Irradiance thresholds for chorioretinal damage in rhesus monkeys vary linearly with core temperatures between 34 and 390C. Damage results from the combined thermal effects of retinal irradiation and the body temperature. Visible damage is calculated to occur at a tissue temperature of 42.50C. Fever increases the retina's susceptibility to burns from the sun, lasers, and other radiant energy sources
I. G. Pikhovskaia
Full Text Available The clinical case of a toxocariasis chorioretinitis which is of interest for ophthalmologists is described. Insufficient knowledge of clinic and diagnostics of a lesion of eyes by Toxocara canis, their infrequent occurrence, similarity of the ophthalmologic picture with inflammatory diseases and eye neoplasms can be at the bottom of gross diagnostic mistake and wrong choice of treatment tactics.
Full Text Available Chorioretinal folds are a rare presentation of a meningioma. We report a case of ameningioma with chorioretinal folds as its initial presentation. A 39-year-old female patientcomplained of progressive blurring of the right eye. A fundus examination of the right eyerevealed chorioretinal folds. Magnetic resonance imaging found a tumor mass involving theright orbit and right anterior middle cranial fossa. An echo-guided biopsy confirmed themeningioma. She received surgical excision of the meningioma, and her visual acuity wasstationary at 12/20 after 15 months of follow-up. We review the etiologies of chorioretinalfolds and elucidate the strategies for dealing with them. Certain underling diseases associatedwith chorioretinal folds are lethal and require prompt management. Ophthalmologistsshould evaluate these patients carefully in a stepwise manner.
Full Text Available Background: Chickenpox is rarely associated with posterior segment inflammation. We report on a case of unilateral chickenpox chorioretinitis with retinal exudates and periphlebitis. Case Presentation: A 21-year-old healthy man, who suffered from chickenpox 2 weeks prior to symptom development, exhibited mild anterior chamber cells, vitreous opacity, sheathing of retinal veins, and yellow-white exudates in his right eye. Varicella zoster virus DNA was detected by polymerase chain reaction in the aqueous humor. He was treated with intravenous acyclovir followed by oral prednisolone and valaciclovir. Aqueous cells quickly disappeared and retinal exudates diminished within 1 month, leaving faint retinal scarring. Retinal arteritis had never been observed in this patient. Conclusions: Although the ocular findings in this case were similar to acute retinal necrosis (ARN, the clinical features differed from ARN in the following points: (1 mild anterior chamber inflammation, (2 absence of retinal arteritis, and (3 prompt resolution of inflammatory findings. The distinctive clinical features indicated that chorioretinitis associated with chickenpox may not have the same pathological conditions as ARN.
Full Text Available Syphilis is a multi systemic infection caused by Treponema pallidum. Ocular manifestations of Syphilis have a myriad of presentations and severity. A 31year old male patient was referred from ophthalmology department as a case of chorioretinitis for screening for syphilis. Patient had diminished vision and redness of right eye for 2 months duration. History of premarital exposure and extramarital contact was present. Ocular examination revealed - Rt eye: conjunctival congestion and Argyll Robertson pupil; Lt eye: normal. Fundoscopy of right eye showed yellowish white retinal lesions, macular edema and hyperaemia and left eye was normal .No genital lesion, scars or cutaneous lesion was present.VDRL was reactive in 1 dilution,TPHA was positive ; HIV test was negative ; CSF revealed VDRL - Negative and TPHA -Negative.Patient was treated with Injection procaine penicillin 1.2 Million units intramuscularly daily for 21 days. The patient responded well to treatment and there was improvement in his vision. Ocular Syphilis can occur at any stage of Syphilis and may be the only presenting sign. Syphilis serology was positive confirming the disease.This case highlights the importance of syphilis with ocular manifestation - there by proving that diagnosis of syphilis based on ocular finding is clinically challenging.
Yoo, Woong Sun; Park, Yeon Jung; Yoo, Ji Myung
Achondroplasia is a congenital disorder resulting from a specific disturbance in endochondral bone formation. The ophthalmic features reportedly associated with achondroplasia are telecanthus, exotropia, inferior oblique overaction, angle anomalies and cone-rod dystrophy. This is first report of chorioretinal coloboma in achondroplasia. An 8-year-old female was diagnosed with a developmental delay, known as achondroplasia, seven months after birth. Upon her initial visit, visual acuity was 0....
Full Text Available Purpose: To report the anatomical and functional outcomes of surgery for retinal detachment associated with chorioretinal colobomas. Methods: In this retrospective interventional case series, 28 eyes of 28 patients (including 18 male subjects who had undergone surgery for retinal detachment associated with chorioretinal colobomas were evaluated regarding the type of intervention, final visual acuity and anatomical outcomes, as well as complications. Cases with less than 3 months of follow-up were excluded. Results: Primary surgery included vitrectomy in 25 (89.3% and scleral buckling in 3 (10.7% eyes. The internal tamponade used in eyes undergoing vitrectomy was silicone oil in 23 (92% eyes and 20% sulfur hexafluoride (SF6 in 2 (8% eyes. Silicone oil was removed in 11 eyes (45.8%. The mean number of operations per eye was 1.57±0.74, mean follow-up was 40±36 months, and the retina remained attached in 26 eyes (92.9% at final follow-up. Mean preoperative visual acuity was 2.33±0.55 (range, 1.15-2.9 logMAR which significantly improved to 1.72±0.9 (range, 0.09-3.1 logMAR postoperatively (P < 0.001, however, final median visual acuity was counting fingers at 2 m. The most common complications were cataracts (100% and ocular hypertension (46.4%. Conclusion: The most prevalent surgical procedure for treatment of retinal detachment associated with chorioretinal coloboma was pars plana vitrectomy and the most frequently used tamponade was silicone oil. Although anatomical success was satisfactory, functional outcomes were not encouraging which reflects the complexity of the condition and associated abnormalities.
Full Text Available Myopic foveoschisis is one of the major complications of pathologic myopia, and it was most recently identified by new imaging modalities. During the natural evolution of this complication, anatomical and visual improvement without surgical intervention is an unusual course, and most of these eyes remain stable or progressively worsen. The authors report a case of a highly myopic eye that developed patchy chorioretinal atrophy after spontaneous resolution of myopic foveoschisis, which to the best of our knowledge has not been reported previously in the medical literature.
Full Text Available Abstract Introduction Syphilis is well known as an infectious disease which can present with a large variety of symptoms. Clinical diagnosis can be difficult and may be complicated in modern medicine by immunosuppressive treatment and possible side effects of medication. Case presentation We describe a rare case of placoid chorioretinitis due to Treponema pallidum which developed after the primary symptom of proteinuria was not recognized as a rare manifestation of syphilis. Diagnosis of syphilitic chorioretinitis and/or endophthalmitis was made by broad range amplification of the bacterial 16S ribosomal RNA gene obtained from vitreous after diagnostic vitrectomy. Conclusion This case shows that clinicians should be alert in patients with proteinuria and chorioretinitis as they can represent rare manifestations of syphilis. Syphilis should be in the differential diagnosis of any unknown symptom and in the presumed side effects of medication.
Hordijk, R; VandeLogt, F; Houtman, WA; VanEssen, AJ
We describe a boy and his father with the chorioretinal dysplasia-microcephaly-mental retardation syndrome (CDMMS). Our report extends the phenotypic spectrum of autosomal dominant CDMMS by describing microphthalmia for the first time in an autosomal dominant family. The boy was also severely mental
Goswami, Mayank; Zhang, Pengfei; Pugh, Edward N.; Zawadzki, Robert J.
Chorioretinal blood vessel morphology in mice is of great interest to researchers studying eye disease mechanisms in animal models. Two leading retinal imaging modalities -- Optical Coherence Tomography (OCT) and Scanning Laser Ophthalmoscopy (SLO) -- have offered much insight into vascular morphology and blood flow. OCT "flow-contrast" methods have provided detailed mapping of vascular morphology with micrometer depth resolution, while OCT Doppler methods have enabled the measurement of local flow velocities. SLO remains indispensable in studying blood leakage, microaneurysms, and the clearance time of contrast agents of different sizes. In this manuscript we present results obtained with a custom OCT/SLO system applied to visualize the chorioretinal vascular morphology of pigmented C57Bl/6J and albino nude (Nu/Nu) mice. Blood perfusion maps of choroidal vessels and choricapillaris created by OCT and SLO are presented, along with detailed evaluation of different OCT imaging parameters, including the use of the scattering contrast agent Intralipid. Future applications are discussed.
N. A. Fedoruk
Full Text Available Aim: To reveal ultrastructural changes of chorioretinal complex and their possible reversibility under sub-threshold laser exposure at wavelengths of 0.81 and 0.532 μm in 1, 8 and 30 days. Methods: Experimental study was performed on 16 chinchilla rabbits (32 eyes using laser at wavelengths of 0.532 and 0.81 μm in CW, micropulse, and transpupillary thermotherapy modes. Transmission electron microscope EM-10C (Opton, Oberkochen, Germany was used to perform ultrastructural study of retina following laser exposure. Results: In a day after sub-threshold laser exposure, ultrastructural changes were mainly detected in retinal pigment epithelium (RPE, choriocapillaries, and photoreceptors. In 8 days, intracellular regeneration of RPE and partial restoration of choriocapillary blood flow and RPE macrophages were observed. In 30 days, RPE morphology, the number and the structure of photoreceptor outer segments were re-established. Mitochondria of photoreceptor inner segments regenerated as well. Conclusion: Ultrastructural changes of chorioretinal complex following sub-threshold laser radiation were reversible. Intracellular regeneration provided almost complete recovery of chorioretinal complex structure by day 30.
Full Text Available Abstract Background Ocular syphilis is often difficult to diagnose because of the wide variation in clinical features. HIV co-infection may further complicate the picture. Case presentation Herein the authors report an unusual primary syphilitic ocular lesion in a 45-year-old Italian HIV-infected bisexual man who presented with a unilateral eyelid lesion. Associated precocious signs and symptoms in the posterior segment of both eyes, bilateral chorioretinitis and uveitis, are described. Intravenous penicillin and steroid treatment produced a rapid improvement in clinical status and complete resolution. Conclusions Careful questioning about sexual behavior is crucial for unmasking unusual features of ocular syphilis in HIV-infected subjects.
Renard, G; Usui, M; De Kozak, Y; Faure, J P
Retinal lesions are described with the scanning electron microscope in the uveo retinitis induced in guinea pigs by immunization with rod outer segments of bovine retina. The two surfaces in contact of the pigment epithelium and the photoreceptors are separated from each other and observed on flat preparations. On the epithelial side, the evolution of the degenerescence of epithelial cells is observed, from the early disappearance of villosities until the total destruction of the cells. Through lacks in the epithelial layer where the choroid appears, inflammatory cells migrate towards the retina. The impairement of the visual cells is characterized by progressive destruction of outer then inner segments, with preservation of the external limiting membrane. In some areas the degenerative process reaches the layer of visual cells nuclei. Macrophages, and local clusters of lymphocytes are seen in contact with the retinal surface. PMID:135548
Lebech, A M; Lebech, M; Børme, K K;
Toxoplasmosis is a major and preventable cause of severe visual loss and blindness in young people. Ocular toxoplasmosis is the leading cause of posterior uveitis and in most cases it represents a late manifestation of a congenital infection. The clinical picture and anti-Toxoplasma therapy...... of seven patients referred to the Department of Infectious Diseases, Hvidovre Hospital is described. All patients had clinical ocular toxoplasmosis at initial examination with unilateral focal necrotizing retinitis associated with typical old, pigmented scars. All patients had anti-toxoplasmosis Ig......G antibodies. After anti-Toxoplasma therapy with sulfadiazine, pyrimethamine and corticosteroid the ocular lesions were healed to atrophic scars and the inflammatory activity disappeared. We conclude that when the clinical picture is compatible with toxoplasmosis, antibodies to Toxoplasma gondii...
Coats' Disease; Idiopathic Retinal Telangiectasia; Retinal Angiomatous Proliferation; Polypoidal Choroidal Vasculopathy; Pseudoxanthoma Elasticum; Pathological Myopia; Multi-focal Choroiditis; Rubeosis Iridis; Von Hippel Lindau Disease; BEST VITELLIFORM MACULAR DYSTROPHY, MULTIFOCAL (Disorder)
Eugênio Santana de Figueirêdo
Full Text Available PURPOSE: To evaluate the inflammatory response in the choroid, retina and vitreous in rabbit eyes underwent cryotherapy followed by intravitreal triamcinolone acetonide and to compare with those underwent cryotherapy followed by intravitreal injection of saline solution. METHODS: This is a prospective case-control study. Surgical procedures were performed in eleven rabbits. Two animals were excluded because they did not complete the postoperative period or had intraoperative or postoperative complications. All rabbits underwent superior temporal peritomy and transscleralcryotherapy in both eyes. After cryotherapy, animals received intravitreal injection of triamcinolone acetonide in one eye and saline solution in the fellow eye. Animals were sacrificed seven days after the procedure and their eyes were enucleated. Histological sections of eyeballs were prepared and the vitreous humor was aspirated. The count of inflammatory cells was performed by light microscopy. RESULTS: Histological sections of both eyes of nine rabbits were analyzed. Inflammatory cells were found only in the choroid. There was no statistically significant difference in the number of inflammatory cells between the two groups, regardless of cell type analyzed. CONCLUSION: This study showed no statistically significant difference between the use or absence of intravitreal triamcinolone acetonide in the inflammatory response to cryotherapy in rabbit eyes. Studies with larger samples are needed to confirm the trend of this paper.
Dubey, J P; Black, S S; Verma, S K; Calero-Bernal, R; Morris, E; Hanson, M A; Cooley, A J
Sarcocystis neurona is an unusual species of the genus Sarcocystis. Opossums (Didelphis virginianus, D. albiventris) are the definitive hosts and several other species, including dogs, cats, marine mammals, and horses are intermediate or aberrant hosts. Sarcocysts are not known to form in aberrant hosts. Sarcocystis neurona causes fatal disease in horses (Equine Protozoal Myeloencephalitis, EPM). There are numerous reports of fatal EPM-like infections in other species, usually with central nervous system signs and associated with the schizont stage of S. neurona. Here, we report fatal disseminated S. neurona infection in a nine-week-old golden retriever dog from Mississippi, USA. Protozoal merozoites were identified in smears of the cerebrospinal fluid. Microscopically, lesions and protozoa were identified in eyes, tongue, heart, liver, intestines, nasal turbinates, skeletal muscle and brain, which reacted intensely with S. neurona polyclonal antibodies. Mature sarcocysts were seen in sections of muscles. These sarcocysts were ultrastructurally similar to those of S. neurona from experimentally infected animals. These data suggest that the dog is another intermediate host for S. neurona. Data suggest that the dog was transplacentally infected. PMID:24680604
Full Text Available Res Commun 361:1022-6 (2007) PMID:17683515 (description, gene) Jonasson F, Sander B, Eysteinsson T, Jorgensen T, Klintworth GK Svein...H01180 Sveinsson chorioretinal atrophy (SCRA); Helicoid peripapillary chorioretinal degenerati...on (HPCD) Sveinsson chorioretinal atrophy (SCRA), also referred to as helicoid peripapillary chorioretinal degenerati...al, well defined, tongue-shaped strips of atrophic retina and choroid that extend... from the optic nerve into the peripheral ocular fundus. The lesions may be evident at birth and
Iritis; Pars planitis; Choroiditis; Chorioretinitis; Anterior uveitis; Posterior uveitis ... Uveitis can be caused by autoimmune disorders , including rheumatoid arthritis or ankylosing spondylitis . It can also be ...
Anton M Kolomeyer
Full Text Available We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations.
Aicardi syndrome is characterized by agenesis of the corpus callosum, chorioretinal lacunae, severe seizures (starting as infantile spasms), neuronal migration defects, mental retardation, costovertebral defects, and typical facial features. Because Aicardi syndrome is sporadic and affects only fem...
Marina Papadia; Herbort, Carl P.
Purpose: To report a patient erroneously diagnosed with tuberculous choroiditis who was accordingly treated with long term steroids which in turn, worsened the actual disease process that turned out to be central serous chorioretinopathy (CSC). Case Report: A 59-year-old Caucasian man developed a chorioretinal disease in his right eye in 1997. Having a positive tuberculin skin test, tuberculous chorioretinitis was suspected and antituberculous therapy was administered for 4 months. In 200...
Full Text Available Choroid supplies the major blood supply to the eye, especially the outer retinal structures. Its understanding has significantly improved with the advent of advanced imaging modalities such as enhanced depth imaging technique and the newer swept source optical coherence tomography. Recent literature reports the findings of choroidal changes, quantitative as well as qualitative, in various chorioretinal disorders. This review article describes applications of choroidal imaging in the management of common diseases such as age-related macular degeneration, high myopia, central serous chorioretinopathy, chorioretinal inflammatory diseases, and tumors. This article briefly discusses future directions in choroidal imaging including angiography.
Cho, Bum-Joo; Shin, Joo Young; Yu, Hyeong Gon
Pathologic myopia (PM) is one of the leading causes of visual impairment worldwide. The pathophysiology of PM is not fully understood, but the axial elongation of the eye followed by chorioretinal thinning is suggested as a key mechanism. Pathologic myopia may lead to many complications such as chorioretinal atrophy, foveoschisis, choroidal neovascularization, rhegmatogenous retinal detachment, cataract, and glaucoma. Some complications affect visual acuity significantly, showing poor visual prognosis. This article aims to review the types, pathophysiology, treatment, and visual outcome of the complications of PM. PMID:26649982
Bertelsen, Mette; Zernant, Jana; Larsen, Michael;
earliest recorded manifestation of ABCA4-associated disease was a central bull's eye type of macular dystrophy that progressed to chorioretinal atrophy of the macula with coarse rounded hyperpigmentations and expanding involvement of the periphery. The mean age at first presentation was 10.3 years, the...
Kirk, O; Lundgren, Jens Dilling; Pedersen, C;
/100 PY follow-up (95% confidence interval, 0.0-3.2). No cases of cerebral toxoplasmosis, cytomegalovirus chorioretinitis, or disseminated Mycobacterium avium infection were observed. Follow-up time for these was, however, limited. CONCLUSION: PCP-chemoprophylaxis can be safely discontinued after HAART...
Pedersen, C; Gerstoft, J; Tauris, P;
diseases caused by cytomegalovirus and atypical mycobacteria tended to occur later in the course of AIDS. Compared with all other AIDS patients, homosexual men were more likely to develop Kaposi's sarcoma, cytomegalovirus chorioretinitis and mucocutaneous herpes simplex virus infection. The proportion of...
Aicardi syndrome (AIC) is a severe sporadic neurodevelopmental disorder, characterized by a classic triad of agenesis of the corpus callosum, chorioretinal lacunae, and infantile spasms. Because nearly all affected individuals are female and the few known males with AIC have a 47,XXY karyotype, it i...
André Luiz Maltos; Luciana Ligia da Silva; Aderbal Garcia Bernardes Junior; Guilherme Vannucchi Portari; Daniel Ferreira da Cunha
We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, c...
DAYANITHI, GOVINDAN; Desmadryl, Gilles; Travo, Cécile; Chabbert, Christian; Sans, Alain
Trimetazidine (1[2,3,4-trimethoxy-benzyl] piperazine, 2 HCl) is an anti-ischemic agent frequently administered as a prophylactic treatment for episodes of angina pectoris and chorioretinal disturbances. It is also employed as a symptomatic treatment of vertigo but its mechanism of action is yet to be defined. Using Fura-2 fluorescence photometry and whole-cell patch-clamp recordings we investigated the effect of trimetazidine on the [Ca(2+)](i) and current responses induced by the application...
Mitchell, G. A.; Brody, L C; Looney, J; Steel, G.; Suchanek, M.; Dowling, C; Der Kaloustian, V; Kaiser-Kupfer, M; Valle, D
Gyrate atrophy of the choroid and retina (GA) is an autosomal recessive chorioretinal degeneration caused by deficiency of the mitochondrial matrix enzyme, ornithine-delta-aminotransferase (OAT). To study the molecular basis of the mutations causing GA, we cloned and sequenced the human OAT cDNA and determined the intron-exon arrangement of the structural gene. Using the cDNA template, we synthesized antisense RNA probes and performed RNase A protection experiments with RNA from four Lebanese...
