Severe Vitreous Inflammation Research Articles

Toxocara Optic Neuropathy: About 02 Cases

Ocular toxocariasis is recognized to be a cause of childhood blindness. It usually results as a sequel of systemic infestation with the second or third stage larva of T. cani (visceral larval migrans). It is an uncommon cause of uveitis that mainly affects younger patients. Inflammation is typically unilateral and presents as either a granuloma in the peripheral or posterior retina or a moderate to severe vitreous inflammation mimicking endophthalmitis. We report two cases of children with ocular toxocariasis with posterior granuloma, negative for specific serodiagnosis. An anterior chamber puncture of the anterior chamber and an ELISA test with homologous antigens of Toxocara canis on the acqueous humor made the diagnosis diagnosis.

Simultaneous amplification of herpes simplex virus type 2 and Epstein–Barr virus in an immunocompetent host with acute retinal necrosis

Acute retinal necrosis (ARN) is an ocular inflammatory disease characterized by panuveitis and retinal vasculitis. Herpes virus is strongly associated with ARN and can often be detected by polymerase chain reaction (PCR) of vitreous samples. The authors report a case of ARN associated with herpes simplex virus-2 (HSV-2) and Epstein–Barr virus (EBV) in an immunocompetent host. A 72-year-old man with a history of herpes zoster ophthalmicus presented with sudden vision loss in the left eye in the setting of hypertensive anterior uveitis and severe vitreous inflammation. ARN was diagnosed and antiviral and steroid treatment was initiated. Vitritis improved 1 week later and foci of retinal necrosis with occlusive vasculitis were observed. Three days later, a rhegmatogenous retinal detachment developed. Pars plana vitrectomy with retinopexy was performed and a vitreous PCR test was positive for both HSV-2 and EBV. Despite retinal reattachment, visual acuity did not improve. Prophylactic antiviral therapy was continued for the fellow eye. The coexistence of more than one virus in the ARN context is exceedingly rare and might be associated with poor visual outcomes.

Toksoplazma Koryoretinitine Bağlı Geniş Seröz Makula Dekolmanı: Olgu Sunumu

Toxoplasma gondii is an obligate intracellular parasite, which can cause chorioretinitis. Although it is usually a selflimited disease, it may reduce vision secondary to the optic nerve or macular involvement and/or severe vitreous inflammation. The ‘classic’ sign of the infection is pigmented chorioretinal scar. The fluffy white nidus of the necrotizing retinochoroiditis can be seen adjacent to it. Here, we aimed to present a toxoplasmic chorioretinitis case complicated with a large serous macular detachment that we achieved anatomical and functional success as a result of prompt and suitable therapy

Current Practices in Ocular Toxoplasmosis: A Survey of Brazilian Uveitis Specialists

ABSTRACTPurpose: To describe treatment practices for ocular toxoplasmosis among members of the Brazilian Uveitis Society.Methods: An online questionnaire sent to specialists, between October 2014 and March 2015.Results: Most respondents (67.9%) treat all active cases. Most specialists consider visual acuity <20/200 (88.2%), severe vitreous inflammation (94.1%), and ocular disease during acquired infection (88.2%) as absolute indications for treatment. Systemic steroids are associated with anti-toxoplasmic therapy in most cases by 50.9% of the respondents. For immunocompetent individuals, 57.4% of the respondents chose trimethoprim/sulfamethoxazole. Classical therapy (sulfadiazine/pyrimethamine) is preferred most for patients with central lesions (70.4%), immunosuppression (68.4%), acquired infection (70.4%), and atypical forms (74.1%). For patients with frequent relapses, 84.9% of the respondents preferred antibiotic prophylaxis.Conclusions: Treatment patterns of ocular toxoplasmosis are not uniform among Brazilian specialists. Most specialists treat all cases of active retinochoroiditis. Typical cases are more frequently treated with trimethoprim/sulfamethoxazole. However, classical therapy is the regimen of choice when lesions are considered more severe.

