1/14. Retinal tears associated with panuveitis and Behcet's disease.To report retinal tears formation in 3 eyes of 2 patients with active panuveitis and Behcet's disease. We describe 2 patients that were diagnosed and treated for Behcet's disease with active panuveitis. Retinal tears developed while the inflammation was active. The patients were treated with topical, oral steroids, and cyclosporine therapy for bilateral panuveitis. One patient presented with a retinal tear located at the periphery of the active retinal lesion. The other had multiple tears associated with active retinal lesions in both eyes. argon laser photocoagulation was performed in both patients as soon as the tears were detected. Ocular inflammation was controlled with this therapy, and only a few mild flare-ups occurred. The patients have been followed up for 8 and 16 months, respectively. During this period no new retinal tears have developed. Although retinal tear formation is rarely associated with Behcet's panuveitis, the clinician should be aware of this as a possible complication. When structural changes are present in the vitreous, detailed ophthalmoscopy is indicated to assess for retinal tears. If a tear is detected in a patient with panuveitis and Behcet's disease, laser photocoagulation therapy should be performed immediately to prevent retinal detachment.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/14. Immunomodulatory therapy for chronic tubulointerstitial nephritis-associated uveitis.PURPOSE: To describe the clinical course and treatment with immunomodulatory agents in patients with tubulointerstitial nephritis and uveitis syndrome. methods: Retrospective analysis of the charts of six patients with tubulointerstitial nephritis and uveitis syndrome. RESULTS: The mean ( /-SD) age was 24.3 ( /-16.5) years, range 13 to 49 years. Four patients were children, and two were adults. Three were men, and three were women. Five of the six patients had anterior uveitis, and one had panuveitis. All patients had several relapses despite treatment with topical, regional, and oral steroids and methotrexate in one case. The introduction or modification of immunosuppressants (methotrexate, azathioprine, or cyclosporin A) achieved control of the uveitis and prevented relapses over a mean ( /-SD) follow-up period of 19.66 ( /-10.01) months, range 6 to 34 months. No treatment-related side effects were observed. CONCLUSIONS: Tubulointerstitial nephritis and uveitis syndrome is a distinct disease entity in which the nephritis typically resolves, but the uveitis often becomes chronic and is treatment resistant. Immunomodulatory agents can achieve control of the inflammation and prevent relapses.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
3/14. Macular ischaemia in Behcet's disease.PURPOSE: To report macular ischaemia and visual loss in patients with panuveitis due to Behcet's disease. methods: We describe macular ischaemia, a rare finding, in 3 eyes of 3 patients with panuveitis who were diagnosed and treated as having Behcet's disease. The patients underwent fundus fluorescein angiography (FFA) using a digital imaging system and were treated with topical and oral steroids and cyclosporine in 2 cases, and with added azathioprine in the third case. RESULTS: The 3 eyes showed macular ischaemia associated with peripheral retinal vasculitis on FFA and control of inflammation was achieved in all cases. After an average of 2 years follow-up, visual acuity and macular ischaemia improved in 2 eyes, while no recovery was seen in the third. CONCLUSION: The presence of macular ischaemia on FFA in Behcet's disease is a predictor of poor visual outcome. Macular ischaemia may show partial recovery with the treatment of the disease.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
4/14. Immune recovery vitritis presenting as panuveitis following therapy with protease inhibitors.Immune reconstitution in acquired immunodeficiency syndrome (AIDS) patients on highly active anti-retroviral therapy (HAART) with cytomegalovirus (CMV) retinitis manifested as posterior segment intraocular inflammation has been reported. We report an adult hiv-positive Indian male with clinically inactive CMV retinitis who developed panuveitis with hypopyon. This was related to immune recovery mediated by combination anti-retroviral treatment, including protease inhibitors.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