Pityriasis alba is a skin disease, commonly seen in children and young adults. This case presents the ocular association of this disease in a 10 years old Pakistani male. Ocular features in this case were poliosis, tilted disc, high myopia and chorioretinal degeneration. Tilted discs and high myopia can be coincidental but poliosis and decreased pigment in retinal pigment epithelium are closely related with the hypopigmentation seen in this disease. (author)
Insler, M. S.; Davlin, L
The case of a 5-month-old black female child with a linear sebaceous naevus syndrome and multiple congenital anomalies is presented. Ocular malformations consisted of colobomatous changes of the lid and retina, dermoid of the conjunctiva, chorioretinal changes, and peripapillary atrophy of the optic nerve. Systemic findings included midline cleft of the secondary palate with involvement by the naevus, bilateral hearing loss, asymmetrical skull bones, ventricular septal defect, epidermal inclu...
Broadhead, Geoffrey K.; Chang, Andrew A
Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy th...
Prontera, P; Bartocci, A; Ottaviani, V.; Isidori, I.; Rogaia, D; Ardisia, C.; Guercini, G.; Mencarelli, A; Donti, E.
Aicardi syndrome (AIS), a rare neurodevelopmental disorder thought to be caused by an X-linked dominant mutation, is characterized by 3 main features: agenesis of corpus callosum, infantile spams and chorioretinal lacunae. A genome-wide study of a girl with AIS lead us to identify a 6q deletion;12q duplication, derived from a maternal 6q;12q translocation. The two intellectually impaired brothers of the proband showed the same genomic anomalies, but not the constellation of features character...
Vakili, Roya; Tauber, Shachar; Lim, Edward S.
PURPOSE: To report a successful case management of a retinal tear post-Laser in situ Keratomileusis (LASIK) and retreatment. RESULTS: A patient with the history of ocular trauma underwent LASIK procedure for myopic astigmatism. Three months post-LASIK, she received additional excimer laser treatment for a symptomatic persistent central island. One month later; the patient experienced a flap tear at the edge of a prior chorioretinal scar. Retinal tear repair was successfully accomplished by in...
El Matri L.; Chebil A; Kort F
Leila El Matri, Ahmed Chebil, Fedra Kort Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia Abstract: Choroidal neovascularization (CNV) is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV), with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visua...
El Matri, Leila
Leila El Matri, Ahmed Chebil, Fedra Kort Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia Abstract: Choroidal neovascularization (CNV) is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV), with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for v...
Doliwa, Christelle; Escotte-Binet, Sandie; Aubert, Dominique; Sauvage, Virginie; Velard, Frédéric; Schmid, Aline; Villena, Isabelle
Several treatment failures have been reported for the treatment of toxoplasmic encephalitis, chorioretinitis, and congenital toxoplasmosis. Recently we found three Toxoplasma gondii strains naturally resistant to sulfadiazine and we developed in vitro two sulfadiazine resistant strains, RH-RSDZ and ME-49-RSDZ, by gradual pressure. In Plasmodium, common mechanisms of drug resistance involve, among others, mutations and/or amplification within genes encoding the therapeutic targets dhps and dhf...
Ungureanu, E; Geamanu, A; Careba, I; Grecescu, M; Gradinaru, S
Rationale. Neovascular glaucoma is the type of glaucoma most refractory to treatment. The most frequent causes are those associated with retinal hypoxia, such as proliferative diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, central retinal arterial occlusion, ischemic ocular syndrome etc. Rare causes of neovascular glaucoma are multiple and are due to VEGF synthesis associated with chorioretinal inflammations or degenerations. We present a case with neovas...
BACKGROUND: Myopia is an important public health problem because it is common and is associated with increased risk for chorioretinal degeneration, retinal detachment, and other vision-threatening abnormalities. In animals, ocular elongation and myopia progression can be lessened with atropine treatment. This study provides information about progression of myopia and atropine therapy for myopia in humans. METHODS: A total of 214 residents of Olmsted County, Minnesota (118 girls and 96 boys; m...
André Luiz Maltos
Full Text Available We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.
Oytun Erbaş; Hüseyin Serdar Akseki; Betül Eliküçük; Dilek Taşkıran
Trimetazidine (TMZ) has been used as an anti-ischemic agent for angina pectoris, chorioretinal disturbances, and vertigo. Also, it can induce extrapyramidal type adverse reaction such as parkinsonism, gait disorder, and tremor via blockade of D2 receptors. In the present study, we evaluated the effect of TMZ on novelty-induced rearing behavior and apomorphine-induced stereotypy behavior in male rats. Four groups of rat (n = 7) were administrated with TMZ (10 and 20 mg/kg, i.p.), chlorpromazin...
Full Text Available Gyrate atrophy of the choroid and retina is a rare chorioretinal degeneration inherited by on autosonal recessive mode of transmission. It is caused by mutation in gene for ornithine aminotransferase (OAT, located on chromosome 10. It is characterised by high myopia with astigmatism, night blindness during 2 nd and 3 rd decade with a slowly progressive posterior sub capsular cataract. Once diagnosed paediatrician/physician and Ophthalmologist should be aware of the follow up. No single therapy has been shown to halt the progression of the disease.
Granzotto, Enrico; Prado, Cecilia Hissae Miyake Almeida; Barros, Andre Della Barba; Botter, Carlos Eduardo [Clinica Radiologica Documenta Ltda., Ribeirao Preto, SP (Brazil)]. E-mail: firstname.lastname@example.org; Mendes, Rozana de Miranda [Santa Casa de Ribeirao Preto, SP (Brazil); Granzotto, Ticiana [Curso de Especializacao em Oftalmologia Professor Ivo Correa Meyer de Porto Alegre, RS (Brazil)
The authors report the findings of Aicardi syndrome, a disease of unknown etiology composed of multiple spasms, chorioretinal lacunae and agenesis of the corpus callosum. They present a case of Aicardi syndrome with characteristic clinical presentation and magnetic resonance imaging findings. The disease, despite being considered rare, has characteristic imaging findings. Over the past years magnetic resonance imaging has improved its ability in demonstrating other findings besides agenesis of the corpus callosum, making the radiologist's role very important in the diagnostic suspicion of this disease. (author)
Aslankurt, Murat; Aksoy, Adnan; Aslan, Lokman; Yaşar, İbrahim; Gizir, Harun
Seventeen years old male patient was admitted to the clinic with complaints of pain in the right eye, reduction of vision, painful eye movements and headache for 10 days. Visual acuity was found Snellen 0.2 on the right eye and 1.0 on the left eye. Anterior segment examination was normal. Fundus examination revealed bilateral chorioretinal fold on the papillo-macular bundle and serous macular detachment on the right eye. Fundus angiography (FA) revealed late macular hyperfluorescence due to l...
Full Text Available Scott E Pautler,1 David J Browning2 1Department of Ophthalmology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA; 2Charlotte Ear Eye Nose and Throat Associates, Charlotte, NC, USA Abstract: Uveal effusion syndrome usually causes peripheral chorioretinal detachment, but posterior effusion may present as isolated macular edema with serous macular detachment in the setting of hyperopia and a thickened posterior choroid. Carbonic anhydrase inhibitors may be effective to treat this condition. Keywords: uveal effusion, serous, macular detachment, macular edema
Full Text Available AbstractGyrate atrophy is a rare metabolic disease with autosomal recessive inheritance pattern characterised by hyperornithinemia and typical ocular findings. This report presents a 17-year-old intellectually challenged girl consulting for a progressive fall of visual acuity with night blindness. Fundus examination showed patches of chorioretinal atrophy with typical scalloped borders and peri vascular pigmentation in the equatorial region. Fundus fluroscein angiography revealed characteristic staining pattern. Other ocular associations included myopia and posterior sub capsular cataract. Progressive systemic proximal myopathy was one of the associated features. Dietary supplementation of vitamin B6 was advised.
El Matri, Leila; Chebil, Ahmed; Kort, Fedra
Choroidal neovascularization (CNV) is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV), with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed. PMID:25987831
Full Text Available Abstract Background Live intraocular nematode is a rare occurrence. Nematode can migrate actively within the eye, creating visual symptoms and damaging ocular tissue. Case presentation A 26-year old man presented with painless reduced vision of the left eye for one week duration. It was associated with floaters. Visual acuity on the left eye was hand movement. Anterior segment examination was normal with normal intra-ocular pressure. Fundus examination showed a live nematode lying subretinally at the macular area with macular oedema and multifocal chorioretinal lesions at peripheral retina. There was no vitritis, vasculitis or any retinal hemorrhage. Systemic examination revealed normal findings and laboratory studies only showed leucocytosis with normal eosinophil count and negative serum toxocara antibody. The diagnosis of introcular nematode with diffuse unilateral subacute neuroretinitis was made. He was treated with oral anti-helminths and a course of oral steroid at a reducing dose. The nematode had died evidenced by its immobility during the treatment and finally disintegrated, leaving macular oedema with mottling appearance and mild hyperpigmentation. Multifocal chorioretinal lesions had also resolved. However despite treatment his visual acuity during follow-up had remained poor. Conclusions Cases of intraocular nematode, though not commonly encountered, continue to present the ophthalmologist with the problem of diagnosis and management and hence poorer prognosis to the patient.
Full Text Available AIM: Study of peripheral retinal degeneration in relation to axial length of eyeball in myopic patient. METHOD: Study of 200 eyes of 100 patients who attended our hospital between 2010-2012.Detailed history was taken in every case. Inclusion criteria were patient with age group of 11years -70years, Patient with myopia. Exclusion criteria were patient with photopsia, history of trauma, diabetes hypertensive and undergone RD surgeries. Vision and refraction with Streak Retinoscopy was done. Axial length was recorded by A-scan biometry. Fundoscopy was done in all cases. RESULT: In our study number of males was 54 and females were 46. Peripheral chorioretinal lesions were noted to be associated with increased axial length of eye1, 2 .Greater the antero-posterior ocular diameter the greater chance of peripheral chorioretinal degeneration2. CONCLUSION: Examination of periphery of retina is important in all myopic cases. Lattice degenerations are most common lesions1, 3. 60% of lesions are found in superotemporal quadrant. Tendency of bilaterality4 is noted in all degenerations except paving stone degeneration. Prevalence of lattice degeneration is maximum in axial length between 28-30mm5.
Full Text Available Purpose: To report a patient erroneously diagnosed with tuberculous choroiditis who was accordingly treated with long term steroids which in turn, worsened the actual disease process that turned out to be central serous chorioretinopathy (CSC. Case Report: A 59-year-old Caucasian man developed a chorioretinal disease in his right eye in 1997. Having a positive tuberculin skin test, tuberculous chorioretinitis was suspected and antituberculous therapy was administered for 4 months. In 2005, visual symptoms in the same eye recurred and despite negative interferon gamma release assay, tuberculous choroiditis was considered as the diagnosis and the patient further received massive corticosteroid therapy along with antituberculous agents. Despite a deteriorating clinical picture, therapy was continued. Upon initial examination at our center, no sign of inflammation was observed and a diagnosis of CSC was made, consequently steroid therapy was terminated. Conclusion: In some chorioretinopathies, it is difficult to differentiate inflammatory from non-inflammatory causes. One should observe the course of the disease and question the initial diagnosis when no improvement or deterioration occurs despite therapy.
Full Text Available Ioannis Asproudis,1 Ioannis Koumpoulis,1 Chris Kalogeropoulos,1 Georgios Sotiropoulos,1 Margarita Papassava,2 Miltiadis Aspiotis11Department of Ophthalmology, Medical School, University of Ioannina, 2Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina, GreeceAbstract: We report a case of a newborn male child with congenital toxoplasmosis. During pregnancy seroconversion occurred and positive titers of antitoxoplasmic antibodies (immunoglobulin M and G were found in the mother, in the third trimester. She received treatment with spiramycin. After birth, the neonate presented with chorioretinitis and intracranial calcifications. The neonate received treatment with pyrimethamine, sulfadiazine, and leucovorin for 1 year. In addition to using a previously described method, we report for the first time in Greece an estimation regarding the percentage of ocular toxoplasmosis caused by congenital or acquired infection. We estimate that ocular toxoplasmosis in Greece is caused in 7% of the cases by congenital infection, and in 93% of the cases by acquired infection.Keywords: toxoplasmosis, ocular, congenital, acquired, chorioretinitis
João Carlos de Miranda Gonçalves
Full Text Available PURPOSE: Transscleral diode retinal photocoagulation (diopexy is becoming an accepted technique in the treatment of selected retinal diseases. The objective of this study is to evaluate diopexy technique in the production of adhesive chorioretinal lesions during the surgical treatment of the rhegmatogenous retinal detachment. METHODS: 25 patients with rhegmatogenous retinal detachment were enrolled in a prospective clinical-surgical study to evaluate the technique of transscleral diode laser photocoagulation to obtain adhesive chorioretinal lesions during retinal reattachment surgery. The surgery consisted of the placement of an exoplant silicon to produce a buckle effect combined with a drainage of subretinal fluid in most cases. RESULTS: By a mean follow-up of 10 months, 21 of 25 eyes had their retinas reattached after only one surgery with diopexy used in all cases. CONCLUSION: Transscleral diode laser photocoagulation was a technically easy, controlled, effective, reproducible and safe means of obtaining chorioretinal adhesion in retinal reattachment surgery.OBJETIVO: Fotocoagulação transescleral com laser de diodo (diopexia está se tornando técnica utilizada no tratamento de algumas doenças retinianas. O objetivo deste estudo é avaliar a técnica de diopexia na produção de lesões coriorretinianas aderentes durante o tratamento cirúrgico do descolamento de retina regmatogênico. MÉTODOS: Vinte e cinco pacientes com descolamento de retina regmatogênico participaram deste estudo clínico-cirúrgico prospectivo para avaliar a técnica de fotocoagulação com laser de diodo transescleral para obter lesões coriorretinianas aderentes durante a cirurgia de descolamento de retina. A cirurgia consistiu de colocação de explante de silicone para produzir efeito de introflexão escleral combinado com drenagem do líquido subretiniano na maioria dos casos. RESULTADOS: Após um período médio de seguimento de 10 meses, em 21 dos 25 olhos
Full Text Available The aim of this study is to report a clinical case of asymptomatic female Caucasian children with torpedo maculopathy. A 5-year-old girl was referred to our clinic for routine evaluation. The ophthalmic examination revealed best-corrected visual acuity of 20/20 in both eyes, without any changes in the biomicroscopy. Fundus examination showed normal findings in one eye, whereas in the contralateral eye it disclosed, in the temporal sector of the macular region, a whitish, atrophic, oval chorioretinal lesion with clearly defined margins. Posterior evaluations documented the stability of the lesion. Torpedo maculopathy diagnosis is based on its characteristic shape and peculiar location. The differential diagnosis has to be estabilished versus choroidal lesions (melanoma and nevus, congenital or iatrogenic hyperplasia of the retinal pigment epithelium (RPE and particularly versus the congenital pigmented lesions associated with Gardner's syndrome.
Full Text Available Sarah Escott, Ahmad B Tarabishy, Frederick H DavidorfHavener Eye Institute, The Ohio State University, Columbus, OH, USAAbstract: The paper describes the first reported case of multifocal choroiditis following simultaneous hepatitis-A, typhoid, and yellow fever vaccinations. A 33-year-old male developed sudden onset of flashing lights and floaters in his right eye 3 weeks following hepatitis A, typhoid, and yellow fever vaccinations. Fundus examination and angiography confirmed the presence of multiple peripheral chorioretinal lesions. These lesions demonstrated characteristic morphologic changes over a period of 8 weeks which were consistent with a diagnosis of self-resolving multifocal choroiditis. Vaccine-induced intraocular inflammation has been described infrequently. We demonstrate the first case of self-resolving multifocal choroiditis following simultaneous administration of hepatitis A, yellow fever, and typhoid immunizations.Keywords: multifocal choroiditis, vaccination, hepatitis A, typhoid, yellow fever
Janet L. Davis
Full Text Available Current data permit only speculations regarding sex differences in the prevalence of infectious uveitis between women and men because uveitis case surveys do not uniformly report gender data. Differences in prevalence that are reported in the literature could relate to simple differences in the number of women and men at risk for infection or to biological differences between men and women. Compared to other types of uveitis, infectious uveitis may be directly related to occupational exposures or sexual behaviors, which differ between women and men, and may mask actual biological differences in susceptibility to ocular manifestations of the infection and its prognosis. In infectious uveitis for which there is no element of sexual transmission and data is available, prevalence of ocular disease is roughly equal between women and men. Women also have a unique relationship with infectious uveitis in their role as mothers. Vertical transmission of infections such as herpes simplex, toxoplasmosis, and cytomegalovirus can produce severe chorioretinitis in neonates.
Chawla, Rohan; Tripathy, Koushik; Gogia, Varun; Venkatesh, Pradeep
We describe two young immunocompetent women presenting with bilateral retinitis with outer retinal necrosis involving posterior pole with centrifugal spread and multifocal lesions simulating progressive outer retinal necrosis (PORN) like retinitis. Serology was negative for HIV and CD4 counts were normal; however, both women were on oral steroids at presentation for suspected autoimmune chorioretinitis. The retinitis in both eyes responded well to oral valaciclovir therapy. However, the eye with the more fulminant involvement developed retinal detachment with a loss of vision. Retinal atrophy was seen in the less involved eye with preservation of vision. Through these cases, we aim to describe a unique evolution of PORN-like retinitis in immunocompetent women, which was probably aggravated by a short-term immunosuppression secondary to oral steroids. PMID:27511757
El Matri L
Full Text Available Leila El Matri, Ahmed Chebil, Fedra Kort Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia Abstract: Choroidal neovascularization (CNV is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV, with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed. Keywords: myopia, choroidal neovascularization, current treatment, emerging treatment
Full Text Available We tried to evaluate prevalence and characteristics of Iranian HIV infected patients with retinitis due to opportunistic infections. In this cross sectional study, we evaluated 106 HIV infected patients via indirect ophthalmoscopy and slit lamp examination by 90 lens to find retinitis cases. General information and results of ophthalmologic examination were analyzed. Prevalence of retinitis due to opportunistic infections was 6.6%: cytomegalovirus (CMV retinitis 1.88%, toxoplasmosis retinochoroiditis 1.88% and tuberculosis chorioretinitis 2.83%. CD4 count was higher than 50 cell/µlit in both cases with CMV retinitis. Along with increasing survival in the HIV infected patients, the prevalence of complications such as ocular manifestation due to opportunistic infections are increasing and must be more considered.
José Alexandre Bastos
Full Text Available Relatamos um caso de síndrome de Aicardi completa em criança do sexo feminino de 2 meses de idade com defeitos lacunares da coróide, espasmos em flexão, agenesia de corpo caloso e alterações eletrencefalográficas do tipo hipsarritmia assimétrica e alterna atendida no Serviço de Neuropediatria e Neurofisiologia clínica do Hospital de Base de São José do Rio Preto, SP .We report a case of Aicardi syndrome in a female child with 2 month old, ocular abnormalities "chorioretinal lacunae", flexion in spasms, hipsarrhythmic "split brain", callosal agenesis refered to Service of Neuropediatric and Neurophysiology of Base Hospital of São José do Rio Preto, SP, Brazil.
Вологжанина, Елена; Канычева, Наталья; Степнов, Михаил; Синевич, Ольга
Описан случай диагностики позднего врожденного сифилиса (врожденный хориоретинит, периостит, гуммы) у девочки в возрасте 3-х лет.The case of the late congenital syphilis (congenital chorioretinitis, periostitis, gummas) diagnostic of 3 years-old girl is described.
Lund, O E; Förster, C; Bise, K
SSPE, the incidence of which is highest in children of school-age, is relatively frequently associated with bilateral acute central chorioretinitis (30%). Less common are initial visual disturbances in SSPE resulting from inflammatory processes of the encephalitis affecting cortical (occipital) areas and the visual pathways. We report on 2 cases detected after the patients had difficulty in reading and non-characteristic visual field defects. The diagnosis of panencephalitis may be confirmed by electrophoresis of spinal tap and of the EEG. The course of the disease is delayed and frequently lethal. Undefined, and at times seemingly psychogenic visual disturbances in children should always prompt immediate and intensive diagnostic efforts including pediatric and neurologic examination. PMID:6865251
Prontera, P; Bartocci, A; Ottaviani, V; Isidori, I; Rogaia, D; Ardisia, C; Guercini, G; Mencarelli, A; Donti, E
Aicardi syndrome (AIS), a rare neurodevelopmental disorder thought to be caused by an X-linked dominant mutation, is characterized by 3 main features: agenesis of corpus callosum, infantile spams and chorioretinal lacunae. A genome-wide study of a girl with AIS lead us to identify a 6q deletion;12q duplication, derived from a maternal 6q;12q translocation. The two intellectually impaired brothers of the proband showed the same genomic anomalies, but not the constellation of features characterizing the AIS. This could be either a coincidental observation of 2 rare conditions, but can also suggest an alternative hypothesis for the genetic etiology of AIS, indicating the existence of a subset of autosomal genes whose mutation could act in a sex-confined manner. PMID:23801936
Pedersen, C; Gerstoft, J; Tauris, P;
We analysed cumulative disease frequencies in the first 231 adult Danish AIDS patients with life tables. There was a certain hierarchical pattern in the occurrence of complicating diseases. Herpes zoster, Kaposi's sarcoma and Pneumocystis carinii pneumonia were early manifestations, whereas...... diseases caused by cytomegalovirus and atypical mycobacteria tended to occur later in the course of AIDS. Compared with all other AIDS patients, homosexual men were more likely to develop Kaposi's sarcoma, cytomegalovirus chorioretinitis and mucocutaneous herpes simplex virus infection. The proportion of...... patients who developed particular diseases changed with calendar time. Most striking was a three to fourfold decrease in diseases caused by cytomegalovirus. In conclusion, the study showed that disease frequencies in patients with AIDS may vary with the patients risk behaviour and duration of AIDS, and...