Surveying uveitis specialists—a call for consensus

Surveying uveitis specialists—a call for consensus

PREVALENCE, CLINICAL FEATURES, AND CAUSES OF VISION LOSS AMONG PATIENTS WITH OCULAR TOXOCARIASIS

To describe the prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis seen at a uveitis referral center. A review was completed of the charts of patients with ocular toxocariasis who were examined between 1977 and 1996 at the Francis I. Proctor Foundation of the University of California at San Francisco. The prevalence of ocular toxocariasis among all uveitis patients seen at the center was determined. Demographic features, symptoms, and signs in all patients were evaluated. Ocular toxocariasis occurred in 22 (1.0%) of 2,185 uveitis patients. The mean patient age was 16.5 years. Inflammation was usually unilateral (90.9%). Toxocara uveitis presented as a granuloma in the peripheral retina in 50% of cases, as a granuloma in the macula in 25% of cases, and as a moderate to severe vitreous inflammation mimicking endophthalmitis in 25% cases. The primary causes of vision loss were vitritis (52.6%), cystoid macular edema (47.4%), and traction retinal detachment (36.8%). Ocular toxocariasis is an uncommon cause of uveitis that mainly affects younger patients. Inflammation is typically unilateral and presents as either a granuloma in the peripheral or posterior retina or a moderate to severe vitreous inflammation mimicking endophthalmitis.

Mycobacterium chelonae Wound Ulcer After Clear-CorneaCataract Surgery

A N 81Y E A R O L D woman developed a wound infiltrate 3 weeks after clearcornea cataract surgery in the right eye. Initial improvement with topical ofloxacin and corticosteroid was followed by development of a satellite lesion. On consultation, a corneal infiltrate with a crystalline appearance was seen near the surgical wound (Figure1). Acid-fast stain showed acid-fast bacilli (Figure 2) and cultures grew Mycobacterium chelonae, which is sensitive to the following (in order of sensitivity, from greatest to least): clarithromycin, ciprofloxacin, tobramycin, and amikacin. The ulcer improved with topical amikacin sulfate and oral clarithromycin. Six weeks after diagnosis, a pars plana vitrectomy was performed for severe vitreous inflammation. Smears and culture of the vitreous body were negative for microorganisms. Two months later, the patient developed iritis, which responded to lowdose topical corticosteroids. As of this report, the cornea has remained quiet after 1 year of follow-up (Figure 3).

Atypical presentations of ocular toxoplasmosis.

The diagnosis of ocular toxoplasmosis is based most often on the presence of characteristic clinical findings, which include focal retinochoroiditis, an adjacent or nearby retinochoroidal scar, and moderate to severe vitreous inflammation. However, a variety of less common, "atypical" presentations may be unfamiliar to clinicians, delaying both diagnosis and treatment. Patients who are immunocompromised or elderly may, for example, present with large, multiple and/or bilateral lesions. Other unusual manifestations include punctate outer retinal toxoplasmosis, retinal vasculitis, retinal vascular occlusions, rhegmatogenous and serous retinal detachments, a unilateral pigmentary retinopathy mimicking retinitis pigmentosa, neuroretinitis and other forms of optic neuropathy, and scleritis. Although in the past most cases of ocular toxoplasmosis were considered to result from reactivation of a congenital infection, it is now believed that postnatally acquired infection accounts for many cases of this disease. With appropriate use of antiparasitic therapy, the visual prognosis for patients with both typical and atypical forms of ocular toxoplasmosis may be good.

Echographic findings in infectious endophthalmitis.