5/14. Bilateral panuveitis: a possible association with Kikuchi-Fujimoto disease.PURPOSE: To report a case of necrotizing lymphadenitis caused by Kikuchi-Fujimoto disease, which developed bilateral panuveitis. methods: A 16-year-old Chinese female with histologically proven Kikuchi-Fujimoto disease developed bilateral panuveitis 2 years after the onset of lymphadenopathy. RESULTS: Bilateral panuveitis was successfully treated with topical steroid. Serologic investigations were positive for Epstein-Barr virus antibodies and antinuclear antibodies, but no evidence of systemic disease or other causes of ocular inflammation was found. CONCLUSION: Kikuchi-Fujimoto disease may be associated with intraocular inflammation.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/14. Multifocal choroiditis and panuveitis: immunomodulatory therapy.PURPOSE: To report our analysis of the efficacy of immunomodulatory therapy on the course of 19 patients with multifocal choroiditis and panuveitis (MCP). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Nineteen patients with multifocal choroiditis with panuveitis evaluated on the Ocular Immunology and Uveitis Service of the massachusetts eye and Ear Infirmary from 1978 to 2000. methods: Fifteen patients were treated with systemic immunomodulatory therapy; 4 patients (who refused therapy) were treated with systemic steroids. All patients were analyzed for control of inflammation, visual acuity outcome, and tolerance of immunomodulatory therapy. MAIN OUTCOME MEASURES: Control of inflammation and visual acuity. RESULTS: Nineteen patients with bilateral MCP with a mean follow-up of 72.7 months were studied. Fifteen were treated with immunomodulatory agents, whereas 4 patients received only systemic steroids; these 4 developed serious systemic steroid-related complications, and 12 others had cataract and/or glaucoma related to chronic topical, regional, or systemic steroid use before immunomodulatory therapy. Two patients who refused immunomodulatory therapy lost considerable vision in three of their four eyes. Of the 15 patients treated with immunomodulatory drugs, 7 patients lost considerable vision in one eye on steroid therapy but maintained good vision in the other eye once immunomodulatory therapy was instituted. No patient lost vision in any eye once he or she was treated with immunomodulatory treatment. CONCLUSIONS: Immunomodulatory therapy controls inflammation and preserves vision in patients with multifocal choroiditis and panuveitis.- - - - - - - - - - ranking = 1.5keywords = inflammation (Clic here for more details about this article) |
7/14. Massive mycobacterial choroiditis during highly active antiretroviral therapy: another immune-recovery uveitis?PURPOSE: To describe the ocular presentation of disseminated mycobacterial disease occurring during immune-recovery in a patient with acquired immune deficiency syndrome (AIDS). STUDY DESIGN: Case report and literature review. PARTICIPANTS: A 41-year-old AIDS patient with a prior diagnosis of cytomegalovirus retinitis. methods: The patient developed progressive, bilateral multifocal choroiditis with panuveitis 2 months after beginning and responding to highly active antiretroviral therapy. His left eye became blind and painful and was enucleated. Pathologic examination revealed massive choroiditis with well-formed, discrete granulomas and multiple intracellular and extracellular acid-fast organisms within the choroidal granulomas. culture and polymerase chain reaction of vitreous specimens revealed mycobacterium avium complex (MAC). RESULTS: Empiric, and later sensitivity-guided, local and systemic antibiotic therapy was used to treat the remaining right eye, but it continued to deteriorate. Despite medical therapy, three vitrectomies and repeated intravitreal injections of amikacin, a total retinal detachment ensued. One week after the third vitrectomy, the patient died from mesenteric artery thrombosis in the setting of disseminated mycobacterial disease. CONCLUSIONS: This is the first report of ocular inflammation as the presenting finding in the recently recognized syndrome of immune-recovery MAC disease. Pathogenesis of this entity is related to an enhanced immune response to a prior, subclinical, disseminated infection. The formation of discrete granulomas, normally absent in MAC infections in AIDS, reflects this mechanism.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
