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PubMed1980

Vitreous cylinders.

Vitreous cylinders, a rarely discussed ophthalmologic entity, were studied in two clinical cases and in five enucleated eyes. The cylinders were found in four cases of ocular toxoplasmosis, one case of vitreous hemorrhage complicating a malignant melanoma, and one case of pars planitis and one of uveitis, both of unknown causes. Results of scanning electron microscopy in one specimen suggested that cylinders are formed by condensation of vitreous collagen fibers. We emphasize the nonspecific nature of this interesting vitreous finding.

Aged↗
PubMed1986

Intravenous pulse methylprednisolone therapy in severe inflammatory eye disease.

Seventeen patients with severe ocular inflammatory disease were treated with intermittent pulse doses of intravenous methylprednisolone. There were five patients with chronic posterior uveitis, five with retinal vasculitis, three with scleritis, two with chronic anterior uveitis, one with pars planitis, and one with Mooren's ulcer. A standard protocol of intravenous administration of methylprednisolone was followed. In 15 of 17 patients receiving this therapy, visual acuity improved or stayed constant. Side effects included psychological disturbances, hypertension, and elevated glucose levels, but cessation of treatment was not necessary in any patient. Pulse methylprednisolone treatment appears to be an effective therapy for several forms of severe inflammatory eye disease and minimizes the potential side effects of more conventional regimens of corticosteroid administration.

Adolescent↗
PubMed1995

Vasoproliferative tumors of the ocular fundus. Classification and clinical manifestations in 103 patients.

OBJECTIVE: To describe the clinical features of vasoproliferative tumors of the ocular fundus and to propose a comprehensive classification of these tumors. METHODS: A retrospective review of all cases that were diagnosed as acquired retinal hemangioma or vasoproliferative retinal tumor was conducted on the Ocular Oncology Service at Wills Eye Hospital, Philadelphia, Pa. RESULTS: There were 129 vasoproliferative tumors in 113 eyes of 103 patients. The tumors were classified as idiopathic in 84 eyes (74%) and secondary to preexisting ocular disease in 29 (26%). Subclassification into solitary (88 eyes), multiple (17 eyes), and diffuse (eight eyes) involvement was made. Of the 84 eyes with idiopathic tumors, 73 (87%) had solitary tumors, five (6%) had multiple tumors, and six (7%) had diffuse tumors. The lesion was located in the inferior, inferotemporal, or temporal region of the fundus in 78% and developed within 6 mm of the ora serrata retinae in 88%. Associated vitreoretinal findings included intraretinal exudation (82%), secondary exudative retinal detachment (48%), vitreous cells (46%), vitreous hemorrhage (21%), preretinal macular fibrosis (31%), and macular edema (18%). Of the 29 eyes with secondary tumors, the tumor was solitary in 15 (52%), multiple in 12 (41%), and diffuse in two (7%). The most common preexisting ocular disease included intermediate uveitis (pars planitis) in eight eyes (28%), retinitis pigmentosa in six (21%), toxoplasmic retinitis in two (7%), toxocariasis in two (7%), retinochoroidal coloboma in two (7%), and traumatic chorioretinopathy in two (7%). Retinal pigment epithelial hyperplasia was a prominent feature that was adjacent to 58% of the secondary tumors. Overall, management of the 129 tumors consisted of observation in 63 (49%), cryotherapy in 54 (42%), laser photocoagulation in seven (5%), plaque radiotherapy in three (2%), and other modes of treatment in two (2%). CONCLUSIONS: Vasoproliferative retinal tumors can be idiopathic, or they can develop secondary to congenital, inflammatory, vascular, traumatic, dystrophic, and degenerative ocular diseases. They can produce a variety of complications. Awareness and recognition of these tumors and differentiation from other retinal vascular tumors are important.

Adolescent↗
PubMedDate not supplied

Computer registration of uveitis patients.

An analysis was made of 1309 patients with uveitis seen at University Hospitals participating in the Uveitis Centre of the Netherlands Ophthalmic Research Institute. In this series B27-associated anterior uveitis was the most frequent entity (18%) followed by Toxoplasma chorioretinitis (7%). Sarcoid uveitis, pars planitis and Fuchs' heterochromic cyclitis each accounted for approximately 4-5% of cases. In 44% of the patients no specific diagnosis could be made. Central diagnosis registration is of great importance when conducting clinical uveitis research.

