Traumatic Uveitis Research Articles

Presentations of Anterior Chamber Seeds in Children With Retinoblastoma

Anterior segment photographs of the (A) left eye of a 2-year-old girl with diffuse infiltrating retinoblastoma, depicting white fluffy exudates in the anterior chamber (A1), which were floating and changing position with gravity (A2), moving behind the iris on dilating the pupil. (B) Right eye of a 4-year-old boy with IIRC group E retinoblastoma, showing three large white solid iris nodules in the anterior chamber angle. He was being treated as a case of traumatic anterior uveitis for 2 weeks before the diagnosis of retinoblastoma was made. (C) Left eye of a 4-year-old girl with IIRC group E retinoblastoma, showing white cystic iris nodules. Almost the entire iris was studded with these nodules. (D) Left eye of a 14-year-old boy with IIRC group E retinoblastoma, depicting pseudo-hypopyon with plasmoid aqueous and free-floating retinoblastoma cells. He had undergone vitreous tap elsewhere which revealed retinoblastoma cells. Presentations of Anterior Chamber Seeds in Children With Retinoblastoma

Cystercercus Larva in the Anterior Chamber of the Eye of a 7- year-old Nigerian Girl

The case of a 7 year old Nigerian girl with features of traumatic uveitis which was later found to have anterior chamber cestode larva infestation is presented. Though uncommon, ocular cestode larva infestation should be considered when children present with features of ocular inflammation.

Intraocular pressure elevation from topical difluprednate use

Introduction Difluprednate ophthalmic emulsion 0.05% (Durezol™, Alcon, Fort Worth, Texas) is a topical difluorinated derivative of prednisolone with potent anti-inflammatory activity. Difluprednate 0.05% has a reported associated increase in intraocular pressure (IOP) in 3% of patients. Although the occurrence may be low, the possible elevation in IOP may be substantially higher than commonly encountered with other topical steroids. Case Reports A 49-year-old black man presented with a traumatic anterior uveitis recalcitrant to traditional prednisolone acetate 1% treatment. The patient was switched to difluprednate 0.05% in an attempt to better control the ocular inflammation. Although the patient did not exhibit an IOP response after 4 weeks of treatment with prednisolone acetate 1%, he did experience a pressure response within 2 weeks of initiating difluprednate treatment, resulting in an IOP increase from 9 mmHg to 48 mmHg with subsequent microcystic edema. A 44-year-old black woman presented with recurrent scleritis resistant to topical prednisolone acetate, loteprednol etabonate, and oral nonsteroidal anti-inflammatory therapy. Topical loteprednol 0.5% was replaced by difluprednate 0.05%. All evidence of ocular inflammation was eradicated with the changed therapy. IOP rose in the difluprednate-treated eye from 18 mmHg to 34 mmHg over the course of 18 days. In both cases, the IOP elevation was managed rapidly with the discontinuation of difluprednate and temporary use of IOP-reducing agents with no lasting adverse effects. Conclusion Difluprednate 0.05% is a new topical therapeutic option indicated for the treatment of inflammation and pain management associated with ocular surgery with an off-label potential for treatment of other anterior segment inflammatory conditions. However, clinicians need to be aware of the potential risk for significant and potentially rapid onset of IOP increase with this medication and manage patients accordingly.

Tomografia de coerência óptica na commotio retinae: relato de caso

The purpose of this case report was to correlate optical coherence tomography findings and visual outcomes of patients with different degrees of commotio retinae. A 20-year-old male and a 23-year-old male that presented with decreased vision due to Berlin's edema after blunt ocular trauma were evaluated by optical coherence tomography and retinography. The visual acuity in the affected eye was 20/25 in the first patient and counting fingers in the second one. The ophthalmic examination showed traumatic uveitis and fundoscopy revealed mild retinal opacification in the first case and severe opacification in the latter. The optical coherence tomography confirmed the reduction of foveal depression on the first case and the disarrangement of all retinal layers on the second. There has been complete functional and anatomical resolution by optical coherence tomography in the first patient, while the second evolved to permanent visual loss. Optical coherence tomography is a useful method in the evaluation of retinal trauma, helping to understand its physiopathology and to predict its prognosis through the anatomical analysis of the affected region.

