Extensive Ocular Involvement Research Articles

Cutaneous Vitiligo Associated With Chorioidal Vitiligo: Case Report

We report on an unusual case of a 68-year-old patient with previously undiagnosed cutaneous vitiligo and extensive ocular involvement. This case demonstrates that vitiligo can affect choroidal and, due to an atypical pattern of choroidal hypopigmentation, simulate a large choroidal unclear tumor

Asymmetrical Ocular Manifestations of Nephropathic Cystinosis; A Case Report

Patient: Female, 22Final Diagnosis: Nephrogenic cystinosisSymptoms: Bilateral eye painMedication: —Clinical Procedure: —Specialty: OphthalmologyObjective:Rare co-existance of disease or pathologyBackground:Infantile nephropathic cystinosis is the most common and severe variant of cystinosis, which is a rare autosomal recessive condition related to a defect in the transportation of the protein cystine resulting in its deposition in various organs. Due to the rarity of this condition, only 1 case with extensive ocular involvement has been found in the English-language literature. Here, we report a second such case to highlight the significance of early diagnosis in avoiding devastating but preventable vision loss.Case Report:We describe the extensive asymmetrical ocular involvement in a 22-year-old woman who had nephropathic cystinosis since childhood. Despite frequent follow up and systemic and topical cysteamine therapy, she developed ocular complications, including increased intraocular pressure, uveitis, and retinal changes with complete loss of vision in her left eye. In addition, her general condition requires a renal transplant in the near future.Conclusions:Ophthalmologists should be aware of cystinosis and the sequalae of ocular involvement in this disease, despite its rarity. Identification of the earliest corneal deposits should not be overlooked, especially in the context of other systemic manifestations that are indicative of the nephropathic variant of cystinosis.

Prevention of Evisceration or Enucleation in Endogenous Bacterial Panophthalmitis with No Light Perception and Scleral Abscess.

Panophthalmitis is the most extensive ocular involvement in endophthalmitis with inflammation in periocular tissues. Severe inflammation of the anterior and posterior segments is frequently accompanied by corneal opacity, scleral abscess, and perforation or rupture. Enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted. The purpose of this retrospective study is to examine the outcomes of patients with endogenous bacterial panophthalmitis, no light perception and scleral abscess who were treated with multiple intravitreal and periocular injections of antibiotics and dexamethasone. Evaluation included spreading of infection to contiguous or remote sites, following evisceration or enucleation, and sympathetic ophthalmia. Eighteen patients were diagnosed with EBP, with liver abscesses in eight patients, retroperitoneal infection in four, pneumonia in two, infective endocarditis in one, cellulitis in one, drug abuse in one, and mycotic pseudoaneurysm in one. Culture results were positive for Klebsiella pneumoniae in 12 patients, Streptococcus spp. in three, Pseudomonas aeruginosa in one, Escherichia coli in one, and Staphylococcus aureus in one. The average number of periocular injections was 2.2, and the average number of intravitreal injections was 5.8. No eye required evisceration or enucleation and developed the spreading of infection to contiguous or remote sites during the follow-up. No sympathetic ophthalmia was observed in the fellow eye of all patients. Prevention of evisceration or enucleation in patients with EBP, NLP and scleral abscess can be achieved by multiple intravitreal and periocular injections of antibiotics and dexamethasone.

Oral pemphigoid with extensive ocular involvement: a case report

Oral pemphigoid with extensive ocular involvement: a case report

TINU-associated retinal pigment epithelium detachments: a possible novel posterior segment feature

To report a case of tubulointerstitial nephritis and uveitis syndrome (TINU) with novel posterior segment features of bilateral vitritis and retinal pigment epithelial detachments. This is an interventional case report with fundus photographs and fluorescein angiograms of a 9-year-old girl presenting with bilateral acute anterior uveitis 4 months after a diagnosis of acute tubulointerstitial nephritis. Visual acuities remained normal throughout the 6-month period of follow-up. The anterior and posterior uveitis settled, although retinal pigment epithelial detachments persisted and may be related to the underlying disease process in TINU or exogenous steroid treatment, or both. The idiopathic inflammatory response seen in TINU is traditionally associated with an anterior uveitis. This case demonstrates that there may be more extensive ocular involvement and that posterior uveitis and retinal pigment epithelial detachments may represent emerging features of atypical cases of TINU.

Malignant Acanthosis Nigricans: A Case Report

The authors present a case of malignant acanthosis nigricans that has two unusual aspects. The first is involvement of the lid margins with confluent papillomata, causing severe visual impairment, and the second is the association with lung malignancy. A 65-year-old Portuguese man presented with decreased vision, papillomatous lid lesions, pruritus, and progressive thickening of the skin of his face, neck, axillae, and inguinal creases. A diagnosis of acanthosis nigricans was made after skin biopsy. Systemic investigations showed a suprahilar mass, and biopsy was positive for squamous cell carcinoma of the lung. The patient underwent excision of papillomata from all four lid margins, and this was repeated 1 year later. He also completed a course of palliative radiotherapy. Malignant acanthosis nigricans is rarely associated with lung neoplasms, being more commonly a manifestation of intra-abdominal malignancies. Of note in this case is the extensive ocular involvement and visual impairment.

Quantification of ocular inflammation with technetium-99m glucoheptonate

Histological and morphometric evaluation of ocular inflammation is difficult, particularly when there is extensive ocular involvement with abscess formation and necrosis. A quantitative imaging procedure applicable to humans would be important clinically. To establish such a procedure, turpentine-induced ocular inflammation was obtained by subconjunctival injection in the right eye of 55 rabbits. The left eye was used as control and injected with a volume of saline equal to the volume of turpentine in the right eye. Volumes of turpentine or saline were 0.02, 0.04, 0.06, 0.2 and 0.6 ml, and the rabbits were divided into groups 1-5, according to these volumes. Imaging was performed 48 h after turpentine injection and 6 h after intravenous injection of 10 mCi of technetium-99m glucoheptonate (99mTc-GH). An inflammatory reaction index (IRI), defined as the ratio of counts of the right eye divided by counts of the left eye, was used. IRIs were proportional to the degree of inflammation and allowed the distinction of 3 subgroups: one represented by group 4, one by group 5 and one by groups 1, 2 and 3. This method of quantification of ocular inflammatory processes using 99mTc-GH is original, rapid, non-invasive, reproducible and safe, although unable to differentiate inflammatory processes caused by doses of turpentine which are very small and close to each other. It is conceivable that its application to humans will bring new insight into the ocular inflammatory process and response to therapy.

Disseminated Cryptococcosis with Ocular Involvement

A case of disseminated cryptococcosis with extensive ocular involvement is reported. The patient had pulmonary, meningeal, cerebral, cutaneous, lymph node, renal, adrenal and thyroid lesions, as well as granulomatous endophthalmitis.