8/14. Longterm follow-up of patients with multifocal choroiditis and panuveitis.PURPOSE: To report the visual prognosis and longterm complications in patients with multifocal choroiditis and panuveitis (MCP). methods: A retrospective study was performed with patients who met inclusion criteria for MCP at the Uveitis Clinic, Royal victoria Hospital, McGill University, Montreal, canada. Information collected included duration of follow-up, visual acuity (VA) measured at each clinical visit, ocular and systemic treatment and ocular complications observed during follow-up. RESULTS: Nineteen patients (37 eyes) with MCP with a mean follow-up of 76.9 months were studied. Kaplan-Meier survival analysis showed a decrease in the proportion of patients with a final VA > or = 20/40 over time. Cystoid macular oedema was seen in 29.7% of the eyes and was the most frequent macular abnormality observed in our group. On the other hand, choroidal neovascularization was detected in only six (16.2%) of the eyes, but was related to VA < 20/200 in four of these eyes. glaucoma was detected in 10.8% of the eyes. cataract (posterior subcapsular and/or nuclear) was the most common longterm complication, occurring in 40% of affected eyes. cataract surgery improved the VA in 83.3% of these eyes. CONCLUSION: The visual acuity of patients with MCP decreases with time. Visual loss can occur from complications following the inflammation itself and/or iatrogenic induced by the chronic use of corticosteroids.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
9/14. rifabutin-associated panuveitis with retinal vasculitis in pulmonary tuberculosis.INTRODUCTION: rifabutin-associated uveitis has been reported frequently in AIDS patients and more rarely in immunocompetent patients. It is characterized clinically by anterior acute uveitis. Only a few poorly documented cases of rifabutin-induced panuveitis with retinal vasculitis have been reported. Here, we report four cases of rifabutin-associated panuveitis with retinal vasculitis. case reports: We describe four patients with active tuberculosis, treated with a multidrug regimen including rifabutin for at least 1.5 months before presentation. The first patient was immunocompetent, the three others had AIDS and were undergoing triple anti-hiv therapy. Three patients were women with a low body weight. All four patients presented with panuveitis and retinal vasculitis. Interruption of the drug rapidly reduced the ocular inflammation in all cases. CONCLUSION: Four cases of rifabutin-associated panuveitis with retinal vasculitis are reported in patients with active pulmonary tuberculosis. Immunogenicity of mycobacterium tuberculosis as well as the very low weight of the patients might be implicated in the development of this unusual form of rifabutin-associated uveitis.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
10/14. Photodynamic therapy for choroidal neovascularization in patients with multifocal choroiditis and panuveitis.PURPOSE: To evaluate the visual benefit of photodynamic therapy (PDT) with verteporfin in patients with choroidal neovascularization (CNV) secondary to multifocal choroiditis and panuveitis over a longer follow-up period. methods: A total of 14 eyes of 12 patients (mean age 34 years) with a classic subfoveal CNV (13/14) or juxtafoveal CNV (1/14) were treated with PDT. Visual outcome was assessed by best-corrected visual acuity (VA). Morphologic characteristics of CNVs such as localization, size, and activity were monitored by fluorescein angiography. RESULTS: patients were followed for 3 to 45 months (mean 23 months). During this period, one to six PDTs (mean 2.4) were performed. At the time of the first PDT no acute inflammation was seen in the affected eyes. Improved or stabilized visual function (VA loss < or = 2 lines in the Early Treatment diabetic retinopathy Study chart) was observed in 71.4% of the eyes. A total of 78% of the eyes showed an inactive scar in the area of CNV after PDT. treatment failure after PDT occurred due to uninfluenced CNV growth. No further complications were observed. CONCLUSIONS: PDT in subfoveal or juxtafoveal classic CNV secondary to multifocal choroiditis and panuveitis stabilized or improved VA in the majority of patients over a longer follow-up period. No risk factor for failed VA rehabilitation could be defined.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
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