Epidemic of unilateral panuveitis in children from Brazilian Amazonia: clinical and etiological aspects in seven patients.

OBJECTIVES: To describe clinical presentation and results of diagnostic and therapeutic procedures in seven children from an epidemic of panuveitis in the Brazilian Amazonia, as well as environmental analysis and etiological aspects involved. METHODS: Patients underwent full pediatric and ophthalmic examinations, B-scan, ultrasound biomicroscopy, and serological tests. Ocular samples were thoroughly analyzed, including two enucleation specimens. Environmental investigation encompassed water, soil, and river fauna. RESULTS: All patients had bathed in the waters of a regional river, the Araguaia. Six of them presented with intermediate uveitis, with snowbanking. Five had cataract and four showed inferior endothelial opacity, with localized anterior synechiae. One showed total leukoma, with flat anterior chamber. Only two had active uveitis, one of them with anterior chamber nodule. Serology revealed high prevalence of anti-Toxocara canis immunoglobulin G (IgG) antibodies. In three cases, vitreous and lens samples disclosed spicules of freshwater sponges Drulia uruguayensis and D. ctenosclera, also detected in the waters of the river. CONCLUSION: Freshwater sponge spicules could be potential new etiological agents of ocular pathology, but further studies are needed, considering the heterogeneity of the ocular lesions and results of serological and environmental studies.

Acanthamoeba keratitis--importance of the early diagnosis.

This is a case report of Acanthamoeba as a causative agent of keratitis at the Department of Ophthalmology, University Hospital Rijeka. Delay in treatment led to an advanced stage of the disease with multiple complications. Initially, presented symptoms were similar to those of herpetic keratitis. In the mean time progression of the disease led to a cloudy cornea with a stromal ring infiltrate, poor vision, elevated intraocular pressure, a mature cataract and finally corneal melt. Corneal scrapings were obtained from a 28 years old female patient, wearing soft contact lenses and with poor lens hygiene. Acanthamoeba cysts were identified by the cytological examination. Culture of the corneal scraping had confirmed Acanthamoeba as the etiological agent. Making the diagnosis of Acanthamoeba is difficult. We presented this case of delayed diagnosis and unfavorable outcome as a reminder that clinical suspicion remains the most important diagnostic tool. Contact lens wears with a new diagnosis of herpes simplex keratitis are in high risk group, especially those with significant pain or poor response to conventional therapy. We also wanted to point out the possibility of an early, prompt and inexpensive diagnosis with the cytological examination.

Freshwater sponge spicules: a new agent of ocular pathology

In a recent outbreak of human ocular injuries that occurred in the town of Araguatins, at the right bank of Araguaia river, state of Tocantins, Brazil, along the low water period of 2005, two patients (8 and 12-year-old boys) presented inferior adherent leukoma in the left eye (OS), and peripherical uveites, with snowbanking in the inferior pars plana. The third one (13-year-old girl) showed posterior uveites in OS, also with snowbanking. Histopathological analysis of lensectomy material from the three patients and vitrectomy from the last one revealed several silicious spicules (gemmoscleres) of the freshwater sponges Drulia uruguayensis and D. ctenosclera. This work brings material evidences, for the first time in the literature, that freshwater sponge spicules may be a surprising new etiological agent of ocular pathology.

Freshwater sponge spicules: a new agent of ocular pathology.

In a recent outbreak of human ocular injuries that occurred in the town of Araguatins, at the right bank of Araguaia river, state of Tocantins, Brazil, along the low water period of 2005, two patients (8 and 12-year-old boys) presented inferior adherent leukoma in the left eye (OS), and peripherical uveites, with snowbanking in the inferior pars plana. The third one (13-year-old girl) showed posterior uveites in OS, also with snowbanking. Histopathological analysis of lensectomy material from the three patients and vitrectomy from the last one revealed several silicious spicules (gemmoscleres) of the freshwater sponges Drulia uruguayensis and D. ctenosclera. This work brings material evidences, for the first time in the literature, that freshwater sponge spicules may be a surprising new etiological agent of ocular pathology.

Prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria.

AIMS: To determine the prevalence and spectrum of ocular pathology, and the prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria. METHODS: People affected by leprosy, aged 30 years and above, resident in eight leprosy villages were invited to participate. Ocular examination was undertaken of each consenting individual. RESULTS: 480 people were examined. 456 (48%) of 960 eyes had at least one ocular lesion, but only 37% of all lesions were leprosy related and potentially sight threatening. The prevalence of blindness (VA<3/60 with available correction) was 10.4%. An additional 7.5% of subjects were severely visually impaired (3/60< or =VA<6/60). Cataract was the commonest cause of blindness. Other major causes were non-trachomatous corneal opacity and trachoma. CONCLUSIONS: Blindness and low vision are highly prevalent among leprosy patients in this setting. Only a third of the burden of ocular pathology is related to the direct effects of leprosy. Efforts to reduce the backlog of cataract and trichiasis, to improve early detection and management of lagophthalmos, and to provide refractive services are urgently required.

[Ocular toxocarosis--as an example of diagnostic and therapeutic difficulties]. / Toksokaroza oczna--jako przyklad trudnosci diagnostycznych i terapeutycznych.

Diagnostic and therapeutic problems of ocular toxocarosis in patients with late pathological changes was observed. Multispecialistic methods (ophtalmological, radiological, immunoserological) in evaluation of patients were used. In the course of prolonged observation of patients treated many times with albendazole (Zentel, Smith Kline and Beecham GB) no improvement of vision and no regression of late and irreversible ocular pathology were noted.