Bullous central serous chorioretinopathy and retinal pigment epithelium sequelae postblunt trauma.

A 68-year-old man presented with diminution of distance and near vision in the right eye for a duration of 1 month postblunt trauma with a stick. On examination, his visual acuity in the right eye was 20/320 and near vision was

Ocular changes in patients with psoriasis.

Eye involvement in psoriasis is little known to many dermatologists, although psoriasis has been acknowledged as a systemic disease for decades. The ophthalmic complications of psoriasis are numerous and can affect almost any part of the eye. The most common ocular changes in patients with psoriasis, including blepharitis, conjunctivitis, keratitis, iridocyclitis, UV-induced cataracts, uveitis, and birdshot chorioretinitis, have been described in the literature. Recognition of the ocular complications of psoriasis is of significant clinical importance, because various pathogenic mechanisms may contribute to the development of ocular manifestations, including direct eye involvement with psoriatic plaques, psoriasis-related immune-mediated inflammatory processes, and complications of psoriasis treatments.

[Characteristics of inflammatory response in patients after senile cataract surgery].

The aim of the work was to study prognostic value of some laboratory markers (anti-DNA antibodies, cell adhesive molecules, neopterin) in heriatric patients with exudative inflammation after cataract surgery. 12 in-patients with postoperative iridocyclitis and endophthalmitis were included. The assays were taken twice: after admission and before discharging. The follow-up period was 6 months. Preliminary data show that high serum levels of sVCAM, sICAM and anti-DNA antibodies, as well as very low levels of anti-DNA antibodies seems to be associated with poor outcomes in those patients (enucleation, blindness, lens extraction). Small cohort doesn't allow us to make strict conclusion about prognostic value of these laboratory markers. The study should be continued.

Recurrent iridocyclitis due to cotton fiber in anterior chamber.

BACKGROUND: Cotton is commonly used during ophthalmic surgical procedure. Cotton fibers may get attracted to the instruments due to electrostatic forces and become adhered to the surface. With the introduction of these instruments during the surgical procedure cotton fiber may get entry into the eye. In the literature they have been infrequently reported due to insignificant effect on the ocular structures. We present a case of recurrent iridocyclitis due to cotton fiber in the anterior chamber. Patient was relived of his symptoms after removal. CASE: A 78-year-old male presented with pain, redness and blurring of right eye vision since last six months. The patient had undergone phacoemulsification with implantation of hydrophilic intraocular lens (IOL) six years earlier. Postoperative follow up was uneventful from his records till last 6 months. Slit-lamp examination revealed a cotton fiber in the anterior chamber touching the endothelium. Keratic precipitates were seen on the endothelium. Removal of the cotton fiber resulted in subsidence of inflammation. CONCLUSION: We recommend use of plastic eye and trolley drapes, lint free instrument wipes and use of needle cap to support the globe during creation of side port while performing phacoemulsification instead of cotton buds to avoid entry of cotton fiber into the anterior chamber.

Long-term efficacy of deep sclerectomy in Posner-Schlossman syndrome.

The Posner-Schlossman syndrome (PSS) is an elusive disease that can lead to serious consequences such as glaucomatous damage. Deep sclerectomy has been proven thus far to be the most effective surgical intervention to keep intraocular pressure (IOP) elevation under control compared with other surgical techniques, because it presents the least amount of postoperative complications. The aim of this case report is to demonstrate the efficacy of deep sclerectomy with T-Flux and the long-lasting effects that persist after 7 years in an eye affected by PSS. This case report demonstrates that an intervention of deep sclerectomy can lead to excellent results in terms of visual acuity as well as IOP lowering early in the history of the patient affected by PSS so that it can preclude establishment of glaucomatous damage.

Glucocorticoids in juvenile idiopathic arthritis.

Although the use of corticosteroids in juvenile idiopathic arthritis (JIA) is now much more limited owing to the availability of methotrexate and biological agents, there are clinical scenarios where it is still indicated. For example, corticosteroids may be indicated for intraarticular injections to prevent joint deformities, as a "bridge" drug to relieve symptoms in polyarticular disease while waiting for methotrexate and biologics to exert their full therapeutic effects, and in the treatment of chronic iridocyclitis, macrophage activation syndrome, and systemic JIA, although the advent of interleukin (IL)-1 and IL-6 blockers has greatly reduced the latter indication.

Hypertensive iridocyclitis associated with delayed onset biopsy proven Cytomegalovirus retinitis.

We describe a case of primary hypertensive iridocyclitis with biopsy-proven Cytomegaloviral retinitis. It is an observational case report of a 69-year-old diabetic gentleman on azathioprine for Crohn's disease who presented with recurrent episodes of hypertensive iridocyclitis. On the 4 th attendance in 5 months, a granular white lesion was noted in the temporal periphery of the mid-peripheral fundus and a chorioretinal and vitreous biopsy performed. Vitreous PCR was positive for Cytomegalovirus (CMV). Hematoxylin and eosin staining revealed cytomegalic-like inclusions within necrotic neural retina. Transmission electron microscopy revealed herpes family virus particles and immunohistochemistry demonstrated CMV protein. This case provides further evidence implicating CMV infection in the etiology of hypertensive iridocyclitis. With hindsight, the cumulative effect of diabetes and azathioprine on the immune surveillance system proved sufficient to render the patient susceptible to CMV retinitis.

