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Ophthalmic and Vision Research - Volume:6 Issue: 4, Oct-Dec 2011

Journal of Ophthalmic and Vision Research
Volume:6 Issue: 4, Oct-Dec 2011

  • تاریخ انتشار: 1390/10/26
  • تعداد عناوین: 16
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  • Ebrahim M. Nashtaei, Masoud Soheilian, Carl P. Herbort, Mehdi Yaseri Page 233
    Purpose
    To compare the patterns of uveitis, emphasizing similarities and discrepancies, in the Middle East and Europe.
    Methods
    Six articles reporting uveitis patterns from the Middle East including a total of 2,693 cases, and seven articles with a sum of 4,379 cases from Europe were analyzed and patterns in each region were defined and compared.
    Results
    In both regions, uveitis was most commonly seen in the fourth decade of life with anterior uveitis being the most common anatomical form. Idiopathic cases accounted for the majority of anterior and intermediate uveitis; toxoplasmosis was the most frequent entity in posterior uveitis while Behcet's disease and idiopathic forms were the next most common causes in the Middle East and in Europe, respectively.
    Conclusion
    Since patterns of uveitis differ in various geographic regions, discovering these patterns would be helpful for the diagnosis and treatment of this condition. This necessitates applying a universal diagnostic classification system to enable accurate comparisons.
  • Nadia Bouchenaki, Carl P. Herbort Page 241
    Purpose
    To report the management of Vogt-Koyanagi-Harada (VKH) disease based on indocyanine green angiography (ICGA).
    Methods
    VKH patients with acute episodes of inflammation (inaugural or recurrent) who had received standard ICGA-guided care were studied retrospectively. Standard of care included high dose systemic corticosteroids at presentation and close ICGA follow-up with addition of immunosuppressive agents and/or intensification of ongoing therapy when recurrent choroidal lesions were detected by ICGA. Visual acuity, number of subclinical recurrences, type and duration of therapy, proportion of quiescent patients after therapy, and ICGA findings were recorded.
    Results
    Nine patients including 8 female and one male subject were studied. Five patients had inaugural disease and 4 presented with recurrent acute episodes. Visual acuity increased from 0.86±0.36 to 1.14±0.34 in the right eyes, and from 0.77±0.34 to 1.05±0.33 in the left eyes. The number of ICGA-detected occult choroidal recurrences amounted to 13. Mean duration of treatment was 30.1±34.6 months leading to recurrence-free status after discontinuation of therapy in 6 cases with mean duration of 29.5 months.
    Conclusion
    Continuous monitoring and aggressive therapy guided by ICGA in VKH disease prolongs treatment as compared to textbook guidelines but offers the prospect of reaching inflammation-free status after discontinuation of therapy. Zero tolerance to subclinical choroidal inflammation avoids irremediable evolution towards sunset glow fundus in patients treated early after the initial acute inflammatory attack.
  • Homayoon Nikkhah, Alireza Ramezani, Hamid Ahmadieh, Masoud Soheilian, Mohsen Azarmina, Mohammad Hossein Dehghan, Siamak Moradian, Ramin Nourinia Nourinia Page 249
    Purpose
    To evaluate the demographic and clinical features of childhood pars planitis, and to determine the therapeutic and visual outcomes of the disease.
    Methods
    Medical records of pediatric patients (less than 16 years of age at diagnosis) with pars planitis and at least 6 months of follow-up who were referred to Labbafinejad Medical Center, Tehran, Iran over a 22 year period were reviewed.
    Results
    Overall, 117 eyes of 61 patients including 51 (83.6%) male subjects were included. Mean age at the time of diagnosis was 7.8±3.2 (range, 3-16) years. Mean best corrected visual acuity (BCVA) was 0.88±0.76 logMAR at presentation which improved to 0.39±0.51 logMAR at final visit (P < 0.001). Endotheliitis was present in 23 (19.6%) eyes and was significantly more prevalent in subjects younger than 9 years (P=0.025). Cataract formation (41.9%) and cystoid macular edema (19.7%) were the most prevalent complications. Univariate regression analysis showed that better baseline visual acuity (OR=0.38, 95%CI 0.21-0.70, P=0.002), age older than 5 years at disease onset (OR=0.36, 95%CI 0.14-0.9, P=0.029), absence of endotheliitis (OR=0.39, 95%CI 0.15-0.99, P=0.047) and female gender (OR=3.77, 95%CI 1.03-13.93, P=0.046) were significantly associated with final BCVA of 20/40 or better.