Full Text Available Toxoplamosis is a parasitic zoonosis which occurs worldwide, but is prevalent in Europe, South America and Africa. When infection occurs for the first time during pregnancy, mother to child transmission of the parasite can cause congenital toxoplasmosis. Rate of congenital infection ranges from less than 0.1 to approximately 1 per 1,000 live births. The risk of transmission depends on the gestational age at the time of maternal infection. A diagnosis of congenital toxoplasmosis is usually considered in infants who present: hydrocephalus, chorioretinitis, and intracranial calcifications, but this triade is very rare. Approximately 85% of the infants with congenital toxoplasmosis are clinically normal at birth; however, sequelae of infection may become apparent only months or even years later. Chorioretinitis is the main complication of congenital toxoplasmosis, late onset retinal lesions and relapse can appear many years after birth, but the overall ocular prognosis is satisfactory when infection is identified and treated accordingly. Fortunately, serious neonatal forms and severe neurological impairment have become rare, but prompt treatment of children with convulsions, abnormal muscle tone, hydrocephalus, may improve the prognosis and result in almost normal outcome. For infants who have congenital toxoplasmosis, treatment soon after birth for 1 year with pyrimetamine, sulfadiazine and leukoverin led to remarkable resolution of serious, active disease. A long follow-up is necessary to assess the long-term outcome of children and young adults with congenital toxoplasmosis, that is favourable for the majority of cases. Epidemiological surveillance needs to be improved in order to determine the effectiveness of prevention programs.Articoli Selezionati del “3° Convegno Pediatrico del Medio Campidano” · Guspini · 25 Maggio 2013Guest Editor: Roberto Antonucci
Daniel da Rocha Lucena
Full Text Available Trata-se de série retrospectiva de 10 pacientes com rotura retiniana e retinocoroidite por toxoplasmose atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, de janeiro de 2007 a abril de 2008, com objetivo de avaliar a relação entre lesões de retinocoroidite e a ocorrência de rotura retiniana. Foram utilizados teste de Fisher e qui-quadrado com nível de significância pThis study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80% had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50%. No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828 or three zones (p=0.2507. The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.
Full Text Available Subramaniam Suresh1, Saidin Nor-Masniwati1, Muhd Nor Nor-Idahriani1, Wan-Hitam Wan-Hazabbah1, Mohamed Zeehaida2, Embong Zunaina11Department of Ophthalmology, 2Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MalaysiaBackground: The purpose of this study was to evaluate the immunoglobulin (Ig G avidity of serological toxoplasmosis testing in patients with ocular inflammation and to determine the clinical manifestations of ocular toxoplasmosis.Methods: A retrospective review of all patients presenting with ocular inflammation to the Hospital Universiti Sains Malaysia, Kelantan, Malaysia between 2005 and 2009 was undertaken. Visual acuity, clinical manifestations at presentation, toxoplasmosis antibody testing, and treatment records were analyzed.Results: A total of 130 patients with ocular inflammation were reviewed retrospectively. The patients had a mean age of 38.41 (standard deviation 19.24, range 6–83 years. Seventy-one patients (54.6% were found to be seropositive, of whom five (3.8% were both IgG and IgM positive (suggestive of recently acquired ocular toxoplasmosis while one (0.8% showed IgG avidity ≤40% (suggestive of recently acquired ocular toxoplasmosis and 65 patients (50.0% showed IgG avidity >40% (suggestive of reactivation of toxoplasmosis infection. Chorioretinal scarring as an ocular manifestation was significantly more common in patients with seropositive toxoplasmosis (P = 0.036. Eighteen patients (13.8% were diagnosed as having recent and/or active ocular toxoplasmosis based on clinical manifestations and serological testing.Conclusion: Ocular toxoplasmosis is a clinical diagnosis, but specific toxoplasmosis antibody testing helps to support the diagnosis and to differentiate between reactivation of infection and recently acquired ocular toxoplasmosis.Keywords: ocular toxoplasmosis, chorioretinal scar, toxoplasmosis antibody, IgG avidity test
Full Text Available The evolution and persistence of ocular pathology was assessed in a cohort of Onchocerca volvulus infected patients treated annually with ivermectin for 23 years. Patients were resident in rural Central and Kara Region of Togo and ocular examinations included testing of visual acuity, slit lamp examination of the anterior eye segment and the eye fundus by ophthalmoscopy. Before ivermectin treatment, vivid O.volvulus microfilariae (MF were observed in the right and left anterior eye chamber in 52% and 42% of patients (n = 82, and dead MF were seen in the right and left cornea in 24% and 15% of cases, respectively. At 23 years post initial treatment (PIT, none of the patients (n = 82 presented with MF in the anterior chamber and cornea. A complete resolution of punctate keratitis (PK lesions without observable corneal scars was present at 23 years PIT (p<0.0001, and sclerosing keratitits (SK lessened by half, but mainly in patients with lesions at early stage of evolution. Early-stage iridocyclitis diminished from 42%(rE and 40%(lE to 13% (rE+lE(p<0.0001, but advanced iridocyclitis augmented (p<0.001 at 23 years PIT compared to before ivermectin. Advanced-stage papillitis and chorioretinitis did not regress, while early-stage papillitis present in 28%(rE and 27%(lE of patients at before ivermectin regressed to 17%(rE and 18%(lE, and early-stage chorioretinitis present in 51%(rE+lE of cases at before ivermectin was observed in 12%(rE and 13%(lE at 23 years PIT (p<0.0001. Thus, regular annual ivermectin treatment eliminated and prevented the migration of O. volvulus microfilariae into the anterior eye chamber and cornea; keratitis punctata lesions resolved completely and early-stage sclerosing keratitits and iridocyclitis regressed, whilst advanced lesions of the anterior and posterior eye segment remained progressive. In conclusion, annual ivermectin treatments may prevent the emergence of ocular pathology in those populations still exposed
O. V. Chudinova
Full Text Available Purpose: to study the morphometric changes in retina and the state of regional hemodynamics for chorioretinites of different etiology, to draw parallels between these methods of study with evaluation of their diagnostical significance.Methods: Clinical and instrumental examination was performed in 15 patients (15 eyes — group 1 — with the verified diagnosis of toxoplasmous chorioretinitis and in 13 patients (13 eyes — group 2 — with the diagnosis of tuberculous chorioretinitis. Control (group 3 consisted of 20 subjects (40 eyes, 9 males, 11 females, without any pathology of organ of vision. Complex ophthalmologic examination was performed in all the patients; the examination included the following procedures: determination of visual acuity with correction, computer perimetry, biomicroscopy of eye fundus, inspection of eye fundus using Goldman lens, optic coherent tomogra- phy (OCt, ultrasound Dopplerography (USDG of eye vessels.Results: the following was determined by OCt data: subclinical serous retinal detachment, isolated cells of cyst-like edema, cyst- like edema in macular zone, unevenness of hyperreflective band of pigment epithelium, thinning of neurosensory retina in the area of scarry focus, hyperreflectivity of the zone of the fibrosis being formed, architectonics disorder of NE layers in foveolar zone and para- foveally at the expense of the presence of small hyperreflective parts. In the presence of proliferative process in the vascular coat the reliable decrease of blood flow maximal and minimal velocities in the posterior short ciliary arteries, maximal and minimal velocities of blood flow in the posterior long ciliary arteries in comparison with the values of patients from control group. the data obtained are supposed that proliferative processes in the vascular coat are accompanied by marked local hemodynamic disorders, which should be taken into consideration when complex therapy is prescribed.Conclusion: Dynamic
Pleyer, U; Klauß, V; Wilking, H; Nentwich, M M
A number of "new" (emerging) infections that can also cause inflammatory eye changes are appearing and becoming increasingly important. In the past, diseases such as chikungunya, dengue fever or West Nile virus infections were endemic in tropical regions, but are now expanding worldwide and causing significant morbidity and even mortality. "Globalization" and human migration are important factors leading to the import of these infections. Climate changes are probably even more important. Increasing temperatures provide suitable conditions for new vectors, and may lead to autochthonous transmission of infectious pathogens. Diagnosis of these diseases requires not only careful assessment of medical and travel history, but also the application of specific laboratory diagnostic tests. A broad spectrum of ocular involvement has been reported, with frequent posterior segment involvement. Emerging infections should therefore be considered in the differential diagnosis of retinitis, chorioretinitis, retinal vasculitis and optic neuropathy in a patient living in or traveling back from an endemic area. Since these infections are often vector (insect) borne and effective treatments are almost uniformly lacking, prevention is at least as important as prompt diagnosis and initiation of supportive care. Here, we focus on Chikungunya, Dengue fever, Ebola fever, the West Nile virus and Rickettsioses, which frequently demonstrate ocular involvement. PMID:26649438
Full Text Available Myopia is a common ocular disorder generally due to increased axial length of the eye-globe. Its extreme form high myopia (HM is a multifactorial disease leading to retinal and scleral damage, visual impairment or loss and is an important health issue. Mutations in the endocytic receptor LRP2 gene result in Donnai-Barrow (DBS and Stickler syndromes, both characterized by HM. To clearly establish the link between Lrp2 and congenital HM we inactivated Lrp2 in the mouse forebrain including the neural retina and the retinal and ciliary pigment epithelia. High resolution in vivo MRI imaging and ophthalmological analyses showed that the adult Lrp2-deficient eyes were 40% longer than the control ones mainly due to an excessive elongation of the vitreal chamber. They had an apparently normal intraocular pressure and developed chorioretinal atrophy and posterior scleral staphyloma features reminiscent of human myopic retinopathy. Immunomorphological and ultrastructural analyses showed that increased eye lengthening was first observed by post-natal day 5 (P5 and that it was accompanied by a rapid decrease of the bipolar, photoreceptor and retinal ganglion cells, and eventually the optic nerve axons. It was followed by scleral thinning and collagen fiber disorganization, essentially in the posterior pole. We conclude that the function of LRP2 in the ocular tissues is necessary for normal eye growth and that the Lrp2-deficient eyes provide a unique tool to further study human HM.
Khairallah, Moncef; Kahloun, Rim; Ben Yahia, Salim; Jelliti, Bechir; Messaoud, Riadh
Emergent and resurgent arthropod vector-borne diseases are major causes of systemic morbidity and death and expanding worldwide. Among them, viral and bacterial agents including West Nile virus, Dengue fever, Chikungunya, Rift Valley fever, and rickettsioses have been recently associated with an array of ocular manifestations. These include anterior uveitis, retinitis, chorioretinitis, retinal vasculitis and optic nerve involvement. Proper clinical diagnosis of any of these infectious diseases is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by the detection of a specific antibody in serum. Ocular involvement associated with emergent infections usually has a self-limited course, but it can result in persistent visual impairment. There is currently no proven specific treatment for arboviral diseases, and therapy is mostly supportive. Vaccination for humans against these viruses is still in the research phase. Doxycycline is the treatment of choice for rickettsial diseases. Prevention, including public measures to reduce the number of mosquitoes and personal protection, remains the mainstay for arthropod vector disease control. Influenza A (H1N1) virus was responsible for a pandemic human influenza in 2009, and was recently associated with various posterior segment changes. PMID:23258387
Llorente, Antolin M; Castillo, Christine L
Cytomegalovirus (CMV) is the most ubiquitous member of the herpes virus family and is the leading cause of congenital (vertical) infection in newborns (Fowler, Stagno, & Pass, 2003; Llorente, Steigmeyer, Cooper, Rivers, & Gazley, 2011; Noyola et al., 2000; Steigmeyer & Llorente, 2010). CMV is related to the group of viruses capable of causing more pernicious infectious diseases, such as chicken pox (Santos de Barona, 1998). Although the virus generally remains dormant, individuals whose symptoms are clinically apparent often are dramatically affected. Common symptomatic characteristics of the virus include microcephaly, jaundice, liver-spleen infections, pneumonia, cardiac anomalies, chorioretinitis, vision loss, sensory-neural hearing loss, mental retardation, and mononucleosis (Demmler, 1991; Kashden, Frison, Fowler, Pass, & Boll, 1998; Noyola et al., 2000; Pass, 2005; Santos de Barona). The prognosis of individuals with CMV is highly variable, and the prognosis of individuals with congenital CMV can usually be determined based on the extent of infection at birth. The purpose of this investigation is to present longitudinal results of neuropsychological evaluation of two dizygotic twin sets (one twin of each set is asymptomatic CMV-positive and the other is uninfected) who were reared in the same environment. In addition, the present findings are discussed within the context of emerging murine and other animal analogues of CMV as well as within the extant CMV literature. PMID:23428280
Brownlee, W J; Anderson, N E; Sims, J; Pereira, J A
Acute multifocal placoid pigment epitheliopathy (AMPPE) is an autoimmune chorioretinal disease that can be complicated by neurological involvement. There is limited information on this potentially treatable condition in the neurological literature. The objective of this patient series is to describe the neurological complications of AMPPE. We retrospectively identified patients with neurological complications of AMPPE seen at Auckland Hospital between 2008 and 2013 and summarised cases in the literature between 1976 and 2013. We identified five patients with neurological complications of AMPPE at Auckland Hospital and 47 reported patients. These patients demonstrated a spectrum of neurological involvement including isolated headache, stroke or transient ischaemic attack, seizures, venous sinus thrombosis, optic neuritis, sensorineural hearing loss and peripheral vestibular disorder. We propose criteria to define AMPPE with neurological complications. A cerebrospinal fluid (CSF) lymphocytosis in a patient with isolated headache may predict the development of cerebrovascular complications of AMPPE. Patients with cerebrovascular complications of AMPPE have a poor prognosis with high rates of death and neurological disability among survivors. Predictors of poor outcome in those who develop neurological complications of AMPPE are a relapsing course, generalised seizures and multifocal infarction on MRI. All patients with neurological complications of AMPPE, including headache alone, should be investigated with an MRI brain and CSF examination. Patients with focal neurological symptoms should receive intravenous (IV) methylprednisolone followed by a tapering course of oral steroids for at least 3months. Patients with AMPPE and an isolated headache with a CSF pleocytosis should be treated with oral steroids. PMID:27183958
Schimiti Rui Barroso
Full Text Available Purpose: To establish the prevalence of refractive errors and ocular disorders in preschool and schoolchildren of Ibiporã, Brazil. Methods: A survey of 6 to 12-year-old children from public and private elementary schools was carried out in Ibiporã between 1989 and 1996. Visual acuity measurements were performed by trained teachers using Snellen's chart. Children with visual acuity <0.7 in at least one eye were referred to a complete ophthalmologic examination. Results: 35,936 visual acuity measurements were performed in 13,471 children. 1.966 children (14.59% were referred to an ophthalmologic examination. Amblyopia was diagnosed in 237 children (1.76%, whereas strabismus was observed in 114 cases (0.84%. Cataract (n=17 (0.12%, chorioretinitis (n=38 (0.28% and eyelid ptosis (n=6 (0.04% were also diagnosed. Among the 614 (4.55% children who were found to have refractive errors, 284 (46.25% had hyperopia (hyperopia or hyperopic astigmatism, 206 (33.55% had myopia (myopia or myopic astigmatism and 124 (20.19% showed mixed astigmatism. Conclusions: The study determined the local prevalence of amblyopia, refractive errors and eye disorders among preschool and schoolchildren.
Kolomeyer, Anton M; Baumrind, Benjamin R; Szirth, Bernard C; Shahid, Khadija; Khouri, Albert S
We investigated the use of fundus autofluorescence (FAF) imaging in screening the eyes of patients with diabetes. Images were obtained from 50 patients with type 2 diabetes undergoing telemedicine screening with colour fundus imaging. The colour and FAF images were obtained with a 15.1 megapixel non-mydriatic retinal camera. Colour and FAF images were compared for pathology seen in nonproliferative and proliferative diabetic retinopathy (NPDR and PDR, respectively). A qualitative assessment was made of the ease of detecting early retinopathy changes and the extent of existing retinopathy. The mean age of the patients was 47 years, most were male (82%) and most were African American (68%). Their mean visual acuity was 20/45 and their mean intraocular pressure was 14.3 mm Hg. Thirty-eight eyes (76%) did not show any diabetic retinopathy changes on colour or FAF imaging. Seven patients (14%) met the criteria for NPDR and five (10%) for severe NPDR or PDR. The most common findings were microaneurysms, hard exudates and intra-retinal haemorrhages (IRH) (n = 6 for each). IRH, microaneurysms and chorioretinal scars were more easily visible on FAF images. Hard exudates, pre-retinal haemorrhage and fibrosis, macular oedema and Hollenhorst plaque were easier to identify on colour photographs. The value of FAF imaging as a complementary technique to colour fundus imaging in detecting diabetic retinopathy during ocular screening warrants further investigation. PMID:24163061
Zinc, an essential trace element, is present in unusually high concentrations in the chorioretinal complex relative to most other tissues. Because little has been known about the interactions between the retinal pigment epithelium and free or protein-associated zinc, we studied 65Zn uptake by human retinal pigment epithelium in vitro. When monolayers were exposed to differing concentrations from 0 to 30 microM 65Zn in Dulbecco's modified Eagle's medium with 5.4 gm/l glucose at 37 degrees C and 4 degrees C, we observed a temperature-dependent saturable accumulation of the radiolabel. With 15 microM 65Zn, we saw a biphasic pattern of uptake with a rapid first phase and a slower second phase over 120 min. Uptake of 65Zn was inhibited by iodacetate and cold, and reduced approximately 50% by the addition of 2% albumin to the labelling medium. Neither ouabain nor 2-deoxyglucose inhibited uptake. Cells previously exposed to 65Zn retained approximately 70% of accumulated 65Zn 60 min after being changed to radiolabel-free medium. Following removal of cells from the extracellular matrix adherent to the dish bottom, a variable amount of nonspecific binding of 65Zn to the residual matrix was demonstrated. These observations are consistent with a facilitated type of transport and demonstrate the ability of human retinal pigment epithelium in vitro to accumulate and retain zinc
J. A. Zhou
Full Text Available This article reports on a retinal stimulation system for long-term use in animal electrical stimulation experiments. The presented system consisted of an implantable stimulator which provided continuous electrical stimulation, and an external component which provided preset stimulation patterns and power to the implanted stimulator via a paired radio frequency (RF coil. A rechargeable internal battery and a parameter memory component were introduced to the implanted retinal stimulator. As a result, the external component was not necessary during the stimulation mode. The inductive coil pair was used to pass the parameter data and to recharge the battery. A switch circuit was used to separate the stimulation mode from the battery recharging mode. The implantable stimulator was implemented with IC chips and the electronics, except for the stimulation electrodes, were hermetically packaged in a biocompatible metal case. A polyimide-based gold electrode array was used. Surgical implantation into rabbits was performed to verify the functionality and safety of this newly designed system. The electrodes were implanted in the suprachoroidal space. Evoked cortical potentials were recorded during electrical stimulation of the retina. Long-term follow-up using OCT showed no chorioretinal abnormality after implantation of the electrodes.