Diagnostic Western blot for lens-specific proteins in aqueous fluid after traumatic lens-induced uveitis

Diagnostic Western blot for lens-specific proteins in aqueous fluid after traumatic lens-induced uveitis

The Transcaruncular Approach to Orbital Fracture Repair

The transcaruncular approach to the medial orbit is growing in popularity and although reported complications are minimal, ophthalmic and orthoptic sequelae can occur after any conjunctival surgery and nonophthalmic surgeons should be aware of these. This study aims to document these sequelae in a cohort of patients having transcaruncular surgery. A retrospective case series of all consecutive patients undergoing orbital fracture repair through a transcaruncular approach for medial wall and floor fractures in two centers over a 2-year period was examined. Computed tomography findings, pre- and postoperative ophthalmic and orthoptic findings, including ocular motility (with Hess chart evaluation), Hertel exophthalmometry, slit lamp biomicroscopy examination, follow-up time, and occurrence of complications were recorded. Thirteen patients, mean age 34 years (range, 18-82 years), underwent repair for medial wall (n=5) or combined medial wall and orbital floor (n=8) fractures with median a follow up of 7 months (range, 2-18 months). Preoperative ocular injuries included conjunctival chemosis, eyelid swelling, subconjunctival hemorrhage, retinal haemorrhage, traumatic uveitis and traumatic mydriasis, eye movement restriction, and enophthalmos (range, 3-4 mm). Postoperatively, corneal epitheliopathy with reduced vision (6/60), orbital inflammation, inferior oblique underaction, and superomedial fornix symblepharon at the caruncular incision sight each occurred in one patient along with extensive subconjunctival hemorrhage and a suture-related conjunctival granuloma in others. All patients experienced an improvement in diplopia and globe restriction. Ophthalmic complications can occur with this approach, and so it may be advisable to seek an ophthalmic opinion with the aim of comanagement in planning this approach.

Neovascularización retiniana en microhifema traumático

This is a case of retinal ischaemia with subsequent neovascularization, in a 13 year-old boy who sustained a traumatic hyphema after blunt trauma. Hyphemas can occur after blunt trauma, intraocular surgery, spontaneously and in association with the use of substances that alter platelet or thrombin function (aspirin, ethanol). Associated injuries are traumatic anterior uveitis, iridodialysis, optic atrophy, secondary hemorrhage and a traumatic cataract. This case illustrates the formation of retinal neovascularization in association with a microhyphema and the need for careful and prolonged ophthalmological examination in this clinical context.

Pediatric uveitis in Southern Turkey

Uveitis in the pediatric population is not so common, and the etiology is different from adults. In the present study the charts of the pa-tients with onset of uveitis at 16 years of age or younger were reviewed in order to analyze the etiology in pediatric patients with uveitis, and to com-pare the results with other studies carried out on different populations. The charts of 90 cases, followed at the Uvea-Immunology Clinic of the Cukurova University Medical Faculty Department of Ophthalmology, be-tween January 1987 and February 1996 were reviewed retrospectively. There were 47 girls, 43 boys, aged 5-20 (13.64 ± 4.24) in the study group. The average age at onset of uveitis was 12.20 ± 4.81, and the follow-up pe-riod was 9-98 months(z1.80 ± 11.13). Of the 90 patients 31 (34.4%) had panuveitis, 30 (33.3%) had anterior uveitis, 21 (23.3%) had posterior uveitis and 8 (8.9%) had intermediate uveitis. Only 2 (9.5%) of the patients with posterior uveitis were considered idiopathic after extensive laboratory and clinical work-up, whereas idiopathic cases constituted 48.4% of panuveitis, and 46.7% of anterior uveitis cases. Of the 90 patients an associated condition could be found in only 59 (65.6%) patients. Of these 59 patients 23 had toxoplasmosis (39%), which constituted the most common associated condi-tion in this study. The second most common underlying cause was Behqet's disease (17%), followed by pars planitis (13.6%), Fuchs' heterochromic iri-docyclitis (8.5%), JRA (5.1%), leukemia (5.1%), and herpetic eye disease (5.1%). There were single cases with Reiter, toxocariasis, traumatic uveitis, and sympathetic ophthalmia. Environmental, cultural and genetic factors may be accountable for the differences in relative frequencies of some of the associated conditions between our findings and those of previously pub-lished studies in patients with pediatric uveitis.

Biochemical studies of lacrimal fluid in predicting of clinical manifestations of traumatic uveitis (TU

Biochemical studies of lacrimal fluid in predicting of clinical manifestations of traumatic uveitis (TU

Serum sialic acid levels in patients with sympathetic ophthalmitis.

