlated with final visual outcome, and corticosteroid therapy changed both the character and severity of inflammation. Early enucleation of the exciting eye after onset of symptoms in the fellow eye was found to improve visual prognosis. Electron microscopy performed on fresh tissue and choroidal cell cultures revealed no viral particles, and viral and mycoplasma cultures all proved negative.

Adolescent↗
PubMed1983

Light and electron microscopic study of Dalén-Fuchs nodules in sympathetic ophthalmia.

A light and electron microscopic study was undertaken in an effort to establish the origin of the "epithelioid" cells in Dalén-Fuchs nodules from an eye enucleated because of sympathetic ophthalmia. The nodules were visible as minute (130-160 microns), round, grayish-white mounds elevating the retinal pigment epithelium. Bruch's membrane appeared intact in all the sections examined. By electron microscopy the "epithelioid" cells had round to oval nuclei with abundant, relatively lucent cytoplasm containing parallel profiles of rough-surfaced endoplasmic reticulum, prominent Golgi lamellae, clusters of polyribosomes, and scattered mitochondria. Many interdigitations of the plasma membranes, some of which exhibited fascia adherens type attachments, were observed. Some cells within the nodules showed large membrane-bound phagosomes containing laminated structures. Other "epithelioid" cells displayed moderately electron dense membrane-bound granules that appeared to be early precursors of lipofuscin granules. Examination of the nodules under ultraviolet light showed myriad autofluorescent yellowish-orange dots consistent with lipofuscin. Additionally, a montage of electron micrographs from the edge of the nodule, coupled with the above findings, provided support to the concept proposed by Ishikawa and Ikui (1972) that the "epithelioid" cells in Dalén-Fuchs nodules represent transformed retinal pigment epithelial cells forming a cage-like framework within the nodule. This study also emphasizes the remarkable capabilities for differentiation by the retinal pigment epithelial cells.

Female↗
PubMed1983

Human sympathetic ophthalmia. An analysis of the inflammatory infiltrate by hybridoma-monoclonal antibodies, immunochemistry, and correlative electron microscopy.

A case of human sympathetic ophthalmia, enucleated after surgical trauma, was studied by means of hybridoma-derived monoclonal antibodies, histochemistry, and transmission electron microscopy. The choroidal infiltrate was composed predominantly of T-lymphocytes of the suppressor/cytotoxic subset (OKT8+); only 5% of the cells were immunoglobulin-producing B-lymphocytes (kappa or lambda light chain positive), thereby explaining the well-known paucity of plasma cells in the infiltrate. The epithelioid cells and phagocytic histiocytes in the choroid were la+ and OKM1+, antigenic determinants specific for bone marrow-derived monocytes, and their cytoplasms exhibited histochemical reactivity for alpha-1-antichymotrypsin and lysozyme. Ultrastructurally, the choroidal epithelioid cells contained single melanin granules in the cytoplasm, but these were membrane-bound and frequently associated with lysosomal material, features militating against these cells being transformed choroidal melanocytes. By means of immunologic and ultrastructural analysis, the Dalen-Fuchs nodules were found to be composed of a mixture of histiocytes (la+ and OKM1+) and depigmented retinal pigment epithelial cells (la- and OKM1-); the latter cells focally formed desmosomes and displayed inclusions of lipofuscin. Scattered within the Dalen-Fuchs nodules were small numbers of T-lymphocytes of the suppressor/cytotoxic subset. We have concluded that the uveitis and retinal pigment epithelial changes are mediated by a T-cell, delayed hypersensitivity pathogenetic mechanism (cell-mediated immunity), possibly directed at surface membrane antigens that may be shared by photoreceptors, retinal pigment epithelial cells, and choroidal melanocytes.

Animals↗
PubMed1985

Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia.

An immunohistological study using monoclonal antibodies directed at specific membrane antigens of various inflammatory cells was carried out in order to evaluate the identity and topographic localization of the immuno-competent cells in an enucleated eye from a 6-year-old black patient with a three-month history of sympathetic ophthalmia. Correlative light and transmission electron microscopic examination of serial sections was also performed. The data demonstrated that the predominant cells within the choroidal infiltrate were T-lymphocytes (Leu 1+). T-cell subset analysis disclosed that most of these cells harbored specific antigenic determinants of the helper phenotype (Leu 3a+). A smaller proportion of the T cells demonstrated the specific determinants of the suppressor subtype (Leu 2a+). The helper/suppressor ratio varied slightly and ranged in most areas of the choroid between 3:1 and 4:1. Additionally, approximately 15% of the infiltrating lymphocytes harbored the Leu 14+ determinant specific for B cells. The latter were located in the outer choroid adjacent to the sclera. Very few natural killer (NK) cells (Leu 7+) were identified throughout the choroid. The granulomatous foci in the choroid were composed mainly of epithelioid cells and histiocytes expressing the OKM1+ and M221+ antigenic determinants on their membranes and demonstrating a high cytoplasmic nonspecific esterase activity (ANAE+). Within the Dalen-Fuchs nodules, similar to the choroidal nodules, there was a predominance of histiocytes and epithelioid cells (OKM1+, M221+, ANAE+), a few T-helper cells (Leu 1+, Leu3a+) and some OKM1-, M221- cells whose origin could not be determined. These findings were corroborated by electron microscopic observations of serial sections. Careful light and electron microscopic studies disclosed breaks in Bruch's membrane underlying some of Dalen-Fuchs nodules. In our opinion, these observations may be interpreted as the demonstration that Dalen-Fuchs' nodules and the choroidal granulomatous foci could be formed by identical cells of similar function and origin.

Child↗