Vetrivel, Umashankar; Muralikumar, Shalini; Mahalakshmi, B; Lily Therese, K; Madhavan, H N; Alameen, Mohamed; Thirumudi, Indhuja
Toxoplasma gondii is an intracellular Apicomplexan parasite and a causative agent of toxoplasmosis in human. It causes encephalitis, uveitis, chorioretinitis, and congenital infection. T. gondii invades the host cell by forming a moving junction (MJ) complex. This complex formation is initiated by intermolecular interactions between the two secretory parasitic proteins-namely, apical membrane antigen 1 (AMA1) and rhoptry neck protein 2 (RON2) and is critically essential for the host invasion process. By this study, we propose two potential leads, NSC95522 and NSC179676 that can efficiently target the AMA1 hydrophobic cleft, which is a hotspot for targeting MJ complex formation. The proposed leads are the result of an exhaustive conformational search-based virtual screen with multilevel precision scoring of the docking affinities. These two compounds surpassed all the precision levels of docking and also the stringent post docking and cumulative molecular dynamics evaluations. Moreover, the backbone flexibility of hotspot residues in the hydrophobic cleft, which has been previously reported to be essential for accommodative binding of RON2 to AMA1, was also highly perturbed by these compounds. Furthermore, binding free energy calculations of these two compounds also revealed a significant affinity to AMA1. Machine learning approaches also predicted these two compounds to possess more relevant activities. Hence, these two leads, NSC95522 and NSC179676, may prove to be potential inhibitors targeting AMA1-RON2 complex formation towards combating toxoplasmosis. PMID:27445648
Camila V. Ventura
Full Text Available ABSTRACT Purpose: In 2015, a twenty-fold increase in the prevalence of microcephaly in Brazil was reported, and the Ministry of Health associated this abnormal prevalence with the maternal-fetal Zika virus (ZIKV transmission. Methods: We assessed the ophthalmological findings of ten mothers and their infants that had been clinically diagnosed with ZIKV-related microcephaly and presented ocular abnormalities, born from May to December 2015. Results: Seven mothers (70.0% referred symptoms during pregnancy (malaise, rash and arthralgia, of which six (85.7% were in the first trimester. At the time of exam, no ophthalmological abnormalities were identified in the mothers and they did not report ocular symptoms during pregnancy. Serology was negative in all infants for Toxoplasmosis, Rubella, Cytomegalovirus, Syphilis and Human Immunodeficiency Viruses. Ocular findings included macular alterations (gross pigment mottling and/or chorioretinal atrophy in fifteen eyes (75.0%, and optic nerve abnormalities (hypoplasia with double-ring sign, pallor, and/or increased cup-to-disk ratio in nine eyes (45.0%. Conclusions: Patients presented normal anterior segment and important macular and optic nerve abnormalities. Further studies will assess the visual significance of these alterations.
Ohno-Matsui, Kyoko; Lai, Timothy Y Y; Lai, Chi-Chun; Cheung, Chiu Ming Gemmy
Complications from pathologic myopia are a major cause of visual impairment and blindness, especially in east Asia. The eyes with pathologic myopia may develop loss of the best-corrected vision due to various pathologies in the macula, peripheral retina and the optic nerve. Despite its importance, the definition of pathologic myopia has been inconsistent. The refractive error or axial length alone often does not adequately reflect the 'pathologic myopia'. Posterior staphyloma, which is a hallmark lesion of pathologic myopia, can occur also in non-highly myopic eyes. Recently a revised classification system for myopic maculopathy has been proposed to standardize the definition among epidemiological studies. In this META-PM (meta analyses of pathologic myopia) study classification, pathologic myopia was defined as the eyes having chorioretinal atrophy equal to or more severe than diffuse atrophy. In addition, the advent of new imaging technologies such as optical coherence tomography (OCT) and three dimensional magnetic resonance imaging (3D MRI) has enabled the detailed observation of various pathologies specific to pathologic myopia. New therapeutic approaches including intravitreal injections of anti-vascular endothelial growth factor agents and the advance of vitreoretinal surgeries have greatly improved the prognosis of patients with pathologic myopia. The purpose of this review article is to provide an update on topics related to the field of pathologic myopia, and to outline the remaining issues which need to be solved in the future. PMID:26769165
Sun, Zhuli; Chen, Haoyu; Shi, Fei; Wang, Lirong; Zhu, Weifang; Xiang, Dehui; Yan, Chenglin; Li, Liang; Chen, Xinjian
Pigment epithelium detachment (PED) is an important clinical manifestation of multiple chorioretinal diseases, which can cause loss of central vision. In this paper, an automated framework is proposed to segment serous PED in SD-OCT images. The proposed framework consists of four main steps: first, a multi-scale graph search method is applied to segment abnormal retinal layers; second, an effective AdaBoost method is applied to refine the initial segmented regions based on 62 extracted features; third, a shape-constrained graph cut method is applied to segment serous PED, in which the foreground and background seeds are obtained automatically; finally, an adaptive structure elements based morphology method is applied to remove false positive segmented regions. The proposed framework was tested on 25 SD-OCT volumes from 25 patients diagnosed with serous PED. The average true positive volume fraction (TPVF), false positive volume fraction (FPVF), dice similarity coefficient (DSC) and positive predictive value (PPV) are 90.08%, 0.22%, 91.20% and 92.62%, respectively. The proposed framework can provide clinicians with accurate quantitative information, including shape, size and position of the PED region, which can assist clinical diagnosis and treatment. PMID:26899236
Ferrara, Daniela; Waheed, Nadia K; Duker, Jay S
The body of knowledge of in vivo investigation of the choroid has been markedly enhanced by recent technological advances in optical coherence tomography (OCT). New insights elucidating the morphological features of the choriocapillaris and choroidal vasculature, in both physiological and pathological conditions, indicate that the choroid plays a pivotal role in many posterior segment diseases. In this article, a review of the histological characteristics of the choroid, which must be considered for the proper interpretation of in vivo imaging, is followed by a comprehensive discussion of fundamental principles of the current state-of-the-art in OCT, including cross-sectional OCT, en face OCT, and OCT angiography using both spectral domain OCT and swept source OCT technologies. A detailed review of the tomographic features of the choroid in the normal eye is followed by relevant findings in prevalent chorioretinal diseases, focusing on major causes of vision loss such as typical early and advanced age-related macular degeneration, polypoidal choroidal vasculopathy, central serous chorioretinopathy, pachychoroid spectrum disorders, diabetic choroidopathy, and myopia. PMID:26478514
Full Text Available Trimetazidine (TMZ has been used as an anti-ischemic agent for angina pectoris, chorioretinal disturbances, and vertigo. Also, it can induce extrapyramidal type adverse reaction such as parkinsonism, gait disorder, and tremor via blockade of D2 receptors. In the present study, we evaluated the effect of TMZ on novelty-induced rearing behavior and apomorphine-induced stereotypy behavior in male rats. Four groups of rat ( were administrated with TMZ (10 and 20 mg/kg, i.p., chlorpromazine (1 mg/kg, i.p., or isotonic saline. One hour later, apomorphine (2 mg/kg, s.c. was administrated to each rat. Our results showed that both doses of TMZ significantly decreased the rearing behavior in rats, whereas the decrease with chlorpromazine was higher. TMZ also decreased the stereotypy scores in a dose-dependent manner. We concluded that TMZ has beneficial effects on rearing behavior and stereotypy, which are accepted to be indicators of antipsychotic effect. Taken together, with its antioxidative and cytoprotective properties, TMZ is worthy of being investigated for its anti-psychotic effects as a primary or an adjunctive drug.
Pineda-Alvarez, Daniel E; Solomon, Benjamin D; Roessler, Erich; Balog, Joan Z; Hadley, Donald W; Zein, Wadih M; Hadsall, Casey K; Brooks, Brian P; Muenke, Maximilian
Holoprosencephaly (HPE) is the most common disorder of the developing forebrain in humans, and is characterized by failed or incomplete cleavage of the cerebral hemispheres and deep brain structures. HPE includes wide phenotypic variability, with a continuum of both brain and craniofacial anomalies. While "classic" eye findings, including the spectrum of midline anomalies ranging from cyclopia to hypotelorism, as well as chorioretinal coloboma and microphthalmia, have been frequently described in patients with HPE, other subtle eye anomalies may also occur. In our study we prospectively analyzed a small cohort of 10 patients in whom we identified mutations in SHH, SIX3, ZIC2, or FGF8, the latter of which is a very recently described HPE-associated gene. We found that 9 of 10 patients had at least two ophthalmologic anomalies, including refractive errors, microcornea, microphthalmia, blepharoptosis, exotropia, and uveal coloboma. These findings contribute to the understanding of the phenotypic variability of the HPE spectrum, and highlight findings in one medically important but often incompletely investigated system. PMID:21976454
Fankhauser, F; Funkhouser, A; Kwasniewska, S
The SAPRO program devised for the OCTOPUS 201 automated perimeter, consists of a number of program components. It is designed to be used on the Octopus 201 computer. In its measurement mode, it employs an algorithm which achieves high speed and efficiency. This is made possible by a threshold bracketing strategy which is simpler than the normal OCTOPUS bracketing. Moreover, three grids with test location distributions of increasing resolution are superimposed in succession on the whole or on part of the visual field to be analyzed. Out of the distribution of test locations, only those which fulfill a number of criteria are actually utilized. These criteria must be given and are adaptable to any given clinical problem. As a result, despite the high spatial resolution achieved, only a fraction of the test locations are utilized using SAPRO as compared with a program using a fixed pattern of test locations. The algorithm is thus able to imitate human intelligence, which tends to concentrate stimuli at places which appear to be relevant for the solution of a problem. The results of program SAPRO are disturbed by short- and long-term fluctuations. Their validity is limited, in a manner similar to that encountered in any other threshold determination procedure. A number of printout modes is available which are oriented towards an optimal understanding of the information contained in various examinations. These principles will be illustrated by one case of inactive disseminated chorioretinitis. PMID:3755124
Prayson, Richard A
Hyaline protoplasmic astrocytopathy is a rare disorder marked by an accumulation of protein material in the cytoplasm of astrocytic cells, mostly in the cortex. The finding has been described in Aicardi syndrome (agenesis of the corpus callosum, chorioretinal lacunae and infantile spasms) as well as in patients with pharmacoresistant epilepsy and in association with focal cortical dysplasia, polymicrogyria and nodular heterotopia. This report describes the first case of this entity described in a patient with tuberous sclerosis. The patient was a 3-year-old boy who presented at age 2months with medically intractable seizures. Has mother has a tuberous sclerosis 2 (TSC 2) gene abnormality and a diagnosis of tuberous sclerosis. On imaging, he was noted to have multiple lesions in the left parietal and temporal lobes consistent with focal cortical dysplasia and a subependymal nodule. He additionally had two hypopigmented lesions on the skin. He underwent resection of the left parietal lobe 32months after seizure onset. Histopathologic examination showed eosinophilic cytoplasmic inclusions within astrocytes in the cortex and superficial white matter focally accompanied by a disordered cortical architecture with dysmorphic neurons and balloon cells, consistent with focal cortical dysplasia classified as type IIb according to International League Against Epilepsy classification criteria (ILAE type IIb). At the time of most recent follow-up, 93months postoperatively, he is still experiencing seizures with overall worthwhile improvement while on seizure medication. PMID:27174083
Bourchany, A; Giurgea, I; Thevenon, J; Goldenberg, A; Morin, G; Bremond-Gignac, D; Paillot, C; Lafontaine, P O; Thouvenin, D; Massy, J; Duncombe, A; Thauvin-Robinet, C; Masurel-Paulet, A; Chehadeh, S El; Huet, F; Bron, A; Creuzot-Garcher, C; Lyonnet, S; Faivre, L
Mowat-Wilson syndrome (MWS) is a rare genetic syndrome characterized by a specific facial gestalt, intellectual deficiency, Hirschsprung disease and multiple congenital anomalies. Heterozygous mutations or deletions in the zinc finger E-box-binding homeobox2 gene (ZEB2) cause MWS. ZEB2 encodes for Smad-interacting protein 1, a transcriptional co-repressor involved in TGF-beta and BMP pathways and is strongly expressed in early stages of development in mice. Eye abnormalities have rarely been described in patients with this syndrome. Herein, we describe four patients (two males and two females; mean age 7 years) with MWS and eye malformations. Ocular anomalies included, iris/retinal colobomas, atrophy or absence of the optic nerve, hyphema, and deep refraction troubles, sometimes with severe visual consequences. All eye malformations were asymmetric and often unilateral and all eye segments were affected, similarly to the nine MWS cases with ophthalmological malformations previously reported (iris/chorioretinal/optic disc coloboma, optic nerve atrophy, retinal epithelium atrophy, cataract, and korectopia). In human embryo, ZEB2 is expressed in lens and neural retina. Using the present report and data from the literature, we set out to determine whether or not the presence of eye manifestations could be due to specific type or location of mutations. We concluded that the presence of eye malformations, although a rare feature in MWS, should be considered as a part of the clinical spectrum of the condition. PMID:25899569
Full Text Available Infectious causes should always be considered in all patients with uveitis and it should be ruled out first. The differential diagnosis includes multiple well-known diseases including herpes, syphilis, toxoplasmosis, tuberculosis, bartonellosis, Lyme disease, and others. However, clinicians should be aware of emerging infectious agents as potential causes of systemic illness and also intraocular inflammation. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. This review recapitulates the systemic and ocular mainfestations of several emergent infectious diseases relevant to the ophthalmologist including Rickettsioses, West Nile virus infection, Rift valley fever, dengue fever, and chikungunya. Retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement have been associated with these emergent infectious diseases. The diagnosis of any of these infections is usually based on pattern of uveitis, systemic symptoms and signs, and specific epidemiological data and confirmed by detection of specific antibody in serum. A systematic ocular examination, showing fairly typical fundus findings, may help in establishing an early clinical diagnosis, which allows prompt, appropriate management.
Full Text Available Vogt-Koyanagi-Harada disease (VKH and sympathetic ophthalmia (SO are types of T-cell mediated autoimmune granulomatous uveitis. Although the two diseases share common clinical features, they have certain differences in gender predilections. VKH classically has been reported as more prevalent in females than males, yet some studies in Japan and China have not found differences in gender prevalence. Male patients have a higher risk of chorioretinal degeneration, vitiligo, and worse prognosis. Conversely, the changing levels of estrogen/progesterone during pregnancy and the menstrual cycle as well as higher levels of TGF-β show a protective role in females. Potential causes of female predilection for VKH are associated with HLA-DR and HLA-DQ alleles. SO, a bilateral granulomatous uveitis, occurs in the context of one eye after a penetrating injury due to trauma or surgery. In contrast to the female dominance in VKH, males are more frequently affected by SO due to a higher incidence of ocular injury, especially during wartime. However, no gender predilection of SO has been reported in postsurgical cases. No clinically different manifestations are revealed between males and females in SO secondary to either ocular trauma or surgery. The potential causes of the gender difference may provide hints on future treatment and disease evaluation.
Sun, Zhuli; Shi, Fei; Xiang, Dehui; Chen, Haoyu; Chen, Xinjian
Pigment epithelium detachment (PED) is an important clinical manifestation of multiple chorio-retinal disease processes, which can cause the loss of central vision. A 3-D method is proposed to automatically segment serous PED in SD-OCT images. The proposed method consists of five steps: first, a curvature anisotropic diffusion filter is applied to remove speckle noise. Second, the graph search method is applied for abnormal retinal layer segmentation associated with retinal pigment epithelium (RPE) deformation. During this process, Bruch's membrane, which doesn't show in the SD-OCT images, is estimated with the convex hull algorithm. Third, the foreground and background seeds are automatically obtained from retinal layer segmentation result. Fourth, the serous PED is segmented based on the graph cut method. Finally, a post-processing step is applied to remove false positive regions based on mathematical morphology. The proposed method was tested on 20 SD-OCT volumes from 20 patients diagnosed with serous PED. The average true positive volume fraction (TPVF), false positive volume fraction (FPVF), dice similarity coefficient (DSC) and positive predictive value (PPV) are 97.19%, 0.03%, 96.34% and 95.59%, respectively. Linear regression analysis shows a strong correlation (r = 0.975) comparing the segmented PED volumes with the ground truth labeled by an ophthalmology expert. The proposed method can provide clinicians with accurate quantitative information, including shape, size and position of the PED regions, which can assist diagnose and treatment.
Seema M Thayil
Full Text Available The pathogenesis of intraocular tuberculosis remains poorly understood partly due to the lack of adequate animal models that accurately simulate human disease. Using a recently developed model of ocular tuberculosis following aerosol infection of guinea pigs with Mycobacterium tuberculosis, we studied the microbiological, histological, and clinical features of intraocular tuberculosis infection. Viable tubercle bacilli were cultivated from all eyes by Day 56 after aerosol delivery of ∼200 bacilli to guinea pig lungs. Choroidal tuberculous granulomas showed reduced oxygen tension, as evidenced by staining with the hypoxia-specific probe pimonidazole, and expression of vascular endothelial growth factor (VEGF was detected in the retinal pigment epithelium (RPE and photoreceptors. Fundoscopic examination of M. tuberculosis-infected guinea pig eyes revealed altered vascular architecture and chorioretinal hemorrhage by Day 56 after infection. This model may be useful in further elucidating the pathogenesis of ocular tuberculosis, as well as in developing tools for diagnosis and assessment of antituberculosis treatment responses in the eye.
Wills, Sarah; Pinard, Chantale; Nykamp, Stephanie; Beaufrère, Hugues
This study established ophthalmic reference values and characterized ocular lesions in two captive populations of boreal owls, including 46 eyes of 23 great grey owls (Strix nebulosa) and 38 eyes from 19 snowy owls (Bubo scandiacus). A complete ophthalmologic exam was conducted, including neuro-ophthalmic reflexes, Schirmer tear test I (STT-I), intraocular pressure (IOP) using rebound tonometry, fluorescein staining, horizontal corneal measurements using Jameson calipers, direct and indirect ophthalmoscopy, and ocular ultrasound biometry. Eyes with an STT of owls and snowy owls (IOP: 9.6 ± 2.6 mm Hg and 9.1 ± 1.9 mm Hg, respectively, and STT-I: 9.8 ± 2.8 mm/min and 9.8 ± 2.4 mm/min, respectively). However, snowy owls overall had a significantly larger eye than did great grey owls, reflected in corneal diameters (23.4 ± 1 vs. 20.0 ± 0.8 mm, respectively) and sonographic biometry. In both species, the most common ocular lesions included keratitis, cataracts, chorioretinal lesions, and abnormal pecten. Establishment of reference ocular parameters will help wildlife veterinarians and rehabilitators determine an appropriate treatment plan and will aid in correctly identifying the presence of ocular disease. PMID:27010284
Monica I. Lee
Full Text Available This case describes an emergency department (ED presentation of ocular syphilis in a human immunodeficiency virus (HIV infected patient. This is an unusual presentation of syphilis and one that emergency physicians should be aware of. The prevalence of syphilis has reached epidemic proportions since 2001 with occurrences primarily among men who have sex with men (MSM. This is a case of a 24-year-old male who presented to our ED with bilateral painless vision loss. The patient’s history and ED workup were notable for MSM, positive rapid plasmin reagin (RPR and HIV tests and fundus exam consistent with ocular syphilis, specifically uveitis. Ocular manifestations of syphilis can present at any stage of syphilis. The 2010 Centers for Disease Control and Prevention guidelines now recommend that ocular syphilis be treated as neurosyphilis regardless of the lumbar puncture results. There is a paucity of emergency medicine literature on ocular syphilis. For emergency physicians it is important to be aware of iritis, uveitis, or chorioretinitis as ocular manifestations of neurosyphilis especially in this high-risk population and to obtain RPR and HIV tests in the ED to facilitate early diagnosis, and treatment and to prevent irreversible vision loss.[West J Emerg Med. 2016;17(4:473-476.
