Intense pulsed light therapy (IPL) induced iritis following treatment for a medial canthal capillary malformation.

The popularity of intense pulsed light (IPL) therapy continues to increase due to its relative safety, high skin coverage rate and ability to treat both vascular and pigmented lesions. An often-overlooked risk is the potential for IPL-induced ocular damage. The damage sustained can cause significant, persistent morbidity and can occur even with very limited IPL exposure to the eye.

[Unique mechanism in heart-shaped balloon burst resulting in blunt ocular injury].

We have previously shown that heart-shaped balloons have a different explosion mechanism than spherical balloons in which the former splits into two rubber parts still attached to the balloon base with a backward whiplash motion. This backward whiplash motion may cause significant blunt ocular trauma if the balloon is inflated by mouth. In this article, the energy of the blunt ocular trauma is estimated by the high speed camera photos analysis of the balloon burst. Furthermore, we describe the followup of eight patients with ocular trauma following inflation of heart-shaped balloons.

Juvenile idiopathic arthritis.

Juvenile idiopathic arthrithis (JIA) is the most common rheumatic disease of childhood.JIA is a chronic disease that is associated with periods of disease flares and periods of disease inactivity.Early, aggressive treatment with nonsteroidal anti-inflammatory drugs, intra-articular corticosteroid injections, or methotrexate, has significantly improved the outcome of most children who have JIA. Biologics have been shown to be both safe and effective for the treatment of more aggressive forms of arthritis and for uveitis. Long-term safety data of biologics is still uncertain. In the near future, it is hoped that genetic testing will allow earlier diagnosis of JIA as well as help predict the disease course of children who have JIA. Genetic analysis also may allow physicians to target therapies more effectively. It is hoped that development of more specific therapies will decrease overall immunosuppression and other associated toxicities.

[Cataract surgery in nanophthalmic eyes]. / Phakoemulsifikation bei nanophthalmischen Augen.

PURPOSE: The aim of this study was to determine the prevalence of nanophthalmos among cataract patients and to evaluate intraoperative and postoperative complications in nanophthalmic eyes. PATIENTS AND METHODS: Medical and operating records of all 3287 patients who had undergone clear cornea phacoemulsification cataract surgery with foldable acrylic IOL implantation during a period of two years (January 2009 to December 2010) were retrospectively reviewed. Nanophthalmos was diagnosed according to a shorter axial length than 20 mm, a shallow anterior chamber, hyperopia and scleral thickness greater than 1.7 mm as determined by echography. Before surgery all patients received an intravenous 20 % mannitol solution. RESULTS: From 3287 eyes, six eyes of four patients were identified as nanophthalmic with an axial length below 20 mm and a scleral thickness greater than 1.7 mm. The prevalence of nanophthalmos was 0.18 %. The average hyperopia was + 7.87 D (+ 6.0 to + 9.50). The mean axial length was 19.58 mm (18.94 to 20.00). The mean biometry calculation was 33.16 D (31.5 to 36.0). In all cases no complications were observed during the surgery. In two eyes a mild iritis was observed one day after surgery. During a follow-up of 3 months no further complications occurred. CONCLUSIONS: Surgical manipulation in a narrow and crowded anterior chamber in nanophthalmic eyes with increased vitreous pressure is always a challenge and must be performed by an experienced surgeon. Preoperative examination of scleral thickness and preoperative administration of hyper-osmotic solution for reduction of vitreous pressure are very important to prevent unexpected complications. There was no need for a prophylactic surgical procedure in our patients.

Anterior segment ischemia with rubeosis iridis after a circular buckling operation treated successfully with an intravitreal bevacizumab injection: a case report and review of the literature.