Computers↗
PubMedDate not supplied

Epidemiological characteristics of uveitis in Switzerland.

Since January 1990, data from uveitis patients have been systematically stored in a computer data bank. During the period from January 1990 to March 1993, 435 new patients (185 female and 250 male, mean age 43 years; range 6-92) were seen at the Uveitis Clinic of the Hôpital Jules Gonin. These 435 patients (630 eyes) were subdivided into anterior uveitis (268 patients--62%), intermediate uveitis (47 patients--11%), posterior uveitis (89 patients--20%) and panuveitis (31 patients--7%). The incidence of uveitis for the referral area considered was calculated to be 17 per 100,000 inhabitants per year. A specific diagnosis was found in 312 cases (72%). The most frequently diagnosed entities were HLA-B27-associated acute anterior uveitis (67 cases--15.4%), uveitis associated with acute herpes zoster ophthalmicus (40 cases--9.2%), toxoplasmosis (39 cases--9%), typical pars planitis (29 cases--6.7%), sarcoidosis (29 cases--6.7%), Fuchs' heterochromic cyclitis (27 cases--6.2%), herpetic anterior uveitis (21 cases--4.8%) and acute retinal necrosis (11 cases--2.5%). Incidence and distribution of most disease entities correspond to those of other European series.

Adolescent↗
PubMed1987

Peripheral proliferative retinopathies.

The cases of 100 consecutive persons (156 eyes) seen with peripheral proliferative retinopathy were reviewed in a retrospective fashion. Associated systemic and ocular diseases included sickling hemoglobinopathies (49%), branch retinal vein obstruction (20%), diabetes mellitus (9%), sarcoidosis (4%), intravenous drug abuse (4%), the ocular ischemic syndrome (1%), pars planitis (1%), Coats' disease (1%) and retinitis pigmentosa/retinal detachment (1%). In ten (10%) patients no obvious cause for the development of new blood vessel growth could be ascertained.

Adolescent↗
PubMed1986

Early pars plana vitrectomy in chronic endophthalmitis of toxocariasis.

Pars plana vitrectomy was performed in 12 eyes affected with chronic endophthalmitis in patients 4-38 years of age. In 3 cases the indication was severe vitreitis and the surgical response was excellent. The other 9 eyes were operated upon during the cicatricial and sequelae stages, and the results were better the earlier surgery was performed. Lensectomy was associated in 5 cases. Good anatomical results were obtained in 9 eyes (75%); the other 3 (25%) were failures because of complications. Visual acuity improved after vitrectomy in 8 cases (66%), remained the same in 1 and became worse in the 3 anatomical failures (25%). Early pars plana vitrectomy is indicated in the chronic endophthalmitis of toxocariasis to prevent development of complications leading to loss of the eye and in order to obtain good functional results with little risk of complications. The ELISA test was performed on 5 vitreous samples and was positive in all. Toxocariasis should be strongly suspected in cases of unilateral vitreitis and/or pars planitis.

Adolescent↗
PubMed1997

Changing trends in the etiologic diagnosis of uveitis.

Just as different fads that seize the imagination of the general public are often carried to excess, so diagnostic or therapeutic fads may take over in the practice of medicine. Analysis of 33 surveys of the causes of uveitis reported by ophthalmologists over the course of 120 years shows how some diagnoses such as syphilis and tuberculosis fell from favor because tests ruled out these diseases, whereas others such as toxoplasmosis became popular because of the finding of the organism in a few cases by a famous ophthalmic pathologist. Yet others (pars planitis, sarcoidosis) were not even causes of disease, but rather merely descriptive, or the ocular component of a systemic disease whose etiology and pathogenesis remain unknown. We will examine the waxing and waning of these diagnostic categories and the impressive confidence of some clinicians in their own diagnostic acumen as they made diagnoses often unsupported by objective evidence.

Europe↗
PubMed1984

Avulsed retinal veins without retinal breaks.