To correlate the initial echographic findings in eyes with infectious endophthalmitis with the visual prognosis and causative microorganism. A retrospective review of the clinical and standardized ocular echographic findings in eyes with infectious endophthalmitis was performed. University-based ophthalmology department. One hundred thirty-seven eyes (136 patients) with infectious endophthalmitis that were evaluated by the ocular echography service of the Doheny Eye Institute, Los Angeles, Calif, between January 1, 1981, and December 31, 1992. Four findings on initial echography were associated with poor initial vision: dense vitreous opacities, retinal detachment, macular detachment, and choroidal detachment. Five findings on initial echography correlated with poor final vision: dense vitreous opacities, vitreous membranes, the presence of retinal detachment, the extent of retinal detachment, and the presence of choroidal detachment. Change (decrease) in vision during the follow-up period was associated with the presence of combined vitreous and subhyaloid opacities, retinal detachment, and choroidal detachment. All eyes with initially clear vitreous on ocular echography had either early streptococcal or culture-negative endophthalmitis. Advanced streptococcal endophthalmitis correlated with the most severe vitreous inflammation, vitreous membranes, and the most extensive posterior vitreous detachment, whereas gram-negative endophthalmitis correlated with choroidal detachment on initial echography. Stepwise logistic regression analysis revealed that the presence of choroidal detachment, not gram-negative microorganisms, was the principal predictor of poor visual outcome in these eyes. Ocular echography is a useful method in the clinical evaluation and treatment of infectious endophthalmitis, especially in eyes with opaque media.

Posterior Segment Ocular Manifestations in Patients with HLA-B27—associated Uveitis

To describe a series of patients with seronegative arthritic syndromes and HLA-B27-associated uveitis with severe, sight-threatening, posterior segment ocular manifestations. The authors reviewed the records of 29 patients (17.4%) with posterior segment involvement from a cohort of 166 patients with HLA-B27-associated uveitis. The inclusion criteria included individuals with a positive HLA-B27 who had at least one of the following findings: (1) severe vitreous inflammation; (2) papillitis; (3) retinal vasculopathy; or (4) pars plana exudates. The study population comprised 13 men and 16 women with a mean age at onset of uveitis of 35.2 years. The average duration of the uveitis was 5.3 years, and the median follow-up time was 26 months. Posterior segment involvement occurred in 34 eyes of the 29 patients. The most common findings included severe and diffuse vitritis in 93.1% of the patients and papillitis in 24 patients (82.7%). Retinal vasculitis occurred in seven patients (24.1%), and pars plana exudates were present in two patients (6.8%). Cystoid macular edema (37.9%) and epiretinal membrane (17.2%) were common causes of visual impairment. Systemic immunosuppressive therapy was required for control of inflammation in 32% of the patients. HLA-B27-associated uveitis may be related to severe, sight-threatening posterior segment manifestations in some patients; this is an under-recognized phenomenon. These patients may require the use of aggressive systemic immunosuppressive therapy to control inflammation and preserve vision.

Current Practices in the Management of Ocular Toxoplasmosis

To determine current practices in the management of ocular toxoplasmosis, 72 of 85 uveitis specialists (85%) in the American Uveitis Society completed a detailed questionnaire. Questions involved the indications for beginning treatment, choice of antiparasitic/antimicrobial agents, and experience with treatment of ocular toxoplasmosis in special situations including pregnancy, neonatal infections, and immunocompromised patients. Most of the respondents treat patients whose visual acuity had decreased to worse than 20/200, lesions located in the peripapillary, perifoveal, or maculopapillary bundle regions, and lesions associated with severe vitreous inflammation. Most would not treat patients who retained visual acuity of 20/20, lesions located in the far peripheral retina, or lesions associated with only trace to mild vitreous inflammation. Treatment of other combinations of factors remains controversial. Eight different antimicrobial drugs are used in various combinations for lesions threatening the macula or optic nerve head. Systemic corticosteroids are used by 59 of 62 respondents (95%) as part of their initial treatment regimen. The most commonly used regimens are pyrimethamine/sulfadiazine/corticosteroids (20 of 62 [32%]) and pyrimethamine/sulfadiazine/clindamycin/corticosteroids (17 of 62 [27%]). Adjunctive therapies (photocoagulation, cryotherapy, or vitrectomy) have been used by 20 of 60 respondents (33%). Most alter treatment during pregnancy, in newborn patients, and in patients with the acquired immunodeficiency syndrome.