PURPOSE: To report a case of anterior segment ischemia (ASI) with rubeosis iridis after circular buckling surgery in a highly-myopic patient which was successfully treated with a second intravitreal bevacizumab injection. METHODS: Case report and review of the literature. DISCUSSION: ASI is a rare but potentially serious complication of posterior segment surgery. Finally it leads to neovascular glaucoma as a result of rubeosis iridis. An encircling band can compromise anterior segment circulation in different ways: by manipulation or disinsertion of the recti muscles, by occlusion of the vortex veins through compression or by changes in the blood supply of iris and ciliary body. This patient developed rubeosis iridis secondary to ASI. There was a remarkable regression of rubeosis iridis one month after a second intravitreal bevacizumab injection. Other case reports of bevacizumab use in neovascular glaucoma have shown clinical improvements of these patients, with intraocular pressure control and reduction of the neovascularization process. CONCLUSION: We describe a highly-myopic patient who developed ASI with rubeosis iridis after a circular buckling operation. Slit-lamp examination and gonioscopy can show very little rubeosis iridis and can be misleading. Iris fluorescein angiography is the most sensitive technique for evaluation of iris vessel abnormalities and is of considerable value in the early detection of rubeosis iridis. This report demonstrates the rapid resolution of rubeosis iridis on iris fluorescein angiography after a second intravitreal injection of bevacizumab. How long this regression will persist is unknown and repeated injections of bevacizumab may be necessary if rubeosis reappears.

Iritis and pupillary distortion after periorbital cosmetic alexandrite laser.

BACKGROUND: To describe a case of ocular complications associated with laser-assisted periorbital cosmetic treatment and to recommend consideration of the ocular damage caused by dermatological laser therapy, including pupillary distortion and anterior uveitis. METHODS: Case report. RESULTS: A 29-year-old Caucasian woman underwent cosmetic alexandrite laser therapy in the left upper eyelid area without protective eye shields. She complained of an irregular oval pupil, photophobia, and blurred vision in her left eye. Initially, her best-corrected visual acuity (BCVA) was 30/25 (OD) and 30/25 (OS). Slit-lamp biomicroscopy revealed a distorted left pupil with 3+ cell activity in the anterior chamber, but normal intraocular pressure. She was treated with topical corticosteroids. However, marked anterior chamber activity, pigment dispersion over the iris surface, and deteriorating BCVA of 10/25 (OS) had developed at the two-week follow-up. The ocular inflammation subsided gradually and her BCVA returned to normal after intensive steroid treatment. At the six-month follow-up, an ocular examination showed poor pupillary motility and persistent pigment over the iris surface. The patient still suffered from glare in dim light and experienced problems with dark adaptation. CONCLUSIONS: Alexandrite laser treatment of the upper eyelid region may penetrate the eyelid, causing anterior uveitis and irreversible damage to the iris. We recommended appropriate eye protection during this therapeutic procedure.

The impact of ustekinumab on extraintestinal manifestations of Crohn's disease: A post hoc analysis of the UNITI studies.

This post hoc analysis of the UNITI studies found ustekinumab (UST) did not significantly improve overall extraintestinal manifestations (EIMs) of Crohn's disease compared to placebo-treated patients at weeks 6 and 52. BACKGROUND AND AIMS: The UNITI trials demonstrated that UST was effective in inducing and maintaining clinical remission in Crohn's disease (CD). However, limited data exists regarding its effectiveness for treatment of EIMs. This post hoc analysis evaluated the efficacy of UST in treatment of EIMs. METHODS: Data from UNITI-1/2 and IM-UNITI (NCT01369329, NCT01369342, NCT01369355) were obtained from the Yale Open Data Access Project (2019-4104). Nine hundred and fourty-one patients eligible for UST induction and 263 patients eligible for maintenance UST were included. The primary outcome of interest was EIM resolution at Week 6 in UST and placebo-treated patients using the chi-square test. EIM resolution at Week 52 was also assessed. McNemar's test was used to compare the proportion of patients who reported active EIMs at weeks 6 and 52 versus baseline. RESULTS: From 941 UST-treated patients in UNITI-1/2, 504 had 527 EIMs at baseline. Overall, there was no significant difference in EIM resolution observed in UST-treated patients (186/504, 36.9%) compared to placebo (90/230, 39.1%; p = 0.564) at Week 6. Patients treated with continuous UST (91/119, 76.4%) had no significant difference in overall EIMs resolved at Week 52 compared to placebo (72/90, 80.0%; p = 0.542). Although many EIMs demonstrated reduction in prevalence compared to baseline at initiation of UST, only erythema nodosum was more likely to improve at Week 52 on treatment versus placebo. CONCLUSION: Overall, UST did not lead to significant resolution of EIMs for CD compared to placebo at weeks 6 and 52.