A localized segment of a retinal vein can be avulsed or torn from the retina by vitreous traction without a concurrent retinal break or tear. Eight eyes in eight patients (five women and three men, 20 to 69 years old) with avulsed retinal veins without retinal breaks showed a wide range of underlying retinal abnormalities, including background diabetic retinopathy, pars planitis, and involutional proliferative retinopathies. Such avulsed retinal veins often cause recurrent vitreous hemorrhage. Despite vitreous hemorrhages in six of the eight eyes, the visual prognoses were excellent in all eyes. An avulsed retinal vein must be considered in the differential diagnosis of those patients with proliferative retinopathies who have vitreous hemorrhage.

Adult↗
PubMed1988

Presumed autoimmune corneal endotheliopathy.

I reviewed 20 previously published cases of presumed autoimmune corneal endotheliopathy. The disease appeared clinically with stromal edema and a slowly migrating line of keratic precipitates. All patients had acute stromal edema and keratic precipitates, and decreased visual acuity. Anterior chamber cells were noted in 11 patients. Inflammatory processes, such as pars planitis and iritis, and intraocular lens implantation were present in 13 patients.

Adrenal Cortex Hormones↗
PubMed1989

Ocular Lyme borreliosis.

In six patients with ocular Lyme borreliosis, bilateral granulomatous iridocyclitis and vitritis were present in five. One of these five also had bilateral optic neuritis. Another patient developed combined trochlear and facial nerve palsies. A syndrome resembling pars planitis with atypical features such as granulomatous keratic precipitates and posterior synechiae should prompt a search for Lyme borreliosis. Topical corticosteroid therapy is necessary to prevent complications of anterior segment inflammation caused by Lyme uveitis, but the benefit of systemic and periocular corticosteroids is uncertain. Oral antibiotics may be effective in treating early stages of ocular Lyme borreliosis. In later stages, intravenous antibiotic therapy is indicated.

Adrenal Cortex Hormones↗
PubMed1984

Breakdown of the blood-retinal barriers and cystoid macular edema.

After reviewing the definition, incidence and main etiologic factors of cystoid macular edema (CME) the authors analyze the structural and physiologic characteristics of the macular area, including the blood-retinal barriers, and the basic concepts of retinal edema. Personal observations on three different groups of diseases associated with CME, retinitis pigmentosa, pars planitis and aphakia, are presented. CME evaluation was made by slit-lamp microscopy, fluorescein angiography and vitreous fluorophotometry. In the situations examined, the main factors involved in CME formation appear to be a marked increase in blood-retinal-barrier barrier permeability and alterations in retinal tissue compliance.

Adolescent↗
PubMed2005

Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop.

PURPOSE: To begin a process of standardizing the methods for reporting clinical data in the field of uveitis. DESIGN: Consensus workshop. METHODS: Members of an international working group were surveyed about diagnostic terminology, inflammation grading schema, and outcome measures, and the results used to develop a series of proposals to better standardize the use of these entities. Small groups employed nominal group techniques to achieve consensus on several of these issues. RESULTS: The group affirmed that an anatomic classification of uveitis should be used as a framework for subsequent work on diagnostic criteria for specific uveitic syndromes, and that the classification of uveitis entities should be on the basis of the location of the inflammation and not on the presence of structural complications. Issues regarding the use of the terms "intermediate uveitis," "pars planitis," "panuveitis," and descriptors of the onset and course of the uveitis were addressed. The following were adopted: standardized grading schema for anterior chamber cells, anterior chamber flare, and for vitreous haze; standardized methods of recording structural complications of uveitis; standardized definitions of outcomes, including "inactive" inflammation, "improvement'; and "worsening" of the inflammation, and "corticosteroid sparing," and standardized guidelines for reporting visual acuity outcomes. CONCLUSIONS: A process of standardizing the approach to reporting clinical data in uveitis research has begun, and several terms have been standardized.

Humans↗
PubMed2006

Retrospective case review of pediatric patients with uveitis treated with infliximab.

