Central Retinitis Research Articles

Refractory Ocular Behçet’s Disease; Outcome of Low Dose Infliximab

A 40-year-old woman had been suffering of many symptoms of Behcet’s disease (BD) since her childhood without being diagnosed. She had recurrent mouth ulcers and from the age of 21 vulva ulcers followed by loss of vision due to central retinitis and later also ankle arthritis. At the age of 31, uveitis due to BD was diagnosed. The fact that BD is often not recognized in Bangladesh explains the marked delay in her diagnosis. The initial central retinitis responded well to oral glucocorticoids, azathioprine and cyclosporine, but in the course of time she became refractory to these agents. Considering her financial constraints, low dose Infliximab (3mg/kg) was used resulting in a remarkable but temporal improvement, she came in remission by using 5mg/kg regimen with increased interval time. We summarize the treatment options for ocular involvement in BD patients Conclusions: In countries like Bangladesh diagnosis of Behcet’s disease can be delayed. Early cooperation of dermatologists and eye surgeons with rheumatologists is necessary. Most cases of resistant ocular BD can nowadays be successfully treated with anti TNF-agents. Promising results are published with other biologics for refractory and multi-resistant cases.

Ocular Syphilis May Lead to Persistent Visual Dysfunction

The spectrum of intraocular and systemic findings in patients with ocular syphilis is described. Persistent visual dysfunction and structural abnormality, in spite of targeted antibiotic therapy, were identified and analysed. Patients with ocular syphilis who were treated at University Hospital Zurich (USZ) between 2010 and 2018 were included in this study. General characteristics, ocular manifestation and visual function (best-corrected visual acuity [BCVA], visual field) before and after treatment were analysed retrospectively. Ocular syphilis was diagnosed in one female and 16male patients (median age 42 years, range 22 to 53 years). A bilateral infection was present in 11 cases, and 28 of 34 eyes were affected (82%). Manifestations included anterior (n = 3), intermediate (n = 4), posterior (n = 10) uveitis, as well as panuveitis (n = 5) and papillitis (n = 6). Abnormal liquor findings were present in 8 patients (47%). Six patients were human immunodeficiency virus (HIV) positive. In all patients, intravenous benzyl penicillin was initiated and led to inactivation of intraocular inflammation. Before the initial intravenous treatment, all patients received one dose of steroids orally (Prednisone [PDN] 50 to 70 mg). Seven patients had systemic steroids added over the course of the antibiotic treatment being gradually decreased during and after the antibiotic treatment. The initial median BCVA of all affected eyes (n = 28) of 17 patients was 0.1 logMAR (0.8 decimal), range 2.8 to - 0.1 logMAR (light perception to 1.25 decimal). At the last visit, the median BCVA was 0 logMAR, range 0.4 to - 0.1 logMAR (0.4 to 1.25 decimal). Median follow-up time was 11 months (range 3 to 60 months). At the last visit, BCVA of 4 eyes (3 patients) was ≤ 0.6. Six eyes of 5 patients had a persisting scotoma with central visual field defects. Morphologically, disintegration and irregularities of outer retinal layers after central retinitis (5 eyes) and atrophy of the peripapillary retinal nerve fibre layer (4 eyes) after papillitis correlated with abnormal vision. The spectrum of ocular manifestations in syphilis is broad. Despite targeted antibiotic therapy, more than a third of affected eyes had lasting abnormal vision. Patients with papillitis and retinitis were at an increased risk for persistent visual dysfunction.

STUDIES ON CHOLINESTERASE OF LABYRINTHINE AND SPINAL FLUID

Part I In spite of the recent development of the chemical substance theory on nerve impulse, very few biochemical investigations have been reported on the cochlear response.The author studied the Cholinesterase (ChE) activity of the labyrinthine fluid of guinea-pigs by Conway's microdiffusion analysis.The results obtained were as follows, 1. ChE in the labyrinthine fluid, both that in endolymph and perilymph, was specific Choli-nesterase.2. ChE activity of endolymph was about 4.36 times as much as that of perilymph. Free acetic acid produced from acetylcholine by 1mg endolymph in 40minutes at 38° was 0.0183mg% and by 1mg perilymph, 0.0042mg%.3. The injection of 2% Quinine hydrochloride solution (0.05gr per kg.) decreased gradually the ChE activity of endolymph and perilymph in parallel, but the diminution was slow and small in comparison with other cases.4. The injection of Dihydrostreptomycin (0.4g per kg) decreased the ChE activity more remarka-bly and earlier than the case of Quinine. The diminution of ChE activity of perilymph was more remarkable than that of endolymph.5. The sound stimulation (3000 cps 90db) for 60 hours diminished markedly the ChE activity of labyrinthine fluid and that of endolymph as if inhibited completely.Without stimulation for 7 days after 60 hours stimulation, the ChE activity of endolymph was recovered remarkably, but that of perilymph still remained low.In case of the experiment of repeated 12 hours stimulation and 7 day nonstimuration, the dimi-nution of ChE activity of labyrinthine fluid was slight.Part II The author carried out the clinical experiments on the ChE activity of spinal fluid by Hesterin's method with Beckman's spectrophotometer.The results obtained were as follows.1. Normal ChE activity was 0.175±0.006 ElogIo/I in equilibrium at range λ500mμ, the upper limit was 0.200, and the lower limit was 0.140.2. In 11 cases of conductive deafness, the ChE activities were normal or slightly below normal value except 2 cases of otitis media exsudativa acuta (0.200, 0.210).3. In 19 cases of nerve deafness, a considerable diminution of ChE activity was observed except 2 cases. Especially, in deafness due to detonation, sudden, traumatic, streptomycin, Menier's syndro-me, following to cerebral abscess, Congenital deafmutism, the ChE activity decreased remarkably.Two cases of Cholesteatoma-deafness and nerve deafness with central retinitis showed normal value.

A Type of Foveo-Macular Retinitis Observed in the U. S. Navy

This report is an attempt to correlate and evaluate the available data from a type of central retinitis observed in the United States Navy personnel and oc­ curring primarily in the Pacific Area. The study was made at the request of the Na­ tional Research Council, Sub-Committee of Ophthalmology, with the consent of Ross T. Mclntire, Surgeon General of the United States Navy, and the coopera­ tion of Capt. W. W. Hall (MC), U.S.N., of the Research Division, Bureau of Medicine and Surgery. The data were furnished by the follow­ ing Navy Medical Officers with the con­ sent of their executive officers:

Paresis of accommodation in central retinitis : Abe, T. Klin M. f. Augenh., 1929, v. 83, July, pp. 56–67

Paresis of accommodation in central retinitis : Abe, T. Klin M. f. Augenh., 1929, v. 83, July, pp. 56–67