Management of patient with Cogan's syndrome: a case report.

INTRODUCTION: Cogan syndrome-CS, is a rare autoimmune disease defined as an inflammation of the eyes followed by bilateral audiovestibular symptoms. CASE PRESENTATION: This is case report of S. A. male, born on April 18th 1986 from Elbasan, presented with the gastrointestinal, audiovestibulary and eyes disorders, weight loss and progressive fatigue. CT-scan showed an inflammation in lymph nodes in the right lower quadrant of his abdomen. MRI examination showed inner ear inflammation. Ophthalmologic examination revealed that patient was very sensitive to light and visual acuity was lowing 5/10 LE and 6/10 RE, a slit-lamp examination ascertained the interstitial keratitis, iritis and conjunctivitis. CONCLUSION: Considering all diseases manifestations, the results of all examinations, a diagnose of CS was finally made. The treatment with steroids and immunosupresors showed an improvement of diseases but hearing loss was not reversed.

[Postoperative Candida Iris nodules: report of a case]. / Nodules iriens postopératoires à candida: à propos d'un cas.

PURPOSE: Description of an uncommon case of postoperative Candida iris nodules. CASE REPORT: A 70-year-old immunocompetent patient developed whitish iris nodules after phacoemulsification in the left eye, without any other signs of endophthalmitis. Histophathological examination showed spores of candida. These nodules did not respond to intracameral amphotericin B but disappeared with oral fluconazole. However, the functional outcome was poor because of persistant inflammation of the anterior segment. CONCLUSION: In the presence of postoperative iris nodules, fungal etiology must be considered.

Ocular involvement in acute febrile neutrophilic dermatosis (Sweet syndrome): new cases and review of the literature.

Sweet syndrome (acute febrile neutrophilic dermatosis) is a dermatologic disorder with accompanying features of systemic inflammation. It is commonly associated with conjunctivitis, but a variety of types of ocular inflammation have been reported. The ocular manifestations of Sweet syndrome include periorbital and orbital inflammation, dacryoadenitis, conjunctivitis, episcleritis, scleritis, limbal nodules, peripheral ulcerative keratitis, iritis, glaucoma, and choroiditis. The ocular inflammation appears concurrently with skin lesions. An overview of Sweet syndrome is presented with a review of cases in the literature describing ocular involvement. We report two additional cases of ocular involvement, one with conjunctivitis and a second with iritis, peripheral ulcerative keratitis, and episcleritis. Of the 20 cases, half were bilateral. Thirteen cases occurred in the setting of classical or idiopathic Sweet syndrome and seven in association with malignancy. Biopsies of ocular tissue were infrequent, but, in the seven cases where ocular tissue was analyzed, the histopathology was similar to that of the cutaneous lesions. The ocular complications of Sweet syndrome resolved with systemic administration of corticosteroid or cyclosporine. Topical ocular steroid treatment was frequently used in conjunction with oral steroid but may not have been valuable.

Two cases of SAPHO syndrome accompanied by classic features of Behcet's disease and review of the literature.