Serum sialic acid levels were measured in 16 patients with sympathetic ophthalmitis, 36 with neglected traumatic uveitis following penetrating injury and 40 healthy subjects. There was no significant alteration of its level in patients with traumatic uveitis. However, its level was significantly elevated in patients with sympathetic ophthalmitis. It was high even in the early stage of the disease. It decreased significantly at the remission stage. It is proposed that measurement of sialic acid level in serum can be used as a diagnostic aid when the diagnosis of sympathetic ophthalmitis remains doubtful on clinical grounds. The extent of rise in its level may be considered a good parameter of the degree of severity of sympathetic ophthalmitis. It may also act as a useful tool to evaluate the drug efficacy in this disease.

Serum beta‐2 microglobulin level in sympathetic ophthalmitis

Serum beta-2 microglobulin (beta 2-m) levels were measured in 12 patients with sympathetic ophthalmitis, 34 with neglected traumatic uveitis following penetrating injury and 36 healthy subjects by ELISA technique. There was no significant alteration of its level in patients with traumatic uveitis. However, its levels were significantly increased in patients with sympathetic ophthalmitis. They were high even in the early stage of the disease. Serum beta 2-m levels paralleled the severity of disease. It decreased significantly at the remission stage. Four patients came back with relapse of the condition and the level of serum beta 2-m was again found to be elevated in them. It is proposed that estimation of beta 2-m can be used as a diagnostic aid when the diagnosis of sympathetic ophthalmitis remains doubtful on clinical grounds. It is also suggested that a rise in serum beta 2-m in patients with traumatic uveitis following perforating injuries may point to the onset of sympathetic ophthalmitis. The extent of rise in its level may be considered a good parameter of the degree of severity of sympathetic ophthalmitis. It may also act as a useful tool to evaluate the drug efficacy in this disease and predict relapse.

Sport associated eye injury: a casualty department survey.

A survey was performed of all patients attending the combined Glasgow Eye Infirmary and Western Infirmary Eye Casualty Department with sports injuries. During an 18-month period a total of 246 patients presented with such injuries. Football was responsible for 110 (44.7%), rugby for 24 (9.8%), squash for 19 (7.7%), badminton for 16 (6.5%), and skiing for 9 (3.7%), and 68 (27.6%) were caused by other sports. One hundred and sixty-two patients (65.8%) had superficial or surrounding soft tissue injuries, 54 (22%) had more severe anterior segment damage in the form of hyphaema or traumatic uveitis, 17 (6.9%) had retinal damage manifest as oedema or retinal tear with or without detachment, and two (0.8%) suffered severe disruption of the globe with subsequent loss of the eye in each case. Forty-six (18.7%) required inpatient care and 200 (81.3%) were treated as outpatients, of whom 104 required at least one follow-up appointment (42.3% of the total). I conclude that with increasing time available for leisure activities there has been a parallel increase in sport associated eye trauma.

Serum fibrin degradation products in acute idiopathic anterior uveitis.

Levels of serum fibrin degradation products were measured by the Staphylococcal clumping test in patients with acute idiopathic anterior uveitis and traumatic anterior uveitis. We found them to be significantly increased (P less than 0.001) in patients with acute idiopathic anterior uveitis (11.0 micrograms/ml). The extent of this increase in the serum levels of fibrin degradation products correlated well with increased severity of the disease. It showed return to normal levels (5.0 micrograms/ml) with the clinical improvement. It increased again with the re-appearance of acute stage of the disease. We found no alteration in the levels of serum fibrin degradation products in patients with traumatic anterior uveitis. We hypothesise that uveal deposition of immune complexes causes secondary platelet damage and intravascular coagulation which results in uveal tissue damage through inflammation.

BACTERIAL ENDOPHTHALMITIS AFTER CATARACT EXTRACTION. A STUDY OF 22 INFECTIONS IN 20,000 OPERATIONS.

Postoperative infection of bacterial origin is a rare but devastating complication of cataract surgery. This paper will indicate its incidence, consider its sources, and analyze factors directly or indirectly related to 22 infections in a series of 20,000 cataract operations performed over a 14-year period at one hospital. Incidence of Infection Two factors cloud the true incidence of postoperative cataract infection. The first is the difficulty of differentiating between bacterial endophthalmitis and aseptic postoperative inflammation. The second is the fact that isolated cases of sporadic postoperative sepsis are almost never reported in the literature. Traumatic uveitis in response to the surgical procedure or a severe reaction to lens material remaining in the eye both may simulate bacterial endophthalmitis in producing the classic signs and symptoms of inflammation. Hypopyon may occur with all three. Early loss of the light sense and eventual loss of the eye favor the diagnosis of endophthalmitis.