Full Text Available Neal V Palejwala, Andreas K Lauer, Richard G Weleber Oregon Retinal Degeneration Center (ORDC, Ophthalmic Genetics Service and Retina-Vitreous Service, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA Purpose: To report a rare case of central vision loss in a patient with choroideremia.Patients and methods: A retrospective, interventional case report.Results: A 13-year-old male with history of choroideremia presented with subacute loss of central acuity in his left eye. Examination and diagnostic testing revealed subretinal fibrosis secondary to a choroidal neovascular membrane (CNVM. A trial of anti-vascular endothelial growth factor (VEGF therapy with the injection of intravitreal bevacizumab was attempted. Mild improvements in acuity and anatomy were noted.Conclusion: Choroideremia is a rare hereditary choroidal dystrophy that predominantly affects males in the first and second decades of life. Visual acuity is usually spared until later in life. CNVM is a rare manifestation of choroideremia with only a handful of case reports presented in the literature. This case is unique in that it is the first reported case that received treatment with intravitreal anti-VEGF therapy. Keywords: anti-VEGF therapy, choroideremia, choroidal neovascular membrane, chorioretinal degeneration, hereditary choroidal dystrophy, intravitreal bevacizumab injection
Chiquet, C; Khayi, H; Puech, C; Tonini, M; Pavese, P; Aptel, F; Romanet, J-P
Syphilis is a sexually transmitted disease caused by Treponema pallidum. Previously known as the "great imitator", this disease can have numerous and complex manifestations. The ophthalmologist should suspect the diagnosis in patients with uveitis or optic neuropathy and high-risk sexual behavior and/or another sexually transmitted disease (such as HIV) or those presenting with posterior placoid chorioretinitis or necrotising retinitis. Ocular involvement in acquired syphilis is rare, tending to occur during the secondary and tertiary stages of the disease. Syphilis may affect all the structures of the eye, but uveitis (accounting for 1-5% of the uveitis in a tertiary referral center) is the most common ocular finding. Granulomatous or non-granulomatous iridocyclitis (71%), panuveitis, posterior uveitis (8%) and keratouveitis (8%) are often described. In the secondary stage, the meninges and the central nervous system can be affected, sometimes with no symptoms, which justifies performing lumbar puncture in patients with uveitis and/or optic neuropathy. The diagnosis of ocular syphilis requires screening with a non-treponemal serology and confirmation with a treponemal-specific test. Parenterally administered penicillin G is considered first-line therapy for all stages of ocular syphilis. Systemic corticosteroids are an appropriate adjunct treatment for posterior uveitis, scleritis and optic neuritis if ocular inflammation is severe. Prolonged follow-up is necessary because of the possibility of relapse of the disease. With proper diagnosis and prompt antibiotic treatment, the majority of cases of ocular syphilis can be cured. PMID:24655791
Lee, Monica I; Lee, Annie W C; Sumsion, Sean M; Gorchynski, Julie A
This case describes an emergency department (ED) presentation of ocular syphilis in a human immunodeficiency virus (HIV) infected patient. This is an unusual presentation of syphilis and one that emergency physicians should be aware of. The prevalence of syphilis has reached epidemic proportions since 2001 with occurrences primarily among men who have sex with men (MSM). This is a case of a 24-year-old male who presented to our ED with bilateral painless vision loss. The patient's history and ED workup were notable for MSM, positive rapid plasmin reagin (RPR) and HIV tests and fundus exam consistent with ocular syphilis, specifically uveitis. Ocular manifestations of syphilis can present at any stage of syphilis. The 2010 Centers for Disease Control and Prevention guidelines now recommend that ocular syphilis be treated as neurosyphilis regardless of the lumbar puncture results. There is a paucity of emergency medicine literature on ocular syphilis. For emergency physicians it is important to be aware of iritis, uveitis, or chorioretinitis as ocular manifestations of neurosyphilis especially in this high-risk population and to obtain RPR and HIV tests in the ED to facilitate early diagnosis, and treatment and to prevent irreversible vision loss. PMID:27429702
Zhang, Rui; Qian, Jiang; Guo, Jie; Yuan, Yifei; Xue, Kang; Yue, Han; Chen, Ling
Purpose. To describe the clinical manifestations and treatment outcomes of syphilitic uveitis in a Chinese population. Methods. This is a retrospective case series of 15 consecutive patients with syphilitic uveitis treated at a uveitis referral center between 2012 and 2015. Results. Fifteen patients were diagnosed with syphilitic uveitis based on positive serological tests. Nine patients were male. Coinfection with human immunodeficiency virus was detected in two patients. Twenty eyes presented with panuveitis and all patients had posterior involvement. The most frequent manifestations were retinal vasculitis and papillitis, while syphilitic posterior placoid chorioretinitis was only found in three eyes. All patients received systemic penicillin therapy according to CDC guidelines. Nine patients were misdiagnosed before presenting to our center and the delay in treatment with penicillin was associated with poor final visual outcomes (P syphilis with human immunodeficiency virus was uncommon. All patients in this study had posterior involvement and the most common manifestations were retinal vasculitis and papillitis. Syphilis should be considered as an important differential diagnosis especially for posterior uveitis and panuveitis. Early diagnosis and appropriate treatment are important for visual prognosis. PMID:27144014
Full Text Available The aim of the study was to describe a patient with pseudoxanthoma elasticum (PXE, showing Stargardt-like retinal abnormalities, who underwent treatment with intravitreal bevacizumab for subfoveal choroidal neovascularization (CNV of the right eye (RE. A 57-year-old woman with diagnosis of angioid streaks, retinal flecks, and chorioretinal Stargardt-like atrophy due to PXE was referred to our department for sudden decreased vision in her RE (20/160. Upon a complete ophthalmologic examination, including fluorescein angiography (FA, and optical coherence tomography (OCT, the patient was diagnosed with subfoveal CNV of the RE. Owing to the subfoveal localization of the CNV, the patient was submitted to intravitreal bevacizumab injection. At the 1-month follow-up, visual acuity (VA improved (20/40, and FA and OCT revealed the CNV closure. Twelve months after the treatment, the patient′s VA remained stable with no recurrence of active CNV. On the basis of our findings, a single intravitreal bevacizumab injection seems to induce total regression of CNV complicating PXE, in a patient showing Stargardt-like retinal abnormalities. Further investigations are required to confirm our results.
Jayanta Kumar Das
Full Text Available An 18-year-old woman was referred with late sequelae of chloroquine-induced Steven-Johnson syndrome. At the time of presentation, the symblepharon was involving the upper lids to almost the whole of the cornea, and part of the lower bulbar conjunctiva with the lower lid bilaterally. Other ocular examinations were not possible due to the symblepharon. B-scan ultrasonography revealed acoustically clear vitreous, normal chorioretinal thickness, and normal optic nerve head, with an attached retina. Conjunctivo-corneal adhesion released by superficial lamellar dissection of the cornea. Ocular surface reconstruction was carried out with a buccal mucous membrane. A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization. Best corrected visual acuity of 20/120 in both sides after 1 month and 20/80 after 3 months was achieved and maintained till the 2.5-year follow-up.
Yu. I. Khoroshikh
Full Text Available The results of clinical trial of various approaches in treatment the exudative forms of macular degenerations, including age-related, against chronic slow intensity inflammatory process on the extreme retinal periphery of an eye are described in represented material. There were 91 patients (105 eyes in the research with different types of an exudative macular degeneration. The general criteria of inclusion were: age of 18–80 years old, complaints to discomfort in eyes, a spot before an eye, distortions and decrease in the central sight, ophthalmoscopic symptoms of hypostasis in the central and peripheral areas of a retina. It is analyzed the general criteria of diagnostics and treatment of the disease in the article. Considering defeat of the chorioretinal structures located near the ora serrata at persons of young and advanced age. Practical recommendations to a choice of methods of diagnostics and treatment of various clinical and morphological forms of the disease are made. Screening methods of identification of patients with the peripheral uveitis are offered. The scheme of risk calculation of development the macular pathology at persons with changes on the extreme periphery of a retina, that can be used as a method of prevention of development predictively adverse of “wet" forms of an age-related macular degeneration, by means of timely sparing treatment at patients with chronic inflammatory diseases of eyes is given.
Wong, Tien Y; Ohno-Matsui, Kyoko; Leveziel, Nicolas; Holz, Frank G; Lai, Timothy Y; Yu, Hyeong Gon; Lanzetta, Paolo; Chen, Youxin; Tufail, Adnan
Choroidal neovascularisation (CNV) is a common vision-threatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm. PMID:24990871
Full Text Available Toxoplasmosis is a common worldwide parasitic infection that caused by Toxoplasma gondii. The clinical progress is generally asymptomatic in patient with normal immune system, on the other hand severe clinical presentations seen in patients with immune deficiency or pregnancy. Congenital toxoplasmosis can emerge due to contamination during pregnancy but 6-8 weeks prior to pregnancy are also at risk. Infants with toxoplasmosis have some clinical semptoms such as chorioretinitis, epilepsia, hypotonia, psychomotor disorders, mental retardation, encephalitis, microcephaly, hydrocephalus, intracranial calcifications, hepatosplenomegaly. Early diagnosis during pregnancy and subsequent treatment. may prevent malformations. Toxoplasmosis diagnosis during pregnancy is mostly based on IgM and IgG antibody screening tests. While IgM indicates the acute infection, it disappears in early period and can be detected in low consantrations through long ages. Therefore IgG avidity test takes more place in the diagnosis of toxoplasmosis during pregnancy. High avidity levels indicate acquired infection prior than 16 weeks, so that it is recommended to perform the test in the first trimester. Low IgG avidity level may indicate a newly onset infection. Amniotic fluid T.gondii PCR, anomaly screening with ultrasonography, Toxoplasma gondii cyst dying with Wright-Giemsa dye in plasental and fetal tissue are the other diagnostic tools can be performed during pregnancy. Avidity test methods during the 16 weeks of pregnancy reduce repeating serum analysis, amniotic fluid PCR reguirement, unnecessary antibiotic treatments and noncompulsory abortus. [TAF Prev Med Bull 2012; 11(6.000: 767-772
Samedi, Veronica Mugarab; Skappak, Christopher; Jantzie, Lindsay; Trevenen, Cynthia; Kamaluddeen, Majeeda; Ekwalanga, Pauline; Al Awad, Essa Hamdan
Background Cytomegalovirus (CMV) is one of the most common causes of serious viral intrauterine infections. It is universally distributed among the human population with an average incidence of 0.15 to 2%. Indeed, at least half of the women in the reproductive age have evidence of prior CMV infection. Epidemiology and Pathogenicity However, it is not a usual practice to screen asymptomatic pregnant woman or neonates for CMV. Even if a mother developed a primary CMV infection during pregnancy, up to 90% of the newborns with congenital CMV will be asymptomatic at the time of birth. Only 5 to 7% of the infected babies will be acutely symptomatic, and the typical clinical presentation includes intrauterine growth restriction, microcephaly, various cutaneous manifestations (including petechiae and purpura), hematological abnormalities (particularly resistant thrombocytopenia), hepatosplenomegaly, chorioretinitis, hepatitis, etc. In contrast, acquired CMV infection is extremely unlikely to cause any serious sequelae for the infant. Cases We present a case of congenital and acquired CMV infection in twins with a focus of dissimilarity in presentation, clinical course, and outcome. PMID:26929859
Ungureanu, E; Geamanu, A; Careba, I; Grecescu, M; Gradinaru, S
Rationale. Neovascular glaucoma is the type of glaucoma most refractory to treatment. The most frequent causes are those associated with retinal hypoxia, such as proliferative diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, central retinal arterial occlusion, ischemic ocular syndrome etc. Rare causes of neovascular glaucoma are multiple and are due to VEGF synthesis associated with chorioretinal inflammations or degenerations. We present a case with neovascular glaucoma associated with an extremely rare cause, angioid streaks Objective. The objective of our prsentation was to asses efficacy of the 5-FU associated trabeculectomy following bevacizumab intravitreal administration Methods and results. Case report of a 48 years old female patient which presented at the emergency room with painful red left eye. At presentation best corrected left eye visual acuity was 1/10, intraocular pressure was 36 mm Hg. Examination established the diagnosis of Neovascular glaucoma associated with angioid streaks. After intravenous Manitol, oral Acetazolamide and topical treatment with fixed combination timolol-brinzolamide, topical steroid and mydriatic intraocular pressure decreased. Intravitreal bevacizumab injection was performed, followed after 3 weeks by trabeculectomy. Discussion. Angioid streaks are an extremely rare cause of neovascular glaucoma. The treatment is similar to the treatment for other causes of neovascular glaucoma. PMID:27057253
Guerreiro, Cleo E; Appelboam, Helen; Lowe, Robert C
A five-year-old entire male Tibetan Terrier was referred for left-sided periorbital swelling and blepharospasm 4 days following ipsilateral maxillary tooth extraction. Examination of the left eye revealed mild exophthalmos, pain on retropulsion, and absent menace response and pupillary light reflexes. Examination of the posterior segment was not possible owing to the anterior segment pathology. Differential diagnoses considered were iatrogenic globe penetration and peribulbar abscess/cellulitis. Ocular ultrasound was consistent with a penetrating wound to the globe. Treatment with systemic prednisolone and marbofloxacin, and topical atropine sulfate 1%, prednisolone acetate, and brinzolamide was started. Marked clinical improvement allowed visual confirmation of the perforation. Oral prednisolone was tapered over the following 10 weeks. At final re-examination (10 months), the patient was visual, and fundic examination revealed an additional chorioretinal scar, most likely an exit wound that was obscured by vitreal debris on initial examinations. Neither scar was associated with retinal detachment. To the authors' knowledge, this is the first reported case of successful medical management of iatrogenic globe penetration following exodontic procedures. PMID:23869648
Full Text Available Aditi Gupta, Rajiv Raman, Tarun SharmaShri Bhagwan Mahavir Department of Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, IndiaWe read with great interest the recent article by Kashima et al,1 in which the authors report a case of asymmetric severity of diabetic retinopathy in Waardenburg syndrome. We want to highlight some concerns regarding this report. Previous reports have described many systemic and local factors associated with the development of asymmetric diabetic retinopathy.2,3 These include myopia ≥5 D, anisometropia >1 D, amblyopia, unilateral elevated intraocular pressure, complete posterior vitreous detachment, unilateral carotid artery stenosis, ocular ischemic syndrome, and chorioretinal scarring.2,3 In any suspected case of asymmetric diabetic retinopathy, it is prudent to rule out the abovementioned factors first. In the present case, although the authors clearly mention the absence of internal carotid and ophthalmic artery obstruction on magnetic resonance angiography, it would have been more informative if the authors had also provided the refractive error, intraocular pressure, and posterior vitreous detachment status of both the eyes.Likewise, it would have been useful to note the arm-retina time and retinal arteriovenous filling time in both the eyes on fundus fluorescein angiography, which is usually used to diagnose ocular ischemic syndrome by monitoring extension of the retinal circulation time, including time of blood circulation from the arm to the retina and the retinal arteriovenous filling time.4,5 The mere absence of internal carotid obstruction on magnetic resonance angiography cannot rule out the presence of ocular ischemic syndrome because, rarely, ocular ischemic syndrome can also occur secondary to other causes, such as arteritis.6,7 Comparing the arm-retina time and retinal arteriovenous filling time on fundus fluorescein angiography in both the eyes would be more helpful to rule out ocular
Full Text Available Introduction. Sarcoidosis is an antigen-mediated disease of unknown cause defined by granulomatous inflammation of different organs. Objective. The aim of this study was to analyze the clinical picture in 26 patients with a definitive and presumed ocular sarcoidosis. Methods. The following tests were conducted: angiotensin-converting enzyme, tuberculin skin test, liver enzymes and calcium in urine and serum. Enlarged hilar lymph glands were diagnosed using X-ray tomography or computed tomography of the mediastinum. A biopsy of lymph glands was performed either transbronchially or transmediastinally. Ophthalmic examination included biomicroscopic examination, intraocular pressure measurement, photofundus, fluorescein angiography, optical coherence tomography and computerized perimetry. Results. The average follow-up period of the disease was 6.1 years. The average age was 52.0 years. There were 62.5% female patients, with bilateral incidence of 69.2%. The clinical picture included: panuveitis (in 30.8% of patients, anterior uveitis (26.9%, posterior uveitis (26.9%, intermediate uveitis (7.7% and vitritis in (7.7%. The following complications were observed: cataract (in 34.6% of patients, cystoid macular edema (23.1%, glaucoma (15.4%, macroaneurysms (15.4%, neovascularization (7.7% and band keratopathy (3.8%. There was a statistically significant difference in the visual acuity (p=0.033 and severity of clinical symptoms (p=0.02 between the groups of patients with retinal vasculitis associated with “candle-wax” phenomenon and the group of patients with multiple chorioretinal lesions - “white dot” syndrome. Conclusion. To our consideration, the differences observed between the two groups are the result of retinal vasculitis and subsequent macular edema, which is significantly more frequent in the group with “candle-wax” phenomenon.
Full Text Available Descreve-se, pela primeira vez no Brasil, um caso de criptococose canina com acometimento oftalmo e dermatopático, com diagnóstico intra-vitam, em animal da raça Pastor Alemão, fêmea, com 24 meses de vida, criado em São Paulo, em contacto com outros cinco cães assintomáticos, que havia se infectado pelo contato com dejetos de pombos (Columba livia. Evoluia há 90 dias, com quadro tegumentar e ósseo, sintomas e lesões características, sendo, ainda, detectada forma assintomática de coriorretinite, de início unilateral. O diagnóstico foi estabelecido pelos dados da anamnese, dos exames físico, dermatológico e complementares (radiográfico, cultivo micológico, histopatologia de pele tendo-se evidenciado e isolado cepa de Criptococcus neoformans var. neoformans. Após nove meses de terapia com itraconazol (9mg/kg/SID/VO houve involução total do quadro, sem qualquer efeito adverso à droga.A case of cryptococcosis with ocular and cutaneous involvement is reported by the first time in Brazil in a dog. A two-year-old female German Shepherd living in a hold house with other five healthy dogs was infected through the contact with pigeon (Columba livia feces. The illness started 90 days previously with cutaneous and bone involvement resulting in characteristic clinical signs and lesions, in addition to a initially unilateral asymptomatic chorioretinitis. The diagnosis was established based on anamnesis, physical and dermatologic examinations and complementary exams (radiographs, skin biopsy and histopathology and the isolation of a Cryptococcus neoformans var. neoformans strain was accomplished. There was a complete resolution of the disease after nine months of therapy using itraconazole (9mg/kg, q24h, PO and no side effect was observed.