We describe two patients with SAPHO (synovitis-acne-pustulosis-hyperostosis-ostitis) syndrome who presented some of the classic features of Behcet's disease. The first case is a man diagnosed as SAPHO at 74 years old. His major complaint is pain and swelling of the bilateral sterno-clavicular region for more than 14 years. Another conspicuous complication was bilateral glaucoma and episodes of iritis were recognized during the follow-up period. The second case is a 65-year-old woman, who first consulted us with right knee pain. As she had a past history of palmoplantar pustulosis and anterior chest pain, her sterile knee arthritis was diagnosed as SAPHO. She also had been suffering from recurrent oral aphthous ulceration since 6 months before visiting our hospital. Considering the clinical courses of our two cases and a review of five previously reported cases, these conditions may imply that classic features of Behcet's disease are minor complications of SAPHO syndrome. Human leukocyte antigen typing and frequent association of sacroiliitis in our cases and in the review of the literature for SAPHO syndrome with some of the classic features of Behcet's disease may indicate this condition to be a closely related disease with seronegative spondylo-arthritis.

Severe iritis and choroidal effusion following selective laser trabeculoplasty.

A patient with uncontrolled primary open-angle glaucoma underwent selective laser trabeculoplasty and developed a significant anterior chamber reaction, shallow anterior chamber, and choroidal effusion. Common complications associated with selective laser trabeculoplasty include conjunctival injection, mild anterior chamber reaction, and post-treatment intraocular pressure elevation. The authors believe this is the first reported case of severe iritis and choroidal effusion following selective laser trabeculoplasty.

Early-onset pauciarticular juvenile rheumatoid arthritis associated with human leukocyte antigen-DRw5, iritis, and antinuclear antibody.

Evidence has been sought for a genetically determined predisposition among children with juvenile rheumatoid arthritis (JRA) who are also at particular risk for the development of inflammatory eye disease.45 unrelated Caucasian patients (41 female) with early-onset pauciarticular JRA were human leukocyte antigen (HLA) types. 28 of the study group were found to be HLA-DRw5 compared with 16 of 84 controls (X(2), 24.3, P = <0.001). 9 patients were HLA-DRw8 compared with 4 of 84 controls (X(2), 7.51, P = <0.01). Iritis developed in 24 of the 45 children studied, 17 of whom were typed as HLA-DRw5 when compared to controls (X(2), 26.76, P = <0.001) and 6 with iritis typed as HLA-DRw8 (X(2), 9.10, P = <0.01). Antinuclear antibody was found in the serum of 17 of the 28 patients typing as HLA-DRw5 compared with 4 of the 17 who did not have this antigen (X(2), 5.88, P = <0.02). No such association was seen in patients with HLA-DRw8. In a study of linked genes, a delta value of 0.090 was found for HLA-DRw5 with HLA-B12, of 0.070 for DRw5 with HLA-Cw4, and a value of 0.050 for DRw5 and HLA-Bw35. This suggests a linkage disequilibrium between HLA-DRw5 and these two B series alleles, a conclusion which was supported by haplotype analysis in families of 11 of the disease probands. HLA-DRw5 has not previously been reported to be increased in any rheumatic disease group. It is proposed that HLA-DRw5 is a genetic marker defining those at risk for early-onset pauciarticular JRA with iritis.

Cataract secondary to electrical shock from a Taser gun.

A 35-year-old man presented with traumatic iritis, angle-recession glaucoma, and a retinal dialysis secondary to blunt trauma from a Taser gun in the right eye and a unique electrical cataract in the left eye. Taser guns, which can also function as stun guns, can lead to electrical cataract formation. Given the increasing use of Taser guns by law enforcement and citizens, blunt mechanical and electrical sequelae of Taser gun injuries should be recognized.

Hypopyon iritis after primary fresh amniotic membrane transplantation.

