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1.
Middle East Afr J Ophthalmol ; 27(2): 134-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874049

RESUMO

Nodular posterior scleritis represents a small percentage of all cases of posterior scleritis. Because of the scarcity of nodular posterior scleritis, it may be confused or even misdiagnosed as an intraocular tumor or posterior uveitis. Here, we are reporting a case of nodular posterior scleritis in a 25-year-old medically free male. Furthermore, we reviewed previously reported cases of nodular posterior scleritis. Our patient presented with a choroidal mass of about one disc diameter in size. In addition, the patient had exudative retinal detachment and chorioretinal folds. B scan ultrasonography showed subretinal fluid, macular nodular thickening and underlying echolucent area along with medium internal reflectivity on A scan. Fluorescein angiography revealed early pinpoint areas of hyperfluorescence and late pooling under the detached retina. Indocyanine green angiography demonstrated early diffuse hypofluorescence corresponding to the area of detachment and late multiple pinpoint spots of hyperfluorescence. After intravenous methylprednisolone 1 g for 3 days followed by a course of oral prednisolone along with mycophenolate mofetil, the patient experienced rapid recovery with improvement in vision and complete resolution of subretinal fluid. On further follow-up, the patient regained 20/20 vision. Nodular posterior scleritis is a rare unilateral disease with strong female predominance. Multimodal imaging should be employed to confirm the diagnosis. The disease must be diagnosed correctly to avoid any unnecessary diagnostic work-up and aggressive management. Most cases carry excellent prognosis with no recurrence.


Assuntos
Neoplasias da Coroide/diagnóstico , Melanoma Amelanótico/diagnóstico , Descolamento Retiniano/diagnóstico , Esclerite/diagnóstico , Administração Oral , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Neoplasias da Coroide/tratamento farmacológico , Corantes/administração & dosagem , Quimioterapia Combinada , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Verde de Indocianina/administração & dosagem , Infusões Intravenosas , Masculino , Melanoma Amelanótico/tratamento farmacológico , Metilprednisolona/uso terapêutico , Imagem Multimodal , Ácido Micofenólico/uso terapêutico , Prednisolona/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Esclerite/tratamento farmacológico , Tomografia de Coerência Óptica
3.
Graefes Arch Clin Exp Ophthalmol ; 258(9): 1959-1963, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32504100

RESUMO

PURPOSE: Coronavirus disease 2019 (COVID-19) is an ongoing global public health problem, and most of the COVID-19 research is focused mainly on the respiratory system because of life-threatening results. However, manifestations in other organs should not be ignored since they can also be a mode of transmission. We sought to describe the ocular manifestations of COVID-19 and investigate the association between ocular involvement and clinical presentation and laboratory outcomes. METHODS: This cross-sectional study was conducted between March 1, 2020, and April 30, 2020. Ninety-three sequentially hospitalized and clinically confirmed COVID-19 patients were included in the study. The systemic and ocular symptoms, clinical findings, and laboratory outcomes were recorded. RESULTS: Of the 93 COVID-19 patients, 54 (58.1%) were male, and 39 (41.9%) were female. Mean age of the patients was 39.4 ± 21.9 (min 7, max 88) years. Twenty patients (n 21.5%) had at least one ocular abnormality. Most common findings included hyperemia (n = 20), epiphora (n = 9), increased secretion (n = 6), chemosis (n = 3), follicular conjunctivitis (n = 2), and episcleritis (n = 2). The most common symptom was photophobia (n 15). Patients with ocular involvement were more likely to have higher neutrophil counts (p = 0.001), and increased CRP (p < 0.001), PCT (p = 0.001), and ESR levels (p < 0.001). Mean lymphocyte count was statistically lower in patients with ocular manifestations (p = 0.001). Mean age and number of patients with fever over 37.3 °C in the ocular involvement group was found to be higher (p < 0.001, p = 0.006, respectively). CONCLUSION: Older age, high fever, increased neutrophil/lymphocyte ratio, and high levels of acute phase reactants seemed to be risk factors for ocular involvement.