Coppieters, Frauke; Ascari, Giulia; Dannhausen, Katharina; Nikopoulos, Konstantinos; Peelman, Frank; Karlstetter, Marcus; Xu, Mingchu; Brachet, Cécile; Meunier, Isabelle; Tsilimbaris, Miltiadis K; Tsika, Chrysanthi; Blazaki, Styliani V; Vergult, Sarah; Farinelli, Pietro; Van Laethem, Thalia; Bauwens, Miriam; De Bruyne, Marieke; Chen, Rui; Langmann, Thomas; Sui, Ruifang; Meire, Françoise; Rivolta, Carlo; Hamel, Christian P; Leroy, Bart P; De Baere, Elfride
Inherited retinal dystrophies (iRDs) are a group of genetically and clinically heterogeneous conditions resulting from mutations in over 250 genes. Here, homozygosity mapping and whole-exome sequencing (WES) in a consanguineous family revealed a homozygous missense mutation, c.973C>T (p.His325Tyr), in RCBTB1. In affected individuals, it was found to segregate with retinitis pigmentosa (RP), goiter, primary ovarian insufficiency, and mild intellectual disability. Subsequent analysis of WES data in different cohorts uncovered four additional homozygous missense mutations in five unrelated families in whom iRD segregates with or without syndromic features. Ocular phenotypes ranged from typical RP starting in the second decade to chorioretinal dystrophy with a later age of onset. The five missense mutations affect highly conserved residues either in the sixth repeat of the RCC1 domain or in the BTB1 domain. A founder haplotype was identified for mutation c.919G>A (p.Val307Met), occurring in two families of Mediterranean origin. We showed ubiquitous mRNA expression of RCBTB1 and demonstrated predominant RCBTB1 localization in human inner retina. RCBTB1 was very recently shown to be involved in ubiquitination, more specifically as a CUL3 substrate adaptor. Therefore, the effect on different components of the CUL3 and NFE2L2 (NRF2) pathway was assessed in affected individuals' lymphocytes, revealing decreased mRNA expression of NFE2L2 and several NFE2L2 target genes. In conclusion, our study puts forward mutations in RCBTB1 as a cause of autosomal-recessive non-syndromic and syndromic iRD. Finally, our data support a role for impaired ubiquitination in the pathogenetic mechanism of RCBTB1 mutations. PMID:27486781
McMonnies, Charles W
Pathological myopia is one of the leading causes of visual impairment worldwide. Myopic development and progression is biomechanical and dominated by axial elongation. This clinical perspective examines some of the stretch-related fundal changes, which are associated with axial elongation and myopic pathology. The biomechanics of stretching of the fundus appears to depend on genetically and/or visual experience-based scleral changes, which reduce its thickness and elastic modulus so that it becomes more susceptible to the distending forces of intraocular pressure. These changes include reduced collagen synthesis, altered collagen fibres, tissue loss, altered proteoglycans and increased matrix metalloproteinase activity. Such changes are associated with reduced scleral rigidity and related increased potential to stretch in response to intraocular pressure. As axial elongation progresses, the sclera appears likely to continue to reduce in thickness and in its capacity to resist intraocular pressure, especially when pressure becomes elevated. Tessellation, lacquer cracks, myopic crescents, staphylomata, chorioretinal atrophy and retinal detachment are examined within a model for stretching of the fundus. Age, refractive error and axial length, for example, are associated with increased pathological progression. Myopic pathological progression can become dominated by vascular changes and include a greater risk of loss of acuity and blindness. Measures to control myopic pathology, which successfully slow or prevent stretching of the fundus, appear to be key factors in reducing or even avoiding permanent visual loss associated with this condition. For example, limiting axial elongation and related myopic fundus pathology by inhibiting changes which reduce the elastic modulus of scleral tissue is a desirable outcome from interventions to control myopia. Similarly, reducing exposure to the distending stress of elevated intraocular pressure appears to be a desirable form of
Brian T Chan-Kai
Full Text Available Brian T Chan-Kai1, Steven Yeh2, Richard G Weleber2, Peter J Francis2, Grazyna Adamus2, S Robert Witherspoon3, Andreas K Lauer11Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; 2Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; 3Retina Institute of Texas, Dallas, Texas, USAAim: Transplant chorioretinopathy is a rare complication following solid organ or bone marrow transplantation and can result in severe vision loss. This series presents electroretinogram (ERG results in patients with this condition.Methods: Patients who presented with bilateral vision loss following bone marrow or solid organ transplantation were identified. A complete ophthalmologic examination, fundus photography, and fluorescein angiography (FA were performed. Full-field ERG was obtained in all patients and a multifocal ERG (mfERG was obtained in two patients.Results: Four patients were identified. All patients had bilateral vision loss and displayed a characteristic pattern of mottled hyperfluorescence on FA. Three patients developed progressive vision loss ranging from 20/60 to hand motions whereas one retained 20/40 vision. All patients exhibited moderate to severe cone dysfunction, while the degree of rod abnormalities was varied. Two patients with severe cone dysfunction showed mild clinical changes initially, but later developed progressive vision loss and chorioretinal atrophy.Conclusion: Transplant chorioretinopathy patients undergoing ERG testing show cone dysfunction with a variable degree of rod dysfunction. ERG abnormalities preceded the visual acuity and clinical changes in two patients, suggesting that ERG may be a helpful predictor of the clinical course in this rare disease.Keywords: transplant, chorioretinopathy, electroretinogram, ERG, mfERG
Gisseman, Jordan D; Herce, Honey H
Focal Dermal Hypoplasia (FDH) or Goltz syndrome is a rare multi-system disorder with cutaneous, ocular, dental, and skeletal anomalies due to dysplasia of mesoectodermal derived tissues. It is an X-linked inheritance syndrome caused by mutations in the PORCN gene. This study is aimed to investigate the ocular findings in patients with Goltz syndrome. To date, there have been a limited number of case reports on the ocular manifestations of FDH. This is a prospective, non-consecutive, observational case series. Prospective ophthalmologic evaluation was performed on 18 patients with confirmed genetic testing for FDH, Goltz Syndrome, as a component of a larger multi-subspecialty study to better characterize the findings of this condition. Special attention was placed on evaluating the incidence of anophthalmia, microphthalmia, colobomas (iris, optic nerve, and/or retinal), cataracts, nystagmus, and strabismus. A complete ophthalmologic exam was done on all the patients. The mean patient age was 12.8 years (1-55 years). Eighty-nine percent were female and 77% (14/18) of patients had some form of an ophthalmologic manifestation of the condition. Ophthalmological findings included chorioretinal colobomas (61%), iris colobomas (50%), microphthalmia (44%), anophthalmia (11%), cataracts (11%), and conjunctival and eyelid papillomas (5%). Nystagmus was present in 33% and strabismus in 22% of the patients. Visual acuity ranged from 20/20 to no light perception. This study demonstrates a higher incidence of ophthalmologic manifestations as previously reported (77% vs. 40%). To our knowledge, this is the largest case series reported in the literature with 18 patients. © 2016 Wiley Periodicals, Inc. PMID:27001926
MA Kai; LIU Ning-pu; YANG Xiu-fen; HAN Cui; ZHANG Ning; XU Jun; LIU Shou-bin; LU Hal; Torkel Snellingen; WANG Ning-li
Background A Chinese family with autosomal dominant central areolar choroidal dystrophy (CACD) was identified.The purpose of this study was to collect the clinical findings from the family and to identify the genetic entity by linkage nalysis.Methods Forty-three individuals from 3 generations of the family underwent ophthalmologic examinations, including best-corrected visual acuity, examination of the anterior segments, and inspection of the ocular fundus after pharmacologic mydriasis. Affected family members further underwent color vision test, color fundus photography,fluorescein angiography, automated perimetry, and electroretinography. The family was followed up for 30 months.Peripheral venous blood or buccal swabs were collected from each family member and genomic DNA was extracted.Linkage analysis was performed for candidate genes or loci using microsatellite markers.Results Seven family members in 3 continuous generations were diagnosed as having autosomal dominant CACD.The family showed progressive development of the disease, affecting both male and female. Age of onset of visual disturbances varied between 11 and 50 years. Phenotypic variability among affected individuals was apparent and ranged from relatively normal-appearing fundus with mild parafoveal pigment mottling to geographic atrophy of the macula. Fluorescein angiography showed hyperfluorescent parafoveal changes in early stage or well-demarcated area of chorioretinal atrophy with enhanced visibility of the residual underlying choroidal vessels in the late stage. Peripheral retina and visual fields were normal in affected individuals. Electroretinogram showed normal or mild reduction in the photopic amplitude. Eight candidate genes (STGD4, RCD1, peripherin/RDS, GUCA1A, RIMS1, UNC119, GUC Y2D, and AIPL1) and two genetic loci (4p15.2-16.3, and 17p13) were excluded to be responsible for the disease by linkage analysis.Conclusions The clinical findings of this Chinese family with CACD shared
Full Text Available Purpose: To report an eye with polypoidal choroidal vasculopathy (PCV and a choroidal nevus. Methods: This is an observational case report. Results: A healthy 69-year-old woman was referred to the Osaka University Hospital with a diagnosis of a macular tumor. She complained of having distorted vision in her left eye. The medical history of the patient was unremarkable. At the initial examination, her best-corrected visual acuity (BCVA was 20/20 in both eyes, and the intraocular pressure was 18 mm Hg in both eyes. A slit-lamp examination showed no abnormalities in the anterior segment of both eyes and a fundus examination of the left eye showed a slightly elevated juxtafoveal chorioretinal lesion and polyp-like reddish-orange lesions. The juxtafoveal choroidal lesion was located beneath a choroidal neovascularization (CNV. An optical coherence tomography confirmed CNV with pigment epithelial detachment (PED. Fluorescein angiography showed juxtafoveal hyperfluorescence due to CNV. Indocyanine green angiography demonstrated a branching choroidal vascular network that resembled polypoidal lesions. A fundus autofluorescence showed a mosaic pattern and a slight hyperautofluorescence at the CNV. We diagnosed the patient as having PCV. Aflibercept was injected intravitreally because of her PED. After the injection, PED improved and her visual acuity remained stable during the 12-month follow-up period. Conclusions: In cases of PCV, FAF images are helpful in determining the status of the posterior pole. Intravitreal injections of aflibercept can improve PED associated with CNV, and the BCVA will remain stable for at least 12 months.
Montero, Javier A; Ruiz-Moreno, Jose M
High myopia affects approximately 2% of general population, and is a major cause of legal blindness in many developed countries. Choroidal neovascularization (CNV) is the most common vision-threatening complication of high myopia. Different therapeutic approaches have been attempted such as thermal laser photocoagulation, surgery and photodynamic therapy with verteporfin (PDT). The visual outcome of these therapies has been reported to be better than the natural history of the condition. However, the limited visual acuity improvement after PDT monotherapy and the appearance of subretinal fibrosis and chorioretinal atrophy prompted the association of other therapies. In the past few years a tremendous advance in the knowledge of the mechanisms underling CNV secondary to high myopia and age related macular degeneration has been achieved, leading to new therapeutic targets and novel drugs and combined therapies. These new therapeutic weapons have been designed to achieve a selective shut down of choroidal new vessels. Recent reviews have been published on the natural history and therapies for myopic CNV. Ohno-Matsui reported on the natural history of the condition as well as the outcome of laser photocoagulation, surgical extraction of CNV, foveal translocation and photodynamic therapy on myopic CNV in the short-term. Soubrane et al reviewed the new advances on surgery, laser photocoagulation and PDT, considering some of the potential effects of triamcinolone, pegaptanib and ranibizumab in CNV secondary to age related macular degeneration (AMD). Novack et al reported on the pharmacological therapy of CNV in AMD. The aim of this review is to summarize the recent advances in myopic CNV pathophysiology and the new therapeutic targets and drugs that are changing the clinical management of myopic CNV. PMID:20196722
Daniel J Bonthius
Full Text Available The fetal brain is highly vulnerable to teratogens, including many infectious agents. As a consequence of prenatal infection, many children suffer severe and permanent brain injury and dysfunction. Because most animal models of congenital brain infection do not strongly mirror human disease, the models are highly limited in their abilities to shed light on the pathogenesis of these diseases. The animal model for congenital lymphocytic choriomeningitis virus (LCMV infection, however, does not suffer from this limitation. LCMV is a well-known human pathogen. When the infection occurs during pregnancy, the virus can infect the fetus, and the developing brain is particularly vulnerable. Children with congenital LCMV infection often have substantial neurological deficits. The neonatal rat inoculated with LCMV is a superb model system of human congenital LCMV infection. Virtually all of the neuropathologic changes observed in humans congenitally infected with LCMV, including microencephaly, encephalomalacia, chorioretinitis, porencephalic cysts, neuronal migration disturbances, periventricular infection, and cerebellar hypoplasia, are reproduced in the rat model. Within the developing rat brain, LCMV selectively targets mitotically active neuronal precursors. Thus, the targets of infection and sites of pathology depend on host age at the time of infection. The rat model has further shown that the pathogenic changes induced by LCMV infection are both virus-mediated and immune-mediated. Furthermore, different brain regions simultaneously infected with LCMV can undergo widely different pathologic changes, reflecting different brain region-virus-immune system interactions. Because the neonatal rat inoculated with LCMV so faithfully reproduces the diverse neuropathology observed in the human counterpart, the rat model system is a highly valuable tool for the study of congenital LCMV infection and of all prenatal brain infections In addition, because LCMV
Full Text Available : OBJECTIVE: To evaluate the visual and refractive outcomes of phacoemulsification with intraocular lens (IOL implantation in highly myopic eyes and to assess the intraoperative and postoperative complications. SETTINGS: Tertiary care Centre Ranchi, India. METHODS: Consecutive patients with high myopia were retrospectively studied for outcomes and complications after phacoemulsification and IOL implantation. RESULTS: The study included 125 eyes of 89 patients (53 females and 36 males with a mean age of 56.01±9.51 years and mean follow-up of 19.45±4.07 months. The mean axial length was 29.58±2.57mm and power of the IOL ranged from −4.00 D to + 17.00 D. The mean preoperative logMAR Best corrected visual acuity (BCVA was 0.82±0.26 which improved to 0.38±0.29 at one month and to 0.43±0.33 at last follow-up, the improvement in vision was statistically significant (P<0.0001, paired t test. Postoperatively, 80 eyes (64% had a BCVA between 0.00 logMAR (20/20 and 0.30 logMAR (20/40. Pre-existing myopic chorioretinal degeneration (13.6% was most common factor causing decreased visual acuity. The mean spherical equivalent at one month postoperative was -0.06±1.28 D. The complications included posterior capsule rupture (5.6%, zonular dehiscence (1.6%, retinal detachment (1.6%, cystoid macular edema (8.8% and posterior capsule opacifications (10.4%. CONCLUSIONS: Phacoemulsification with intraocular lens implantation is a safe and effective procedure to improve patients visual acuity in those with high myopia.
Kluxen, G; Hoerauf, A
One of the most significant contributions to tropical medicine and ophthalmology was made by Jean Hissette: African ocular onchocerciasis. During his extensive investigations in the Babindi country, he found numerous adults with river blindness. Their eye disease was caused by the filaria Onchocerca volvulus Leuckart. He noticed the signs of interstitial keratitis and band keratopathy, faint iritis or iridocyclitis, posterior synechiae and often a downward distortion of the pupil. He was the first to describe chorioretinal scarring of the fundus, what became known as the Hissette-Ridley fundus. People reported to him their entoptic phenomena which he unequivocally interpreted to be the images of microfilariae in the patient's own eye. During his stay in Belgium in 1932, he elucidated the pathogenesis of blindness since he was able to provide histological proof of the presence of microfilariae in various ocular tissues of an enucleated eye from a patient living near the Sankuru river. Like other serious health impairments, the severe inflammatory lesions in the eye occurred only after the microfilariae had died. Hence he realized that dying microfilariae play a key role in the mechanisms leading to blindness. Hissette's precise descriptions were the logical fruit of his outstanding observational abilities and enabled him as a man of great intuition to speculate about causal relationships. He evidently benefited from the fact that he took the native Africans seriously and asked them their opinion. In 1933, his friend and teacher Dr. De Mets in Antwerp already wrote on Hissette's discovery in the Belgian Congo: "This study is of exceptional value to specialists which is not only a tribute to its author, but to our common native country (Belgium)." PMID:18546927
Cytomegalovirus (CMV),a DNA herpusvirusesw,is the most common virus leading to intrauterine infetcion.It is transmitted from mother to fetus through placenta,and the neonates who suffering from congenital symptomatic infections may have sensorineural hearing loss,hepatosplenomegaly,microcephaly,chorioretinitis etc.Studies have suggested that the characters of infections on pregnant women,such as the time of infection,the serological results and virus load in amniotic fluid are associated with the outcome of offsprings.This paper is to review the risk of CMV infections on women at childbearing age,screening of CMV infections on pregnant women and the prenatal diagonosis of fetal CMV infection.%巨细胞病毒属于疱疹病毒,可通过胎盘传播给胎儿,是宫内感染最常见的病原体.巨细胞病毒感染可导致新生儿症状性感染,主要表现为感觉神经性耳聋、肝脾肿大、小头畸形、脉络膜视网膜炎等.研究表明妊娠妇女巨细胞病毒感染特征,如感染的时间、血清学结果、羊水中病毒载量等与子代结局关系密切.该文就育龄期妇女感染巨细胞病毒的高危因素、妊娠妇女感染筛查以及胎儿宫内感染诊断及预后评价的进展作一综述.
Jaqueline Dario Capobiango
Full Text Available This study describes the characteristics of 31 children with congenital toxoplasmosis children admitted to the University Hospital of Londrina, Southern Brazil, from 2000 to 2010. In total, 23 (85.2% of the mothers received prenatal care but only four (13.0% were treated for toxoplasmosis. Birth weight was <2500 g in 37.9% of the infants. During the first month of life, physical examination was normal in 34.5%, and for those with clinical signs and symptoms, the main manifestations were hepatomegaly and/or splenomegaly (62.1%, jaundice (13.8%, and microcephaly (6.9%. During ophthalmic examination, 74.2% of the children exhibited injuries, 58.1% chorioretinitis, 32.3% strabismus, 19.4% microphthalmia, and 16.2% vitreitis. Anti-Toxoplasma gondii IgM antibodies were detected in 48.3% of the children. Imaging brain evaluation was normal in 44.8%; brain calcifications, hydrocephaly, or both conditions were observed in 27.6%, 10.3%, and 17.2%, respectively, of the patients. Patients with cerebrospinal fluid protein ≥ 200 mg/dL presented more brain calcifications (p = 0.0325. Other sequelae were visual impairment (55.2% of the cases, developmental delay (31.0%, motor deficit (13.8%, convulsion (27.5%, and attention deficit (10.3%. All patients were treated with sulfadiazine, pyrimethamine, and folinic acid, and 55.2% of them exhibited adverse effects. The results demonstrate the significance of the early diagnosis and treatment of toxoplasmosis during pregnancy to reduce congenital toxoplasmosis and its consequences.
Neovascularização retiniana secundária a obstrução vascular em retinocoroidite por toxoplasmose em paciente HIV positivo: relato de caso Retinal vascular occlusion and neovascularization in acute toxoplasmic retinochoroiditis in a patient with AIDS: case report
Full Text Available Apresentar e discutir o caso de paciente infectado pelo HIV, que desenvolveu quadro de obstrução vascular seguido de neovascularização retiniana e de papila, durante o tratamento específico para retinocoroidite por toxoplasmose e que evoluiu com resolução espontânea da neovascularização sem a necessidade de tratamento associado. Paciente com retinocoroidite por toxoplasmose, que após 4 semanas de tratamento específico (sulfadiazina e pirimetamina desenvolveu quadro de obstrução vascular, seguido de neovascularização retiniana, apresentou involução espontânea, não havendo necessidade de fotocoagulação a laser, ou de outro tratamento adicional. As lesões retinianas ativas de toxoplasmose podem cursar com complicações vasculares, mesmo na vigência de tratamento específico, e geralmente apresentam bom prognóstico com regressão espontânea dos neovasos, sem necessidade de tratamentos adicionais.To present a case of an HIV-infected patient, who presented with active chorioretinal inflammatory lesion suggestive of toxoplasmosis, that during the specific treatment developed a retinal vascular occlusion, and adjacent neovascularization. 35-year-old AIDS patient that, presented with toxoplasmic retinochoroiditis and after 4 weeks of the specific therapy (pyrimethamine and sulfadiazine developed a vascular occlusion and retinal neovascularization that healed without the need for phototocoagulation or other adjunctive therapy. This case demonstrates that acute toxoplasmic retinochoroiditis that develops vascular complications may present a good result with the specific treatment without the need for adjunctive therapy.
Avetisov, Sergey E.; Budzinskaja, Maria V.; Kiseleva, Tatyana N.; Balatskaya, Natalia V.; Gurova, Irina V.; Loschenov, Viktor B.; Shevchik, Sergey A.; Kuzmin, Sergey G.; Vorozhtsov, Georgy N.
This work are devoted our experience with photodynamic therapy (PDT) with > for patients with choroidal neovascularization (CNV). 18 patients with subfoveal CNV in age-related macular degeneration (AMD), 24 patients with subfoveal CNV in pathological myopia (PM) and 4 patients with subfoveal CNV associated with toxoplasmic retinochoroiditis were observed. CNV was 100% classic in all study patients. Standardized protocol refraction, visual acuity testing, ophthalmologic examinations, biomicroscopy, fluorescein angiography, and ultrasonography were performed before treatment and 1 month, 3 months, 6 months, and 1 year after treatment; were used to evaluate the results of photodynamic therapy with > (0.02% solution of mixture sulfonated aluminium phtalocyanine 0.05 mg/kg, intravenously). A diode laser (>, Inc, Moscow) was used operating in the range of 675 nm. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3-month follow-up intervals. At 3, 6, 9 month 26 (56.5%) patients had significant improvement in the mean visual acuity. At the end of the 12-month minimal fluorescein leakage from choroidal neovascularization was seen in 12 (26.1%) patients and the mean visual acuity was slightly worse than 0.2 which was not statistically significant as compared with the baseline visual acuity. Patients with fluorescein leakage from CNV underwent repeated PDT with >. 3D-mode ultrasound shown the decreasing thickness of chorioretinal complex in CNV area. Photodynamic therapy with > can safely reduce the risk of severe vision loss in patients with predominantly classic subfoveal choroidal neovascularization secondary to AMD, PM and toxoplasmic retinochoroiditis.