PURPOSE: To report the occurrence of hypopyon iritis after primary, fresh amniotic membrane transplant (AMT). METHODS: A case report of a 65-year-old man who underwent AMT along with placement of hydrophilic contact lens for symptomatic relief of pseudophakic bullous keratopathy for the first time. The amniotic membrane (AM) transplanted was obtained freshly after an elective cesarean section. RESULTS: The patient developed hypopyon on the second postoperative day. Culture of remnants of AM and contact lens were negative. Hypopyon did not respond to periocular antibiotics but disappeared with periocular steroids. Hypopyon was noticed again at 1-week follow-up because of poor compliance of the patient. It again responded to periocular steroids. At 1-year follow-up, the patient is asymptomatic with 20/600 vision. CONCLUSIONS: Sterile hypopyon iritis appeared after primary AMT with fresh AM, and it disappeared with periocular steroids.

Bilateral ankle edema with bilateral iritis.

I report two patient presented to me with bilateral symmetrical ankle edema and bilateral acute iritis. A 42-year-old female of Indian origin and 30-year-old female from Somalia both presented with bilateral acute iritis. In the first patient, bilateral ankle edema preceded the onset of bilateral acute iritis. Bilateral ankle edema developed during the course of disease after onset of ocular symptoms in the second patient. Both patients did not suffer any significant ocular problem in the past, and on systemic examination, all clinical parameters were within normal limit. Lacrimal gland and conjunctival nodule biopsy established the final diagnosis of sarcoidosis in both cases, although the chest x-rays were normal.

[Floorball ­ a common cause of sport related eye injury]. / Innebandy är en vanlig orsak till sportrelaterade ögonskador - Skyddsglasögon bör användas vid innebandyspel på alla nivåer.

Floorball - a common cause of sport related eye injury The aim of this study was to survey the incidence and type of sport related to eye injuries with special interest in floorball. A prospective study was conducted December 1st 2013 through November 30th 2014 at the Department of Ophthalmology, Örebro University Hospital. All patients presenting with an acute sports related eye injury were offered to be included. Information was collected from a self-administered questionnaire and from medical journals. During the study period, 49 patients sought care for sports related eye injuries, and 26 (53%) of those were related to floorball. The number of patients who agreed to take part in the study was 38, of which 25 had injuries related to floorball. Among the floorball players, there were two patients where the injury caused permanent vision impairment. None of the floorball players wore eye protection at the time of injury. According to this study, protective eyewear should be recommended when playing floorball, regardless of age or setting.

Recurrent iritis after implantation of an iris-fixated phakic intraocular lens for the correction of myopia Case report and clinicopathologic correlation.

The iris-claw intraocular lens (IOL) was recently approved by the U.S. Food and Drug Administration for the correction of refractive disorders. Previous reports are not uniform regarding its potential to induce inflammatory reaction. We report the case of a young healthy patient who experienced persistent and intolerable iritis after implantation of an iris-claw IOL. The iritis was resolved only after explantation of the IOL.

Iritis presumed as secondary to disseminated coccidioidomycosis.

BACKGROUND: Coccidioidomycosis is a systemic disease caused by a fungus found in soil and transmitted through inhalation. It is prevalent in western and southwestern United States, Mexico, and South and Central America. Results of skin testing, serologic testing, and tissue cultures confirm the diagnosis. Coccidioidomycosis can manifest in various ways: the infected individual may present asymptomatically, with an acute respiratory infection, or, in more severe or chronic cases, with a multiorgan presentation. Ocular involvement may include anterior segment, posterior segment, or extraorbital involvement. CASE REPORT: A case concerning a patient with iritis presumed as secondary to disseminated coccidioidomycosis is discussed. The patient initially presented to our clinic with signs and symptoms of acute, unilateral iritis and a recent history of iritis in the contralateral eye. The active inflammation was treated topically with Pred Forte and cyclopentolate and resolved without sequelae. Because the presentation was bilateral with an asymmetric timecourse, laboratory tests were ordered to rule out systemic association. Because all tests yielded negative results, the known history of disseminated coccidioidomycosis was presumed to be the etiology of this iritis. CONCLUSION: Although eye findings are rare, disseminated coccidioidomycosis is an important differential to consider when a patient presents with uveitis. For this reason, awareness and recognition of ocular signs and symptoms of this disease is significant in proper patient care and management.