    Conclusion
    Childhood pars planitis was much more common among male subjects. Endotheliitis may be a sign of inflammation spillover and is more prevalent in younger patients. Visual prognosis is favorable in most patients with appropriate treatment.
  • Mozhgan Rezaei Kanavi, Masoud Soheilian Page 255
    Purpose
    To compare the morphologic features of keratic precipitates (KPs) by confocal microscopy in granulomatous versus nongranulomatous noninfectious uveitis.
    Methods
    KP morphology was determined by confocal scan in patients with noninfectious granulomatous and noninfectious nongranulomatous uveitic cases.
    Results
    One hundred and twenty-seven eyes of 90 subjects with noninfectious uveitis were studied. Thirty-nine eyes had granulomatous and 88 had nongranulomatous uveitis. Smooth-rounded KPs were significantly more common in the granulomatous subgroup (P < 0.001) while cruciform and dendritiform KPs were more frequent in nongranulomatous uveitis (P < 0.001 and P < 0.005 respectively).
    Conclusion
    Confocal scan may be used as an adjunctive tool for differentiating granulomatous from nongranulomatous uveitis. Smooth-rounded KPs are strongly suggestive of granulomatous inflammation.
  • Ilknur Tugal-Tutkun Page 259
    Uveitis is less common in children than in adults, and its diagnosis and management can be particularly challenging. Young children are often asymptomatic either because of inability to express complaints or because of the truly asymptomatic nature of their disease. Even in advanced cases, parents may not be aware of severe visual impairment until the development of externally visible changes such as band keratopathy, strabismus, or leukocoria. Therefore, the diagnosis is often delayed and severe complications may be seen at the time of initial visit. Young children may not be cooperative for a complete ocular examination and subtle findings of intraocular inflammation such as trace cells may be easily missed in the early stages of the disease. Children, in general, tend to have more severe and chronic intraocular inflammation that frequently results in ocular complications and visual loss. In children who present with amblyopia or strabismus, a careful examination is required to rule out uveitis as an underlying cause. Delayed and variable presentations cause a distinct challenge in the diagnosis of uveitis in children, furthermore differential diagnosis also requires awareness of etiologies which are different from adults. There are unique forms of uveitis and masquerade syndromes in this age group, while some entities commonly encountered in adults are rare in children.
  • Carl P. Herbort, Marina Papadia, Piergiorgio Neri Page 270
  • Pia Allegri, Roberto Rissotto, Carl P. Herbort, Ugo Murialdo Page 284
    A number of inflammatory, infectious, neoplastic and idiopathic disorders affect the eye and the central nervous system (CNS) concurrently or at different time frames. These conditions pose a diagnostic challenge to the clinician since they may present with similar ocular and neurological manifestations. The purpose of this review is to describe major neurological syndromes including multiple sclerosis, Vogt-Koyanagi-Harada disease, other autoimmune syndromes, and several infectious diseases which may affect the eye. This article may serve as a guide for the diagnosis and treatment of such disorders. It should be noted that these conditions have been viewed from a neurologist's perspective thereby neurologic involvement is stressed.
  • Chiara Posarelli, Ilir Arapi, Michele Figus, Piergiorgio Neri Page 309
    Non-infectious uveitis is a potentially sight threatening disease. Along the years, several therapeutic strategies have been proposed as a means to its treatment, including local and systemic steroids, immunosuppressives and more recently, biologic agents. The introduction of biologics can be defined as a new era: biologic therapies provide new options for patients with refractory and sight threatening inflammatory disorders. The availability of such novel treatment modalities has markedly improved the therapy of uveitis and considerably increased the possibility of long-term remissions. This article provides a review of current literature on biologic agents, such as tumor necrosis factor blockers, anti-interleukins and other related biologics, such as interferon alpha, for the treatment of uveitis. Several reports describe the efficacy of biologics in controlling a large number of refractory uveitides, suggesting a central role in managing ocular inflammatory diseases. However, there is still lack of randomized controlled trials to validate most of their applications. Biologics are promising drugs for the treatment of uveitis, showing a favorable safety and efficacy profile. On the other hand, lack of evidence from randomized controlled studies limits our understanding as to when commence treatment, which agent to choose, and how long to continue therapy. In addition, high cost and the potential for serious and unpredictable complications have very often limited their use in uveitis refractory to traditional immunosuppressive therapy.