Full Text Available Yasushi Ikuno, Satoko Fujimoto, Yukari Jo, Tomoko Asai, Kohji NishidaDepartment of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JapanPurpose: To investigate the rate of choroidal thinning in highly myopic eyes.Patients and methods: A retrospective observational study of 37 eyes of 26 subjects (nine males and 17 females, mean age 39.6 ± 7.7 years with high myopia but no pathologies who had undergone spectral domain optical coherence tomography and repeated the test 1 year later (1 ± 0.25 year at Osaka University Hospital, Osaka, Japan. Patients older than 50 years with visual acuity worse than 20/40 or with whitish chorioretinal atrophy involving the macula were excluded. Two masked raters measured the choroidal thicknesses (CTs at the foveda, 3 mm superiorly, inferiorly, temporally, and nasally on the images and averaged the values. The second examination was about 365 days after the baseline examination. The CT reduction per year (CTRPY was defined as (CT 1 year after - baseline CT/days between the two examinations × 365. The retinal thicknesses were also investigated.Results: The CTRPY at the fovea was −1.0 ± 22.0 µm (range –50.2 to 98.5 at the fovea, –6.5 ± 24.3 µm (range −65.8 to 90.2 temporally, –0.5 ± 22.3 µm (range –27.1 to 82.5 nasally, –9.7 ± 21.7 µm (range –40.1 to 60.1 superiorly, and –1.4 ± 25.5 µm (range –85.6 to 75.2 inferiorly. There were no significant differences in the CTRPY at each location (P = 0.34. The CT decreased significantly (P < 0.05 only superiorly. The superior CTRPY was negatively correlated with the axial length (P < 0.05. The retinal thickness at the fovea did not change. Stepwise analysis for CTRPY selected axial length (P = 0.04, R2 = 0.13 and age (P = 0.08, R2 = 0.21 as relevant factors.Conclusions: The highly myopic choroid might gradually thin and be affected by many factors. Location and axial length are key factors to regulate the rate of choroidal
Full Text Available Nathalie Puche1, Olivier Offret1, Jean-Antoine Bernard1, Francine Behar-Cohen1,21Department of Ophthalmology, Hotel Dieu de Paris, AP-HP, Université Paris Descartes; 2Inserm UMRS872, Physiopathology of Ocular Diseases: Therapeutic Innovations, Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, FrancePurpose: To report the time course of retinal morphologic changes in a patient with acute retinal pigment epithelitis (ARPE using spectral domain optical coherence tomography (SD-OCT.Methods: A 30-year old man was referred for blurred vision of his right eye after five days that appeared suddenly 15 days after recovery from a flu-like syndrome. SD-OCT was performed immediately, followed by fluorescein and infracyanine angiography at eight days and then at three weeks.Results: At presentation, a bubble of sub-macular deposit was observed on the right macula with central golden micronodules in a honeycomb pattern. SD-OCT showed an “anterior dislocation” of all the retinal layers up to the inner/outer segment (IS/OS line and irregular deposits at the OS level together with thickening of the retinal pigment epithelial (RPE layer. As visual acuity increased, eight days later, the OCT showed reduction of the sub-retinal deposits and an abnormal hyperflectivity of the sub-retinal and RPE layers was observed. The patient showed a positive serology for picornavirus.Discussion: The acute SD-OCT sections of this patient with ARPE were compared with histological sections of a 35 day old Royal College of Surgeons rat. Similar findings could be observed, with preservation of the IS/OS line and accumulation of debris at the OS level, suggesting that ARPE symptoms could result from a transient phagocytic dysfunction of the RPE at the fovea, inducing reversible accumulation of undigested OS. Picornaviruses comprising enterovirus and coxsachievirus described as being associated with acute chorioretinitis. In this case, it was responsible for
Full Text Available Purpose : To evaluate the role of primary transpupillary thermotherapy (TTT in the treatment of choroidal melanocytic lesions. Materials and Methods : Retrospective chart review of 24 patients (24 eyes with choroidal melanocytic lesions, including 20 choroidal melanoma and four choroidal nevus treated with primary TTT. Choroidal nevus cases treated with primary TTT either demonstrated risk factors for growth into an early melanoma or had overlying choroidal neovascularization. Results : The mean initial tumor basal diameter was 6.6 (3.0-10.0 mm and the mean initial tumor thickness was 3.0 (1.0-5.0 mm. The mean number of TTT sessions was 2.5 (1-6. The mean decrease in tumor thickness was 1.2 mm (from 3.0 to 1.8 mm at a mean follow-up of 22.7 (range 3-90 months. On the LogMar scale, visual acuity was stable at 1.0. Complications occurred in 50% of eyes. The most frequent complications were vitreous hemorrhage [5 patients (20.8%], focal cataract [5 patients (20.8%], iris atrophy [4 patients (16.6%] and posterior synechia [4 patients (16.6%]. There was no significant difference in the complication rate with respect to tumor thickness >3 mm versus tumor thickness ≤3 mm and juxtapapillary versus nonjuxtapapillary location (Fisher′s exact test, P>0.05. Kaplan-Meier curves showed that 9% of eyes develop recurrence by 1 year and 27% develop recurrence by 5 years after primary TTT. Two eyes (8.3% were enucleated because of neovascular glaucoma and one eye (4.1% was exenterated because of extraocular tumor recurrence. Globe salvage was achieved in 21 patients (87.5%. One patient (4.1% with extraocular tumor recurrence developed liver metastasis and expired. Conclusions : Although TTT may be useful in the treatment of small choroidal melanocytic lesions, the high complication and recurrence rates warrant close monitoring of patients after primary TTT even when a flat chorioretinal scar has been achieved.
RONALD H. GUDERIAN
Full Text Available Se evaluó la importancia de los factores raciales en la epidemiología y las manifestaciones clínicas de la oncocercosis en la raza Negra y la raza indígena Chachi, dos grupos étnicos diferentes del área hiperendémica del foco oncocercótico ecuatoriano. Los Chachi presentaron una significativa mayor densidad de microfilarias en la piel. De los Negros, 72,2% presentaron lesiones oncocercóticas en la piel comparado con 56,4% en los Chachi. Se encontró mayor prevalencia de nódulos palpables en los Chachi (51,4% vs. 43,0%. La presencia de microfilarias en la cámara anterior del ojo fue más frecuente en los Chachi (51,9% vs. 34,2%, pero se evidenció una mayor prevalencia de corioretinitis y atrofia del nervio óptico en los Negros (17,6% vs 11,2% y 8,5% vs. 0,5%, respectivamenteThe importance of racial factors in the epidemiology and clinical manifestations of onchocercosis in the Afro-Ecuadorian and Chachi indigenous races, two distinct ethnic groups in the hyperendemic area of the Ecuadorian onchocercal focus, were evaluated. No difference in the disease prevalence among the two races was noted, although the Chachi had a significant higher dermal microfilariae intensity. Approximately 72.2% of the Afro-Ecuadorians presented with onchocercal skin lesions, as compared to 56.4% of the Chachi. Pretibial depigmentation, sowdah, scrotal elephantiasis and hydrocele were only documented in the Afro-Ecuadorians. Greater prevalence of palpable nodules was found in the Chachi (51.4% vs. 43.0%. Chachi presented with more nodules in the head (25.6% vs 17.6% and iliac crest (40.1% vs. 30.3% regions while the Blacks had more nodules in the sacrococcygeal region (18.2% vs 10.8%. Microfilariae in the anterior chamber was seen more frequently in the Chachi (51.9% vs 34.2%. However, a higher prevalence of chorioretinitis and optic atrophy was seen in the Afro-Ecuadorians (17.6% vs 11.2% and 8.5% vs 0.5% respectively. Several possible causes for these
: Recent GI surgery and higher numbers of positive fungal blood culture specimens may be predictive of candida ocular infections. Normal baseline fundoscopy examination results in patients with such risks may require repeat evaluations to detect delayed manifestations. Keywords: fungal chorioretinitis, fungal endophthalmitis, risks factors for intraocular fungal infection, risks of gasterointestinal surgery
over 60 years of age. This finding is comparable to other American epidemiologic studies. Ocular toxoplasmosis and ARN were also common causes of infectious uveitis. In all, 50.6% of patients had a VA better than 20/40 at the final follow-up visit, indicating the importance of prompt referral and appropriate treatment. Keywords: uveitis, infectious, chorioretinitis, endophthalmitis, toxoplasma
This article traces early career of Kong Pyung Woo, a public figure famous for being the first doctor of medicine in ophthalmology with Korean ethnicity in 1936, for founding and running the oldest and still the most successful private eye clinic in Korea since 1937, and also for his engagement in development of Korean mechanical typewriter since 1949. His case is an illustrative example of how a Korean under the Japanese colonial rule (1910-1945) could build up a career to become a medical doctor, taking full advantage of the chances available. Kong, born in 1907 in a rural province in northwestern Korea, acquired a doctor's license in 1926 by passing the qualifying examination of the Government General in Korea. The qualification test was in itself an outcome of colonial education system, in which the supply of medical doctors by only a few tertiary schools could not meet the demands. After working for a state hospital for one year, Kong volunteered to be a visiting student at Keijo Medical College, to fulfill his dream of "becoming a prominent bacteriologist like Noguchi Hideyo." He was soon officially appointed as a tutor at Department of Ophthalmology, as he had been endorsed by professor Satake Shyuichi for his diligence and earnestness. Satake also encouraged Kong to pursue a doctoral degree and recommended him to Tokumitsu Yoshitomi, a professor in the Department of Pathology at Keijo Imperial University, so that Kong could experience cutting-edge research at the imperial university. Kong reported on his experiments on the pathology of chorioretinitis centralis by 1935. He submitted the reports to Nagoya Imperial University, Japan, as a doctoral thesis, and eventually obtained the degree in 1936, which was the first Korean doctor of medicine in ophthalmology. The doctorate made Kong a public figure and he opened his own private clinic in 1937. The Kong Eye Clinic was the first private eye clinic owned and run by Korean, and soon became popular in Seoul
The management of retinoblastoma remains a challenge to the multidisciplinary team, particularly as treatment affects not only visual outcomes, but also ocular retention and morbidity. Management of retinoblastoma has evolved over the past two decades. To report the result of intra-ophthalmic artery chemotherapy (IAC) for the treatment of refractory and advanced retinoblastoma tumors. All patients who had failed to respond adequately to previous treatments and six naive patients with advanced retinoblastoma, receiving IAC between 2009 and 2012, were included in this institutional interventional case series. The patients received 1-2 treatments of IAC given 4-8 weeks apart. Complete response was defined as regressed tumor and complete disappearance of seeding clinically and partial response was defined as partial regression of the tumor with live parts of the tumor and/or lessening of seeds, but not complete disappearance of them clinically. A total of 24 eyes of 24 patients were treated with IAC during the study period. The mean age at the time of IAC was 38.9 months (14-120 months), and the mean follow-up was 16.8 months (3-36 months) after IAC. Tumor control was achieved in 14 eyes (58.3%). Type 3 (combined fleshy and calcified remnants) was the most common type of regression (37.5%). Complications included vitreous hemorrhage in nine eyes (37.5%), arterial occlusion in two (8.3%), cyclitic membrane possibly secondary to ischemia and tractional retinal detachment in one patient (4.2%), chorioretinal atrophy in three (12.5%) patients, and neovascular glaucoma in one eye (4.2%). In eight (33.3%) patients, no complication happened. Globe salvage was achieved in 62.5% of the cases. The success rate for naive patients was 84%. Sixty-seven percent of the cases received transpupillary thermotherapy and cryotherapy before IAC. Intra-ophthalmic artery melphalan is an effective treatment for advanced cases of retinoblastoma, with a reasonable level of success. In the short
Jonathan P Wigg
Full Text Available In-vivo imaging of choroidal neovascularization (CNV has been increasingly recognized as a valuable tool in the investigation of age-related macular degeneration (AMD in both clinical and basic research applications. Arguably the most widely utilised model replicating AMD is laser generated CNV by rupture of Bruch's membrane in rodents. Heretofore CNV evaluation via in-vivo imaging techniques has been hamstrung by a lack of appropriate rodent fundus camera and a non-standardised analysis method. The aim of this study was to establish a simple, quantifiable method of fluorescein fundus angiogram (FFA image analysis for CNV lesions.Laser was applied to 32 Brown Norway Rats; FFA images were taken using a rodent specific fundus camera (Micron III, Phoenix Laboratories over 3 weeks and compared to conventional ex-vivo CNV assessment. FFA images acquired with fluorescein administered by intraperitoneal injection and intravenous injection were compared and shown to greatly influence lesion properties. Utilising commonly used software packages, FFA images were assessed for CNV and chorioretinal burns lesion area by manually outlining the maximum border of each lesion and normalising against the optic nerve head. Net fluorescence above background and derived value of area corrected lesion intensity were calculated.CNV lesions of rats treated with anti-VEGF antibody were significantly smaller in normalised lesion area (p < 0.001 and fluorescent intensity (p < 0.001 than the PBS treated control two weeks post laser. The calculated area corrected lesion intensity was significantly smaller (p < 0.001 in anti-VEGF treated animals at 2 and 3 weeks post laser. The results obtained using FFA correlated with, and were confirmed by conventional lesion area measurements from isolectin stained choroidal flatmounts, where lesions of anti-VEGF treated rats were significantly smaller at 2 weeks (p = 0.049 and 3 weeks (p < 0.001 post laser.The presented method of in
O. I. Borzunov
Full Text Available Purpose: is to evaluate the effectiveness of YAG laser posterior lens capsule dissection in patients with secondary cataract with concurrent intraocular pathology. Patients and methods: retro- and prospective analysis of the results of the YAG — laser treatment of secondary cataract in the 196 eyes, including the intraocular concomitant pathology (myopia, glaucoma, age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa operated retinal detachment, chronic uveitis in remission, peripheral chorioretinal degeneration. Effectiveness of treatment was evaluated by checking visual acuity and dynamics of complaints as aberration, glare, distortion in the central field of view without proper disease of the macula. Complex preoperative studies included: refractometry, visometry with correction, perimetry, tonometry, biomicroscopy, ophthalmoscopy, ultrasound examination of the eyeball (if necessary. The examination results should demonstrate convincing evidence that posterior capsular opacification is the main reason for the decrease of visual acuity. Results:, Visual acuity, at average increased from 0.4‑0.6 to 0.8‑1.0 in 50 cases after dissection, Visual acuity improved to 2‑3 lines in 66‑4–5, 24‑6‑7 lines in 74 cases. Visual acuity remains the same, but contrast sensitivity was increased in 6 cases. The IOL location after disruption was evaluated by β-scanning and biomicroscopy. In case of the initial correct IOL position in all 195 (100 % cases, there were no dislocation in the postoperative period. Complications that can be identified were single microcraters on the IOL surface in cases of its full contact with the posterior capsule. These injuries did not affect the visual functions.Conclusion: YAG -Laser dissection of secondary cataract is effective, less traumatic, and the optimal treatment of secondary cataract, including patients with concomitant intraocular pathology, and helps to avoid over
Full Text Available Background. Gestational toxoplasmosis is acquired during pregnancy and involves a risk of the parasite crossing the placenta, thereby leading to foetal infection, which can lead to serious sequelae in children, mainly chorioretinitis, cerebral calcification, hydrocephalus and intellectual disability. Objective. Determining the prevalence of maternal and neonatal toxoplasmosis in women attending the Engativa and La Victoria hospitals in Bogota, Colombia, for delivery. Correlating the results with those of a national multicentre study. Determining IgM and IgA anti-toxoplasma prevalence in newborn (NB umbilical cord blood. Materials and methods. This was a cohort study, which was approved by the participating institutions' ethics committees. The patients signed informed consent forms and filled out a survey requesting demographic and prenatal care data. A blood sample was taken from the umbilical cord on delivery for determining anti-toxoplasma IgM. Anti-toxoplasma IgA was also measured in a subset of patients. Children suspected of having either clinical or serological congenital toxoplasmosis were followed-up for 12 months. Results. The study involved taking 3,224 NB umbilical cord blood samples between April 1st 2009 and July 16th 2010. Positive anti-toxoplasma IgG was found in 28.2% of pregnant women (26.1-29.8 95%CI. Anti-toxoplasma IgM was determined in 558 pregnant women and found positive in 34 patients (i.e. 1.1 per 100 NB gestational toxoplasmosis incidence. Nine blood samples were positive (7 for IgM and 2 for IgA. Five of the NB studied (0.15% were positive for IgG after 12 months' follow-up, thereby confirming a diagnosis of congenital toxoplasmosis accounting for 1 in every 645 live births. Conclusion. This study showed that 70% of the pregnant women were not infected with T. gondii in the chosen hospitals in Bogotá. Gestational toxoplasmosis frequency was around 1% and 0.6% for congenital toxoplasmosis.
Full Text Available ABSTRACT Background. For surgical correction of high-degree ametropia aggravated with astigmatism the following options are available: excimer laser correction; phakic lens implantation; bioptika – a combination of ablating the transparent crystalline lens (ATL with implantation of multifocal toric diopter IOL of standard series and LASIK for the correction of a residual refractive error, ATL using 2 IOLs according to the Technology «Piggy Back»; additional meniscus IOL implantation «Add-On»; ATL with implantation of an individual multifocal toric IOL. Purpose. To show a possibility of intraocular correction of high ametropia aggravated with astigmatism using toric multifocal custom IOLs. Material and methods. We observed two patients: the first female patient, 39 years old with a diagnosis of OU: high myopia, compound myopic astigmatism, initial complicated cataract, moderate amblyopia, peripheral chorioretinal degeneration (PCRD. On admission the distance visual acuity was vis OD=0.01 sph (- 15.5 D cyl (- 2.5 D ax 0°=0.6; vis OS=0.01 sph (- 18.0 D cyl (- 2.5 D ax 0°=0.5. The second patient was a 35-year woman with a diagnosis of OU: high hyperopia, compound hyperopic astigmatism, moderate amblyopia. Distance visual acuity on admission was OD=0.03 sph (+ 8.0 D cyl (+ 1.5 D ax 95°=0.5; OS=0.03 sph (+ 8.0 D cyl (+ 0.75 D ax 75°=0.6. Individual multifocal toric IOLs were implanted in both patents after the removal of the lens phacoemulsification. All standard ophthalmic examinations were used as well as the ultrasound biomicroscopy (UBM. Results. In the follow-up: 6 months after the surgery in the first patient the uncorrected visual acuity (UCVA was far vis OD=0.6, vis OS=0.5, near vis OD=0.4, vis OS=0.5, middle distance vis OD=0.4, vis OS=0.4. The second patient 3 months after surgery had the UCVA far vis OD=0.5, vis OS=0.6, near vis OD=0.4, vis OS=0.5, middle distance vis OD=0.2, vis OS=0.3. The maximum possible distance visual acuity
Nimet (U)nay Gündogan; Ay(s)e Gül Ko(c)ak Altinta(s); Nezih Durmazlar; Koray Gümüs; Zerrin Yilmaz; Kemal K(o)semehmeto(g)lu
目的:评估高度近视伴色觉缺失患者的遗传学特征和临床表现方法:就同一家族4代42个成员中有8位患者给予了详细的眼科检查,Ishihara盘和FM100H试验检测患者有无红绿色觉缺失,全视野视网膜电图评价其视网膜功能.结果:患者8位均因高度近视视力下降,其中6例有红绿色觉缺失,眼底检查显示以弥漫性视网膜脉络膜萎缩为特征的近视改变.2例患者ERG检查出现视杆细胞的暗适应异常和视锥细胞的反应消失,根据家系,红绿色觉缺失属X连锁的隐性遗传.结论:在这个家族成员中,同时发生的高度近视和色觉缺失可能有共同的遗传学基础.%AIM: To evaluate genetic characteristics and clinical findings in a family with high myopia and colour vision deficiency (CVD).METHOD: Eight affected subjects of 42 members in four generations of the same family underwent a complete ophthalmic examination. Classical and computer adapted Ishihara Plates and Farnsworth-Munsell 100 Hue (FM100H)tests were used for determining the red-green CVD and full-field electroretinography (ERG) was performed to evaluate retinal function.RESULTS: Eight affected subjects had subnormal visual acuity due to high myopia. The results of colour vision tests were consistent with red-green CVD in six of these affected subjects. Fundus examination showed degenerative myopic changes characterized with generalized chorioretinal atrophy.Abnormal cone and rod dark-adaptation and diminished cone response in ERG were found in two subjects. According to family pedigree, it has been suggested that red-green CVD has X-linked recessive inheritance.CONCLUSION: The concurrence of high myopia with CVD in the members of this family may show a possible evidence for an associate genetic basis on different disorders.