Assuntos
Betacoronavirus , Conjuntivite Viral/diagnóstico , Infecções por Coronavirus/diagnóstico , Infecções Oculares Virais/diagnóstico , Hiperemia/diagnóstico , Doenças do Aparelho Lacrimal/diagnóstico , Pneumonia Viral/diagnóstico , Esclerite/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Turquia/epidemiologia , Adulto Jovem
8.
Eur J Ophthalmol ; 30(3): NP7-NP10, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30638053

RESUMO

PURPOSE: Posterior scleritis is the least frequent form of scleritis accounting for around 2%-8% of all scleritis cases. We aim to present the 6-year clinical course of a 62-year-old female patient with bilateral progressive necrotizing posterior scleritis who suffered from concurrent active psoriasis and psoriatic arthritis. METHODS: Descriptive case report. RESULTS: A middle-aged female patient was referred to our clinic because of left eye peripheral progressively enlarging white retinochoroidal lesions. Her previous work-up ruled out infectious and malignant etiologies. A second diagnostic vitrectomy was performed because of the slowly progressive and the atypical nature of the sectoral retinochoroidal patches in the retinal periphery. Again malignancy was ruled out. With the onset of cystoid macular edema and diffuse retinal vasculitis, which occurred concurrently with the reactivation of psoriasis and psoriatic arthritis, treatment was initiated with systemic immunosuppressants which initially included oral steroids and methotrexate and at the last follow-up 6 years after the first presentation included also cyclosporin and golimumab. Vision was preserved with quiescent uveitis and posterior scleritis. CONCLUSION: Posterior scleritis is an uncommon condition and it is even rarer in the setting of psoriasis. The necrotizing inflammation observed in the present case and by others revealed sectoral progressive chorioretinitis as a clinical manifestation which may initially raise the suspicion of masquerade malignant and infectious etiologies. Detailed thorough history-taking remains the cornerstone in identifying the possible systemic associations even when occult or subclinical.


Assuntos
Artrite Psoriásica/complicações , Psoríase/complicações , Esclerite/etiologia , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Feminino , Angiofluoresceinografia , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Esclerite/diagnóstico , Esclerite/tratamento farmacológico
10.
Indian J Ophthalmol ; 68(1): 221-223, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856531

RESUMO

The purpose of this case is to show the efficacy of buccal mucosa as an alternative to treat a case of severe necrotizing sclero-uveitis (NSU) associated with ocular perforation. We show a severe inflammatory NSU case that did not improve with topical treatment and scleral patch. We performed a buccal mucosa graft taken from the lower lip with excellent functional and anatomical result, with no signs of relapse of the NSU after 2 years of follow-up. Buccal mucosa can be a safe, useful, and effective alternative for the reconstruction of the scleral wall.


Assuntos
Mucosa Bucal/transplante , Procedimentos Cirúrgicos Oftalmológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Esclera/cirurgia , Esclerite/diagnóstico , Uveíte/diagnóstico , Idoso de 80 Anos ou mais , Humanos , Masculino , Esclerite/cirurgia , Índice de Gravidade de Doença , Uveíte/cirurgia
13.
Indian J Ophthalmol ; 67(11): 1894-1896, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31638066

RESUMO

We report two cases of recalcitrant endophthalmitis, a delayed postoperative fungal endophthalmitis following cataract surgery and an atypical mycobacterial endogenous endophthalmitis associated with infective scleritis. Due to recalcitrant nature of the endophthalmitis, one or more sittings of double freeze and thaw cryotherapy was applied over and adjacent to the infective foci in each case. This cryotherapy was used as an adjunct alongside conventional endophthalmitis management following which resolution of infection was observed in both cases.


Assuntos
Crioterapia/métodos , Endoftalmite/cirurgia , Infecções Oculares Bacterianas/cirurgia , Infecções Oculares Fúngicas/cirurgia , Esclerite/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Vitrectomia/métodos , Adulto , Extração de Catarata/efeitos adversos , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Esclerite/diagnóstico , Esclerite/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia
15.
Indian J Ophthalmol ; 67(8): 1360-1362, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31332143

RESUMO

A 52-year-old woman presented with idiopathic active scleritis not responding to oral cyclophosphamide, azathioprine, and oral steroid. Her intraocular pressure in the left eye was 45 mm of Hg in spite of using combination of brinzolamide 1% and brimonidine 0.2% (thrice a day), timolol maleate 0.5% (twice a day) eye drops in both eyes and oral acetazolamide. She was administered subcutaneous golimumab 50 mg injection every 4 weeks along with oral methotrexate 15 mg/week. The scleral inflammation responded and she underwent Ahmed glaucoma valve implantation after two months of initiation of golimumab therapy. After one week of surgery her IOP in left eye was the reduced to 8 mm of Hg. The index case showed that Golimumab can be a useful drug in the management of necrotizing scleritis refractory to the conventional therapy.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Implantação de Prótese , Esclerite/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Feminino , Glaucoma/diagnóstico , Glaucoma/etiologia , Humanos , Injeções Subcutâneas , Pressão Intraocular , Pessoa de Meia-Idade , Esclerite/diagnóstico , Esclerite/etiologia , Tonometria Ocular
16.
Indian J Ophthalmol ; 67(8): 1362-1365, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31332144

RESUMO

A 47-year-old female presented with optic disc oedema, peripapillary subretinal fluid and scattered areas of choroiditis. Her ultrasound B-scan showed sclerochoroidal thickening with widening of sub-Tenon space. Subsequent investigations revealed a positive Mantoux test and high-resolution computed tomography of the chest was suggestive of pulmonary involvement. She responded well to antitubercular treatment and systemic corticosteroid. A review of the literature was conducted to identify additional reports on similar cases and discussed. A high index of suspicion and appropriate laboratory work-up can aid in the diagnosis of tuberculous posterior scleritis.