Implantation of iris-claw Artisan intraocular lens for aphakia in Fuchs' heterochromic iridocyclitis.

Implantation of iris-claw Artisan intraocular lens (IOL) is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs' heterochromic iridocyclitis (FHI) due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.

Usher syndrome associated with Fuchs' heterochromic uveitis.

BACKGROUND: The purpose of this study is to report two new cases of Usher syndrome associated with Fuchs' heterochromic uveitis (FHU), to confirm our previous observation of the association between FHU and retinitis pigmentosa (RP), and to evaluate if FHU is particularly associated with Usher syndrome. METHODS: Retrospective medical record review of all new RP cases at Hadassah Medical Center between the years 2000 and 2007, review of our previously published data, and a meta-analysis of published relevant articles in peer reviewed journals. RESULTS: During the time frame of the study we diagnosed 58 new cases of RP, of whom one male and one female had the typical findings of FHU, and both had Usher syndrome type II. The difference in the occurrence of FHU between the 616 controls and the patients with RP was significant (p = 0.0073, Fisher's exact test). In our combined data, FHU occurred only in two types of RP; RP simplex with an incidence of 0.57%, and Usher syndrome with an incidence of 13.5%. This difference between the incidence of FHU in patients with Usher syndrome and other types of RP was significant (p < 0.0001, Fisher's exact test). Adding up these two cases with what is already published in the literature makes up a total of 17 RP patients with coexisting FHU. CONCLUSIONS: This study confirms the association between FHU and RP; and a particularly stronger association with Usher syndrome type II. Although infectious agents seem to play a role, the cause for this significant correlation is still unclear.

[Extraintestinal manifestations in inflammatory bowel disease]. / Ekstraintestinale manifestationer ved inflammatorisk tarmsygdom.

Extraintestinal manifestations are relatively common in chronic inflammatory bowel disease and affect joints, skin, eyes and bile ducts. The most frequent rheumatologic manifestations are peripheral arthritis and axial arthropathies. Erythema nodosum and pyoderma gangraenosum are common dermatological manifestations, while episcleritis, iridocyclitis and uveitis are common ophthalmological complications. Conventional drugs and biologicals have proven effective in the treatment of several of the manifestations, including peripheral arthritis, pyoderma gangraenosum and episcleritis.

Klebsiella pneumoniae endophthalmitis secondary to liver abscess presenting as acute iridocyclitis.

A 51-year-old man presented with acute iridocyclitis with no evidence of vitritis on B-scan that progressed to endogenous endophthalmitis. Systemic work-up revealed a large liver abscess. Urine, blood, liver abscess, and vitreous aspirate cultures all grew Klebsiella pneumoniae. The eye was enucleated secondary to severe pain from neovascular glaucoma and loss of vision.

[Emergencies in ophthalmology]. / Notfälle in der Augenheilkunde.

Vision may be suddenly impaired from one moment to the next, either spontaneously (vascular occlusion, vitreous hemorrhage, retinal detachment, inflammation) or by an exogen impact (injury). Their signs and symptoms and their treatment will be discussed systematically.

MRI documented acute myelitis in a patient with Vogt-Koyanagi-Harada syndrome: first report.

MRI findings in transverse myelitis complicating Vogt-Koyanagi-Harada (VKH) syndrome have not been documented before. Here, we present a case with acute myelitis complicating VKH syndrome and show the MRI findings.

Immunohistochemical study of chronic nongranulomatous anterior uveitis in juvenile idiopathic arthritis.

PURPOSE: To provide a detailed immunohistochemical analysis of juvenile idiopathic arthritis (JIA)-associated anterior uveitis. DESIGN: Interventional case report. PARTICIPANT: One patient. INTERVENTION: A 12-year-old patient had recurrent pauciarticular JIA and smoldering anterior uveitis in the right eye. Despite treatment with local and systemic corticosteroids and an anti-tumor necrosis factor agent, the right eye became hypotonous and painful and eventually was enucleated. The clinical history and histopathologic and immunohistochemical analyses of the enucleated globe were reviewed. MAIN OUTCOME MEASURES: Histopathologic and immunohistochemical features of JIA-associated anterior uveitis. RESULTS: The iris and ciliary body showed nongranulomatous chronic inflammation predominantly made up of plasma cells, Russell bodies, and plasmacytoid lymphocytes. The ciliary processes and pars plana ciliaris showed focal aggregates of CD20-positive cells with several CD3- and CD8-positive cells and occasional CD4- and CD68-positive cells. Pancytokeratin stain showed ciliary epithelial proliferation admixed with lymphocytes. The iris revealed kappa-positive cells within the stroma and lambda-positive cells on the surface. The iris infiltrate primarily was made up of immunoglobulin (Ig) G-positive cells with occasional IgA- and IgM-positive cells. The anterior chamber exudate was mainly positive for IgG and IgA. CONCLUSIONS: The immunohistochemical findings suggest that JIA-associated nongranulomatous iridocyclitis is a primarily B-cell-infiltrative process.