PURPOSE: To assess the response and adverse events associated with infliximab treatment for refractory, noninfectious pediatric uveitis. DESIGN: Retrospective noncomparative case series of pediatric patients with refractory uveitis treated with infliximab. PARTICIPANTS: Six patients were identified. Diagnoses of the participants included idiopathic uveitis (n = 1), juvenile rheumatoid arthritis with uveitis (n = 3), idiopathic retinal vasculitis with uveitis (n = 1), and bilateral pars planitis, with vitreitis and papillitis of the left eye (n = 1). Uveitis developed in the patients (5 female, 1 male) at a mean age of 9.0 years (+/-5.0 years; range, 0.9-14.8 years). All patients had bilateral eye involvement. These patients were refractory to or dependent on topical steroids (n = 4), oral prednisone (n = 3), or both, and were also refractory to the following therapies: methotrexate (n = 6), cyclosporine (n = 3), mycophenolate mofetil (n = 3), etanercept (n = 3), and daclizumab (n = 1). INTERVENTION: All patients initially received infliximab at doses between 5 and 10 mg/kg at 2- to 4-week intervals, and then were maintained at 4- to 8-week intervals at doses of 5 to 18 mg/kg. Mean follow-up time on treatment has been 48.1 weeks (+/-14.9 weeks; range, 32-74 weeks). MAIN OUTCOME MEASURES: Primary outcome measures included the quantitative measurement of the amount of ocular inflammation in different locations within the eye. Patients were monitored for infusion reactions as well as other potential side effects. The children's clinical status, complete blood counts, and liver function panels were monitored by pediatric rheumatologists every 6 weeks. RESULTS: All 6 patients showed reduction in their intraocular inflammation after infliximab therapy was initiated. Furthermore, control of ocular inflammation was achieved while receiving infliximab therapy. Topical and systemic corticosteroids were able to be discontinued in all patients except for 1 patient, who is currently weaning off prednisone. The only adverse reactions seen were the development of vitreous hemorrhage in 1 patient and a case of transient upper respiratory infusion reaction. No patient has had to discontinue treatment. CONCLUSIONS: Infliximab seems to be an effective agent for the treatment of refractory pediatric uveitis without apparent serious toxicity in this series of patients.

Adolescent↗
PubMed2001

Phacoemulsification cataract extraction and posterior chamber lens implantation in patients with uveitis.

PURPOSE: This study reports outcomes of phacoemulsification cataract extraction and posterior chamber intraocular lens implantation within the capsular bag in patients with uveitis. METHODS: We retrospectively reviewed the charts of 32 patients (39 eyes) with uveitis who underwent phacoemulsification cataract extraction and posterior chamber intraocular lens implantation by two surgeons at The Cleveland Clinic Foundation from January 1990 to June 1998. Patients with less than 3 months of follow-up were excluded. RESULTS: Diagnoses of uveitis included idiopathic (15 eyes), sarcoidosis (10 eyes), pars planitis (four eyes), CMV retinitis (two eyes), Fuchs heterochromic iridocyclitis (two eyes), syphilis (two eyes), and one eye each of tuberculosis, Crohn's disease, HLA-B27 associated, and acute retinal necrosis. Average follow-up was 20 months (range, 3 to 63 months). Best-corrected visual acuity improved in 37 eyes (95%). Average improvement was 4 +/- 3 Snellen acuity lines (range, 1 to 10 lines). Thirty-four eyes (87%) attained final visual acuity better than or equal to 20/40. Visual loss occurred in one eye (3%) with CMV retinitis. No improvement in visual acuity was seen in one eye (3%) that developed a retinal pigment epithelial detachment. Posterior capsule opacification occurred in 24 eyes (62%), 12 of which required Nd:YAG capsulotomy (31%). Other postoperative complications included recurrence of uveitis (41%), cystoid macular edema (33%), epiretinal membrane formation (15%), and posterior synechiae (8%). CONCLUSIONS: Phacoemulsification cataract extraction with posterior chamber intraocular lens implantation is safe in patients with uveitis. The incidences of recurrence of uveitis, cystoid macular edema, epiretinal membrane, and posterior synechiae were lower than those reported previously for extracapsular cataract extraction.

Adult↗
PubMed1987

Changing patterns of uveitis.