Assuntos
Infecções Oculares Bacterianas/diagnóstico , Esclerite/diagnóstico , Tuberculose Ocular/diagnóstico , Antituberculosos/uso terapêutico , Corioidite/diagnóstico , Corioidite/tratamento farmacológico , Corioidite/microbiologia , Corantes/administração & dosagem , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Verde de Indocianina/administração & dosagem , Pessoa de Meia-Idade , Papiledema/diagnóstico , Papiledema/tratamento farmacológico , Papiledema/microbiologia , Esclerite/tratamento farmacológico , Esclerite/microbiologia , Líquido Sub-Retiniano , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Acuidade Visual
17.
BMC Ophthalmol ; 19(1): 144, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291929

RESUMO

BACKGROUND: Rosai-Dorfman disease is a rare non-Langerhans cell histiocytosis. Ocular involvement is even rarer, mostly involving the orbit and eyelids, although marginal corneal ulcers, uveitis, and epibulbar masses have also been reported, and is characterized by multiple recurrences. However, the disease course and optimal treatment strategies remain undetermined, in light of the rarity of this disease. CASE PRESENTATION: We reported a 36-year-old male patient with the extranodal form of Rosai-Dorfman disease, presenting with scleritis and anterior uveitis in the left eye, who experienced subsequent development of an epibulbar tumor in the same eye. The patient was also complicated by a relapsing facial nodule on the right cheek. After the pathological diagnosis of Rosai-Dorfman disease was obtained, the patient underwent surgical excision of the epibulbar tumor and the facial nodule, accompanied by systemic immunosuppression therapy. At the last follow-up, the patient was asymptomatic without signs of recurrence. CONCLUSIONS: This report highlights the progression of ocular manifestations of Rosai-Dorfman disease and emphasizes the importance of systemic therapy.


Assuntos
Túnica Conjuntiva/patologia , Histiocitose Sinusal/complicações , Esclera/patologia , Esclerite/etiologia , Uveíte Anterior/etiologia , Doença Aguda , Adulto , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Histiocitose Sinusal/diagnóstico , Humanos , Masculino , Esclerite/diagnóstico , Uveíte Anterior/diagnóstico , Acuidade Visual
18.
Am J Case Rep ; 20: 886-895, 2019 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-31230060

RESUMO

BACKGROUND Systemic vasculitides constitute heterogenous conditions affecting many organs and systems through blood vessel inflammation. Although there are some classifications for vasculitis, several vasculitides are "unclassified" because they cannot be clearly assigned to one of the known entities. CASE REPORT We report an autopsy case of a 67-year-old Japanese man who presented with fever, ocular pain, erythema, chest pain, and headache. The disease caused episcleritis, thrombophlebitis, extensive deep vein thrombosis, multiple pulmonary nodules and masses, hypertrophic pachymeningitis, and hyper-intensity areas in brain parenchyma on magnetic resonance images. Histopathology of the pulmonary nodule confirmed vasculitis affecting medium-to-small veins and arteries without necrotizing vasculitis or granulomatous inflammation. We diagnosed the patient with unclassified vasculitis based on the clinicopathological characteristics. Steroids in combination with immunosuppressants were used, but the disease was refractory and relapsing. The disease activity was eventually controlled with rituximab, but the patient died of bronchopneumonia. On autopsy, lung and brain findings indicated healed vascular inflammation. CONCLUSIONS This is the first case report of unclassified vasculitis, which is characterized as medium-to-small-sized arteritis and phlebitis, causing episcleritis, thrombophlebitis, deep vein thrombosis, pulmonary vasculitis, and intracranial vasculitis. The clinical conditions share some similarities with granulomatosis with polyangiitis and Behçet's disease; however, they meet no classification criteria of any specific vasculitis. More cases need to be analyzed to confirm our findings.


Assuntos
Esclerite/diagnóstico , Tromboflebite/diagnóstico , Vasculite/diagnóstico , Trombose Venosa/diagnóstico , Idoso , Autopsia , Evolução Fatal , Humanos , Masculino , Esclerite/complicações , Esclerite/terapia , Tromboflebite/complicações , Tromboflebite/terapia , Vasculite/complicações , Vasculite/terapia , Trombose Venosa/complicações , Trombose Venosa/terapia
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