  • Nahid Haghjou, Masoud Soheilian, Mohammad Jafar Abdekhodaie Page 317
    Corticosteroids have been the mainstay of uveitis therapy. When intraocular inflammation is unresponsive to steroids, or steroid related side effects become a concern, steroid-sparing medications may be administered which can be classified into immunosuppressive and immunomodulatory agents. Uveitis treatment can be delivered systemically, topically, periocularly or intraocularly. All of the above mentioned medications can entail significant systemic side effects, particularly if administered for prolonged durations, which may become treatment-limiting. Some medications, particularly hydrophobic compounds, may poorly cross the blood-retinal barrier. Topical medications, which have the least side effects, do not penetrate well into the posterior segment and are unsuitable for posterior uveitis which is often sight-threatening. Intraocular or periocular injections can deliver relatively high doses of drug to the eye with few or no systemic side effects. However, such injections are associated with significant complications and must often be repeated at regular intervals. Compliance with any form of regular medication can be a problem, particularly if its administration is associated with discomfort or if side effects are unpleasant. To overcome the above-mentioned limitations, an increasing number of sustained-release drug delivery devices using different mechanisms and containing a variety of agents have been developed to treat uveitis. This review discusses various current and future sustained-release ophthalmic drug delivery systems for treatment of uveitis.
  • Ramin Nourinia, Talieh Montahai, Nasim Amoohashemi, Hossein Hassanpour, Masoud Soheilian Page 330
    Purpose
    To report a case of idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome associated with positive perinuclear antineutrophil cytoplasmic antibody (P-ANCA). CASE REPORT: A 51-year-old man presented with loss of vision in his right eye since many years ago and blurred vision in his left eye over the past year. Ophthalmologic examination revealed optic atrophy and old vascular sheathing in the right eye and blurred disc margin, macular exudation, flame shaped hemorrhages, retinal vascular sheathing and multiple aneurysms at arterial bifurcation sites in the left eye, findings compatible with IRVAN syndrome. On systemic workup, the only notable finding was P-ANCA positivity.
    Conclusion
    IRVAN syndrome may be a retinal component of P-ANCA associated vasculitis.
  • Marina Papadia, Carl P. Herbort Page 334
    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 (IGRA), 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.
  • Adil Darugar, Alexis Mathian, Phuc Lehoang, Bahram Bodaghi Page 338
    Purpose
    To report an undiagnosed case of systemic sarcoidosis manifesting with bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE). CASE REPORT: A 26-year-old Caucasian man was referred for management of unilateral visual loss together with a paracentral scotoma developing 2 weeks after a flu-like syndrome. Clinical signs and ancillary diagnostic investigations suggested APMPPE. Laboratory tests demonstrated elevated serum angiotensin converting enzyme and lysozyme levels. Chest CT-scan disclosed moderate hilar lymph node calcifications but QuantiFERON-TB gold test was negative and bronchoalveolar lavage and biopsies were unremarkable. Accessory salivary gland biopsy disclosed epithelioid and gigantocellular granuloma formation without caseum, confirming a diagnosis of sarcoidosis. The fellow eye was involved a few days later and the patient complained of dyspnea. Echocardiography disclosed severe granulomatous myocardial infiltration and high dose corticosteroids and intravenous cyclophosphamide were initiated. Systemic treatment controlled both cardiac and ocular lesions, and was tapered accordingly.
    Conclusion
    The constellation of “white dot syndromes” and systemic symptoms necessitates a general work-up to exclude granulomatous disorders such as sarcoidosis or tuberculosis. Delayed diagnosis of cardiac sarcoidosis may have life-threatening consequences and the ophthalmologist may be the first physician to diagnose the condition.
  • Mehrdad Karimi, Masoud Soheilian, Mozhgan Rezaei Kanavi Page 344
    Purpose
    To report a case of bilateral primary intraocular lymphoma. CASE REPORT: A 33-year-old man presented with bilateral blurred vision since two years ago. Examination revealed large keratic precipitates, anterior chamber reaction, posterior subcapsular cataracts, and vitreous infiltration. After a short trial of topical and periocular steroids, diagnostic 25-gauge pars plana vitrectomy was performed and cytologic evaluation of the aspirate confirmed a diagnosis of intraocular lymphoma. The patient was subsequently managed with intravitreal methotrexate in both eyes and responded favorably. Central nervous system workup for lymphoma was negative.
    Conclusion
    Primary intraocular lymphoma should be considered in young adults suffering from chronic recalcitrant panuveitis.
  • Azadeh Doozandeh, Masoud Soheilian Page 348