We conducted a retrospective analysis of 600 patients with uveitis seen at the Estelle Doheny Eye Center to determine the frequency of occurrence of the various forms of uveitis and to see if the causes of uveitis have changed as compared with previous studies. In 402 cases (67.0%) we established a specific diagnosis based on history, physical findings, and laboratory studies: 167 cases (27.8%) involved primarily the anterior segment, 230 (38.4%) the posterior segment, and 111 (18.4%) occurred as panuveitis. Intermediate uveitis (pars planitis) was the single most frequently diagnosed uveitic entity and accounted for 92 cases (15.4%). We compared our findings with those of previously published studies and found that, as new diseases occur and improved diagnostic techniques become available, the differential diagnosis of uveitis continues to change.

Choroiditis↗
PubMed1990

Cellular immune responses of patients with uveitis to retinal antigens and their fragments.

Of two patient populations totaling 82 patients, one in the United States and the other in Japan, we studied the cellular immune responses against S-antigen and interphotoreceptor retinoid binding protein as well as to fragments of each antigen. Behçet's disease, birdshot retinochoroidopathy, pars planitis, ocular sarcoid, sympathetic ophthalmia, and the Vogt-Koyanagi-Harada syndrome were diagnosed in these patients. The response profile of both antigens paralleled each other. This profile was more commonly seen in patients suffering from diseases affecting the retina. Responders reacting to both antigens or to several fragments of an antigen were present. This pattern of response was seen in 26 of the patients tested. Patients with uveitis appeared able to recognize several autoantigens. This might be a consequence of the breakdown of the blood-retinal barrier and may help perpetuate the inflammatory process. Several patients were capable of responding to more than one epitope of the same antigen, which indicates that there are major differences between the experimental model and human autoimmune diseases in the response to autoantigens. Both of these findings may to help develop new immunotherapeutic strategies in the treatment of uveitis.

Adolescent↗
PubMed2002

Efficacy and safety of chlorambucil in intractable noninfectious uveitis: the Massachusetts Eye and Ear Infirmary experience.

PURPOSE: To report our experience with the use of chlorambucil for otherwise treatment-resistant uveitis and to assess its safety and efficacy. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Twenty-eight patients with intractable noninfectious uveitis. METHODS: We reviewed the records of 28 patients (56 eyes) with chronic noninfectious uveitis who were treated with chlorambucil from 1987 to 2000. Diagnoses included Adamantiades-Behçet's disease (ABD) (7 patients), juvenile rheumatoid arthritis (JRA)-associated uveitis (10 patients), pars planitis (2 patients), sympathetic ophthalmia (1 patient), idiopathic uveitis (6 patients), Crohn's disease (1 patient), and HLA-B27-associated uveitis (1 patient). All patients were refractory to other immunomodulatory therapy and systemic steroids. The median duration of treatment with chlorambucil was 12 months (range, 4-50 months), whereas the median daily dosage was 8 mg (range, 4-22 mg). Patients were followed for a median follow-up period of 46 months (range, 4-166 months) after chlorambucil treatment was begun and continued to be followed for relapse after cessation of therapy. MAIN OUTCOME MEASURES: Visual outcome, response to treatment, treatment-related side effects, drug dosage, previous and final treatment, discontinuation of systemic corticosteroids. RESULTS: Chlorambucil was discontinued in seven patients because of side effects: two females had temporary amenorrhea develop, two patients had unacceptable gastrointestinal intolerance, one patient had infection, and 2 patients had progressive leukopenia. Nineteen patients (68%) showed positive clinical response to the treatment, four (14%) initially responded then relapsed after discontinuation of the drug, three patients with ABD had improvement of ocular disease but worsening of systemic symptoms, and two had persistent inflammation. Visual acuity was improved in 24 eyes (43%), stable in 22 (39%), and worsened in 10 eyes (18%). Systemic prednisone was successfully discontinued in 19 of the 28 patients (68%), and 14 patients were free of inflammation at the end of follow-up without any systemic medication. CONCLUSIONS: Chlorambucil can be a safe and effective alternative for preserving vision in patients with otherwise treatment resistant uveitis.

Adolescent↗