Optical coherence tomography and indocyanine green angiography findings in acute syphilitic posterior placoid choroidopathy: case report Achados da tomografia de coerência óptica e angiografia com indocianina verde na coroidopatia placóide posterior aguda sifilítica: relato de caso
Full Text Available The optical coherence tomography (OCT and indocyanine green angiography (ICGA findings of a 58-year-old male with acute syphilitic posterior placoid chorioretinitis are reported herein. Best-corrected visual acuity was 20/150 in the right eye (OD and 20/30 in the left eye (OS at presentation. On funduscopy, there was a central subretinal placoid yellowish lesion in OD. VDRL and serum FTA-ABS were positive. OCT showed increased reflectance and thickening of the subfoveal RPE-choriocapillaris complex corresponding to the lesion in OD. ICGA revealed a hypofluorescent spot corresponding to the lesion in OD and confluent small dots extending to periphery, without any correspondence in fundus examination. The same dots were also seen in OS, even though no lesions could be observed clinically. Intravenous ceftriaxone 2 g daily was given for 10 days. One month after the first visit, visual acuity improved to 20/30 and marked improvement of the lesion was seen. OCT was normal in both eyes at the final visit.Relatamos aqui os achados da tomografia de coerência óptica (OCT e angiografia com indocianina verde (ICGA de um paciente masculino de 58 anos com a coroidopatia placóide posterior aguda sifilítica. A acuidade visual corrigida na apresentação foi de 20/150 no olho direito (OD e 20/30 no olho esquerdo (OE. A fundoscopia evidenciou lesão sub-retiniana placóide amarelada central no OD. As sorologias VDRL e FTA-ABS foram positivas. OCT evidenciou aumento de refletividade subfoveal e espessamento do complexo EPR-coriocapilar correspondente à lesão do OD. ICGA revelou hipofluorescência local correspondente à lesão do OD e pequenos pontos confluentes que se estendiam para a periferia, sem qualquer correspondência na fundoscopia. O mesmo também foi visto no OE, embora nenhuma lesão pode ser observada clinicamente. Ceftriaxona 2 g intravenosa diária foi administrada durante 10 dias. Um mês após a primeira visita, a acuidade visual do OD foi
Eduardo Alberto Tudury
Full Text Available Em 81 cães com sinais clínicos, lesões histológicas e corpúsculos de inclusão no sistema nervoso central característicos de cinomose nervosa foi constatada ocorrência freqüente de: alteração das reações posturais (87,65%, diminuição da secreção lacrimal (83,95%, presença de mioclonias (75,30%, paresias (69,12%, conjuntivite (56,79%, corioretinite/ hiperqueratose naso-digital (51,85%, linfopenia (51,85%, anemia (48,05%, principalmente microcítica hipocrômica, e discretas alterações liquóricas caracterizadas por aumento de proteínas totais (77,33% e pleocitose linfocítica (50,72%. A presença de corpúsculos de Lenz em tecidos extraneurais oscilou entre 30 e 45 %, com maior freqüência em linfonodos. Enquanto outras anormalidades clínicas, neurológicas e laboratoriais não tiveram freqüência expressiva para dar apoio ao diagnóstico, o incorreto programa de vacina��ão foi uma constante.Eighty-one dogs with clinical signs and histological lesions characteristic of distemper encephalomyelitis were evaluated. Only dogs with Lenz inclusion bodies in the central nervous system were included in the study. High prevalent findings included: changes in postural reactions (87.65%, decreased tear production (83.95%, myoclonus (75.30%, paresis (69.12%, conjunctivitis (56.79%, chorioretinitis/digital and nasal hyperkeratosis (51.85%. Anemia (48.05%, lymphopenia (51.95%, and mild changes in the cerebrospinal fluid characterized by increase in total protein (77.33% and lymphocytic pleocytosis (50.72% were common laboratorial findings. Presence of Lenz inclusions bodies in tissues other than nervous system varied from 30 to 45%, with a higher frequence in the limph nodes. Other abnormalities in physical, neurological and laboratorial examinations were not helpful in establishing the diagnosis. Most animals examined were not properly vaccinated.
Vogt, Susan D; Curcio, Christine A; Wang, Lan; Li, Chuan-Ming; McGwin, Gerald; Medeiros, Nancy E; Philp, Nancy J; Kimble, James A; Read, Russell W
In geographic atrophy (GA), the non-neovascular end stage of age-related macular degeneration (AMD), the macular retinal pigment epithelium (RPE) progressively degenerates. Membrane cofactor protein (MCP, CD46) is the only membrane-bound regulator of complement expressed on the human RPE basolateral surface. Based on evidence of the role of complement in AMD, we hypothesized that altered CD46 expression on the RPE would be associated with GA development and/or progression. Here we report the timeline of CD46 protein expression changes across the GA transition zone, relative to control eyes, and relative to events in other chorioretinal layers. Eleven donor eyes (mean age 87.0 ± 4.1 yr) with GA and 5 control eyes (mean age 84.0 ± 8.9 yr) without GA were evaluated. Macular cryosections were stained with PASH for basal deposits, von Kossa for calcium, and for CD46 immunoreactivity. Internal controls for protein expression were provided by an independent basolateral protein, monocarboxylate transporter 3 (MCT3) and an apical protein, ezrin. Within zones defined by 8 different semi-quantitative grades of RPE morphology, we determined the location and intensity of immunoreactivity, outer segment length, and Bruch's membrane calcification. Differences between GA and control eyes and between milder and more severe RPE stages in GA eyes were assessed statistically. Increasing grades of RPE degeneration were associated with progressive loss of polarity and loss of intensity of staining of CD46, beginning with the stages that are considered normal aging (grades 0-1). Those GA stages with affected CD46 immunoreactivity exhibited basal laminar deposit, still-normal photoreceptors, and concomitant changes in control protein expression. Activated or anteriorly migrated RPE (grades 2-3) exhibited greatly diminished CD46. Changes in RPE CD46 expression thus occur early in GA, before there is evidence of morphological RPE change. At later stages of degeneration, CD46
F. Nery Guimarães
& Henderson (2 cases, Saint Louis, 1941; Paige, Cowen & Wolf (3 cases, New York, 1942; and De Lange (Amsterdam, 1929: diagnosed by Paige, Cowen & Wolf in 1942 .Of these reports considered as undoubtful cases of human toxoplasmosis, 10 represent congenital disease (Torres and Paige, Wolf & Cowen, having occurred in either new born or a-few-month-old children. As in the cases, in which it was possible to examine the mothers of those children, these women were of a healthy appearance, the conclusion was drawn that the disease, although extremely severe and fatal, can present an unapparent form. In 2 cases, serum protection tests proved such an unapparent infection of the mothers, in whom neutralizing antibodies against Toxoplasma were met with (Paige, Cowen & Wolf. Although no detailed microscopical study has been made in all cases, the disease is characterized by granulomatous meningoencephalomyelitis (Wolf & Cowen, often associated with myocarditis and chorioretinitis. The symptoms presented by the patients were: fever, convulsions, respiratory disturbances, hydrocephalus, cyanosis, vomiting, temperature lability, etc., the diagnostic sign of the greatest importance being the presence of foci of profound cerebral calcification and chorioretinitis in new born (Wolf, Cowen & Paige. In 2 cases of toxoplasmosis verified in one 6 and the other 8 years old, patients, an encephalitis, clinically atypical, was met with, one of them having recovered his health (Sabin. The remaining three cases were described in adults; in one of them the changes were not typical (these was a concomittant infection by Bartonella bacilliformis and in the two others the disease assumed an "exanthematous form", simulating a macular fever (Pinkerton & Henderson, the most important microscopical evidence being an interstitial pneumonia. Apart from the clinical similarity, also the encephalitis foci met with in this "exanthematous form" of toxoplasmosis resemble those described in "macular fevers"…
. Etiology varies according to the sex of the patient: lung carcinoma metastasises most frequently in men and breast carcinoma in women. These tend to multifocality and are generally localized in the posterior pole. Fifty percent of cases follow an asymptomatic development, but they can cause loss of vision, scotomas, metamorphopsias and photopsias. Charactersitic ophthamoscopic examination shows a placoid, homogenous choroidal lesion with a creamy appearance. The differential diagnosis must consider the amelanotic nevus, choroidal amelanotic melanoma, choroidal haemangioma, rear scleritis, choroidal osteoma, chorioretinitis, Harada’s disease, rhegmatogenous retina detachment, uveal effusion syndrome, and serous central chorioretinopathy. An exhaustive history and complete ophthalmological examination are essential to the diagnosis, to which fluorescein angiography, ocular echography, fine needle puncture aspiration (FNPA, computerized tomography and magnetic resonance can be added as complementary tests. Treatment of these tumours is usually the systemic treatment of the primary tumour; the possibilities of local treatment are observation, external radiotherapy, transpupillary thermotherapy and enucleation.
M. Pérez de Arcelus
important cause of choroidal neovascularisation. The viruses that most frequently affect the retina are of the herpes type and can produce devastating symptoms in immunoincompetent patients, named acute retinal necrosis syndrome. Retinitis due to cytomegalovirus is more frequent in immunodepressed patients, as in the case of AIDS, but it must also be contemplated in patients with lymphoma and immunomodulatory treatment. The most frequent bacterial diseases that affect the retina are syphilis and tuberculosis. Disease due to cat scratches, caused by a borrelia, can produce a neuroretinitis. Toxoplasmosis is the most common of the infectious diseases caused by a parasite and gives rise to chorioretinitis. Toxocariasis, also caused by a parasite, is second in importance, giving rise to choroidal granulomas and retinal tractions.
Cláudia Bonini de Abreu
papilledema, peripapillary exsudate and tapetum pigmentation were noted in three dogs submitted to retinograph. The histopathology showed focal mononuclear infiltrate of choroid, congestion of chorioretinal vessels an subretinal edema in eight dogs. Our results allow to conclude that acquired ocular toxoplasmosis in the dogs is as significant as in man and in doing so other studies must be undertaken.
Condição ocular dos indivíduos facectomizados na região centro-oeste do estado de São Paulo: estudo populacional Cataract-operated individuals at the Center-Western zone of São Paulo state: populational survey
% of the patients had visual acuity improved with refractive error correction. The main causes of poor vision were refractive error, posterior capsule opacification (19.4%, bullous keratophaty (8.3%, cicatricial chorioretinitis (8.3%, aphakic eyes (8.3%, age-related macular degeneration (5.5%, leukoma (5.5%, glaucoma (5.5%, optic atrophy (5.5%, retinal detachment (2.8%, retinal pigment epithelium atrophy (2.8% and high myopia (2.8%. CONCLUSION: Cataract projects are effective in reducing preventable blindness caused by lens opacity. However, long-term scheduled evaluation of operated patients is necessary avoiding consequent blindness resulting from neglected follow-up.
Oswaldo Ferreira Moura Brasil
Full Text Available OBJETIVO: Avaliar a presença de alterações fundoscópicas em pacientes portadores de miopia degenerativa. MÉTODOS: Quarenta pacientes com erro refrativo de pelo menos -6,00 dioptrias foram selecionados para exame oftalmológico, complementado por retinografia do pólo posterior e ecobiometria. RESULTADOS: Foram estudados 57 olhos de 37 pacientes com erro refrativo de -6,25 a -28,50 dioptrias, com média de -14,05, e comprimento axial de 26,06 a 32,86 mm, com média de 28,01. Encontramos crescente temporal em 36,5% e circunferencial em 21% dos olhos. Vasos da coróide foram visualizados em 35% dos olhos. As alterações do pólo posterior foram as seguintes: estafiloma posterior em 10,5%, mancha de Fuchs em 3,5% e "lacquer cracks" em 1,5%. O exame da periferia retiniana evidenciou atrofia corio-retiniana tipo pavimentosa em 17,5%, branco sem pressão em 10,5%, degeneração "lattice" em 5%, ruptura retiniana em 3,5% e retinosquise em 1,5% dos olhos examinados. CONCLUSÕES: Alterações fundoscópicas que levam à baixa visual são freqüentes em pacientes com miopia degenerativa. O exame da periferia retiniana é muito importante nestes pacientes devido ao risco aumentado de descolamento de retina.PURPOSE: To evaluate the presence of fundus changes in degenerative myopia. METHODS: Forty patients with refractive error of at least -6.00 diopters were selected for ophthalmologic examination followed by posterior pole photograph and echobiometry. RESULTS: We studied 57 eyes of 37 patients with refractive error ranging from -6.25 to -28.50 diopters, with mean -14.05, and axial length ranging from 26.06 to 32.86 mm, with mean 28.01. We found a temporal crescent in 36.5% and a peripapillary one in 20% of the eyes. Choroidal vessels were seen in 35% of the eyes. Posterior pole changes were as follow: posterior staphyloma in 10.5%, Fuchs' spots in 3.5% and lacquer cracks in 1.5%. Peripheral retinal examination revealed paving stone chorioretinal
Avaliação da perimetria macular em pacientes com degeneração macular relacionada à idade por meio do oftalmoscópio de rastreamento a laser Evaluation of macular perimetry in patients with age-related macular degeneration using the scanning laser ophthalmoscope
Full Text Available OBJETIVOS: Verificar a relação entre alterações anatômicas (drusas duras, drusas moles, hiperpigmentação, neovasos, descolamento do epitélio pigmentado da retina, hipopigmentação e atrofia coriorretiniana e a sensibilidade à luz em pacientes com degeneração macular relacionada à idade (DMRI; analisar a sensibilidade macular em áreas com ausência de lesões anatômicas nos pacientes com DMRI comparando-as ao grupo de controles, para avaliar a existência ou não de lesão funcional em área sem lesão anatômica. MÉTODOS: Estudo comparativo, descritivo e analítico, de corte transversal. O grupo de casos foi formado por 31 indivíduos portadores de DMRI com idade entre 51 e 88 anos. O grupo de controles ficou composto por 31 indivíduos considerados "sadios", não portadores de DMRI com idade entre 61 e 80 anos. Os grupos foram pareados por sexo e idade. Realizou-se a perimetria macular estática, vermelho-vermelho, com o oftalmoscópio de rastreamento a laser (ORL. Os resultados da perimetria macular foram correlacionados à lesão anatômica identificada no local correspondente pelo laser infravermelho e fotografias coloridas. RESULTADOS: As áreas com neovasos ou atrofia apresentaram sensibilidade significantemente diferente em relação às áreas com ausência de lesões anatômicas nos pacientes com DMRI. Houve perda funcional significativa em áreas com ausência de lesões anatômicas nos pacientes com DMRI em relação ao grupo de controles. CONCLUSÕES: Áreas com neovasos ou atrofia podem ser fatores individuais de piora da sensibilidade macular localizada. Pode ocorrer perda funcional mesmo sem lesão anatômica aparente nos pacientes com DMRI.PURPOSES: To evaluate the correlation between anatomical changes (hard druses, soft druses, hyperpigmentation, new vessels, detachment of retinal pigment epithelium, hypopigmentation and chorioretinal atrophy and light sensitivity in patients with age-related macular
Júlio César de Faria Couto
ultrasonographic alterations in fetuses infected with Toxoplasma gondii, correlating them with neonatal prognosis. METHODS: between June 1997 and May 2003, 150 pregnant women with suspected toxiplasmosis were examined. Acute infection was confirmed in 72 (48% of these pregnant women and congenital toxoplasmosis was diagnosed in 12 (16% fetuses. Prenatal diagnosis was established by polymerase chain reaction in the amniotic fluid. All the patients received antiparasitic therapy. Ultrasound examination was performed every fortnight and all the infants were evaluated during their first year of life. RESULTS: ultrasonographic changes were observed in eight fetuses. All of them showed symmetric bilateral ventricular enlargement that was associated with periventricular calcifications in five cases. Other changes as hepatic calcification, hepatomegaly, polyhydramnium, and pericardial effusion were less frequent. Among these fetuses, four were stillborn and three showed sequelae (chorioretinitis and neuro-psychomotor retardation. The four fetuses that showed normal ultrasonography had a satisfactory development. CONCLUSION: There was a high incidence of ultrasonographic changes in fetuses with congenital toxoplasmosis, mainly brain damage. Other changes as hepatomegaly and pericardial effusion were less frequent and were related to a systemic infection. The prognosis of these fetuses seems to be correlated with the presence of these lesions mainly because they had high mortality ratio and among the survivors the incidence of sequelae was high. The non-symptomatic fetuses evolved in a favorable way without developing sequelae. These results highlight the value of ultrasonographic examination of these fetuses in order to establish a prognosis and allow the elaboration of a suitable post-natal procedure.
王明扬; 李筱荣; 王光璐
Objective To compare the therapeutic effects between transpupillary thermotherapy (TTT) and photodynamic therapy (PDT) for circumscribed choroidal hemangioma(CCH).Methods One hundred and fourteen eyes of 114 cases treated by TTT and twenty eyes of 20 cases treated by PDT were enrolled in the study.Fundus fluorescein angiography(FFA) and ultrasonography(B-scan) were used for examination.In TTT,the entire tumor surface was covered by the laser spots resulting in a gray-white reaction and overlapping laser spots were placed for larger tumors.There were 1 ～ 6 laser spots in each treatment.The session for management was 1 ～ 5 times with 1 ～ 3 months interval.The standard photodynamic therapy with the photosensitizer verteporfin was carried out.The intravenous verteporfin was administered 15 minutes before laser irradiation at 689 nm.Tumors less than 3 mm thick were irradiated for 83 seconds; tumors thicker than 3 mm were irradiated for 166 seconds.The interval time was ≥3 months.Results The five factors were compared.(1) The location of tumor.The rate of efficiency of TTT in foveal and para-foveal cases was 91％ (61/67) and 94.3％ (33/35) in around disk.There was no significant difference in effective rate between the two locations (P =0.563).(2) Retinal detachment.The incidence of retinal detachment over the tumor surface was higher in PDT group than TTT group.(3)Tumor thickness.For tumor with thickness≥4 mm,the effect of TTT was better than PDT penetrate tissue.(4) The response of body tissues and tumor to laser power.There were higher degrees of scarring,pigment,proliferation in TTT cases than PDT cases which only had slight pigment changes and sometimes with delayed chorioretinal atrophy.(5)The efficiency and visual aeuity(VA).There was no significant difference in the rate of efficiency and VA improvement between TTT and PDT groups (P =0.40,0.28).Conclusion The two laser are effective for CCH.The CCH in foveal and para-foveal with less exudation should
João Jorge Nassaralla Junior
Full Text Available PURPOSE: To better define the effect of laser in situ keratomileusis (LASIK on myopic eyes and the risk and incidence of retinal complications after surgery. METHODS: In a prospective study, 200 eyes of 100 patients, 49 male and 51 female, with a mean age of 29.7 years, had a complete posterior pole examination before and at 1 week, 1, 3 and 12 months after bilateral simultaneous LASIK for the correction of myopia. Mean spherical equivalent was 7.75D (range 1.00 to -17.25D. Before LASIK, preventive treatment was carried out on predisposing lesions to retinal complications, with laser photocoagulation. RE: Before surgery, the ophthalmic features were: 86 eyes (43% presented no peripheral abnormalities; 49 eyes (24.5% had lattice degeneration; 18 eyes (9%, white without pressure; 5 eyes (2.5%, white with pressure; 33 (16.5%, oral chorioretinal degenerations; 6 (3%, paving stone; 45 (22.5%, posterior vitreous detachment; 20 (10%, retinal vitreous traction; and 12 (6%, round holes. Comparing the incidence of ophthalmic features before and at one year after surgery, there was not a statistical significant difference (P>0.05. CONCLUSION: Although retinal pathologic conditions have been described as complications after LASIK, our data did not reveal a cause-effect relationship between the refractive error corrective procedure and retinal complications. The retinal changes found after LASIK in this series of patients, appear to reflect the predisposition of myopes. Both patient and doctor should be aware that, even after the refractive error correction, the risk of complications related to the myopic eye would persist.OBJETIVO: Definir melhor o efeito da técnica laser in situ keratomileusis (LASIK em olhos míopes, o risco e a incidência de complicações retinianas após a cirurgia. Este estudo foi realizado no Instituto de Olhos de Goiânia. MÉTODOS: Em um estudo prospectivo, 200 olhos de 100 pacientes, 50 homens e 50 mulheres, com idade média de
N-Acetylcarnosine sustained drug delivery eye drops to control the signs of ageless vision: Glare sensitivity, cataract amelioration and quality of vision currently available treatment for the challenging 50,000-patient population
Mark A Babizhayev
with advancing age, such as cataract and glaucoma, which are by far the commonest causes of blindness in our sample and in all age groups, glaucomatous neurodegeneration can be treated with developed NAC autoinduction prodrug eye drops equipped with corneal absorption promoters. The common blinding affections presenting in developed countries such as, senile macular degeneration, hereditary chorioretinal dystrophies, diabetic retinopathy are poorly represented in our current summary of vital-statistics and will be reported inherent in next N-acetylcarnosine ophthalmic drug studies.Conclusion: The authors present evidence, about why only a certain kind of NAC is safe, and why only certain formulas designed by IVP for drug discovery are efficacious in the prevention and treatment of senile cataract for long-term use. Overall cumulated studies demonstrate that the designed by IVP new vision-saving drug NAC eye drops help the aging eye to recover by improving its clarity, glare sensitivity, color perception and overall vision.Keywords: age-related ophthalmic diseases, cataract, disability-glare, halos, Halometer, visual-acuity, N-acetylcarnosine lubricant eye drops, repurchase behavior analysis, 50,000-patients’ compliance to self-administer eye drops