Uveítis, complicación ocular de enfermedades reumatológicas / Uveitis, ocular complication of rheumatologic diseases

Las espondiloartropatías constituyen una de las causas más frecuentes de uveítis anteriores. Las uveítis asociadas a espondiloartropatías se encuadran dentro del grupo de las uveítis relacionadas con el antígeno de histocompatibilidad HLA-B27. El objetivo de este estudio es presentar una revisión de las uveítis asociadas a las espondiloartropatías seronegativas (espondilitis anquilosante, artropatía psoriásica, artritis reactiva o síndrome de Reiter y enfermedad inflamatoria intestinal), así como la afectación ocular en el contexto de la artritis reumatoide del adulto y la artritis idiopática juvenil. Las manifestaciones oculares, que incluyen epiescleritis, escleritis, queratitis ulcerosa periférica y enfermedad del ojo seco, se pueden encontrar hasta en el 39 por ciento de los pacientes con artritis reumatoide. La uveítis anterior aguda unilateral recidivante es la más frecuente en las espondiloartropatías, y puede ser la forma de inicio de una espondiloartropatía no diagnosticada previamente. La colaboración entre oftalmólogos y reumatólogos o internistas es fundamental para el correcto manejo y tratamiento de estos pacientes(AU)

Spondyloarthropathies are one of the most frequent causes of anterior uveitis. Uveitis associated with spondyloarthropathies fall within the group of uveitis related to the histocompatibility antigen HLA-B27. To present a review of uveitis associated with seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthropathy, reactive arthritis or Reiter's syndrome and inflammatory bowel disease), as well as ocular involvement in the context of adult rheumatoid arthritis and arthritis Juvenile idiopathic. Ocular manifestations, including episcleritis, scleritis, peripheral ulcerative keratitis, and dry eye disease, can be found in up to 39 percent of rheumatoid arthritis patients. Recurrent unilateral acute anterior uveitis is the most frequent in spondyloarthropathies, and can be the initiation of a previously undiagnosed spondyloarthropathy. Collaboration between ophthalmologists and rheumatologists or internists is essential for the correct management and treatment of these patients(AU)

Analysis of Ocular Complications and Blowout Fracture in Orbital Blunt Trauma

PURPOSE: To help predict the severity of ocular complications in orbital blunt trauma by analyzing clinical features of ocular complications and orbital wall fracture. METHODS: A retrospective survey consisting of 169 eyes of 168 patients with orbital blunt trauma who visited Kosin University Gospel Hospital was performed. The patients' age, gender, height, weight, cause of accident, and ocular complications were investigated. The patients were imaged using computer tomography and divided into two groups according to whether they had orbital wall fracture: the orbital contusion group and the orbital wall fracture group. Variables of orbital wall fracture, including the location, length, width, and area were measured using computer tomography in the orbital wall fracture group. RESULTS: The incidence of ocular complication was 27 of 67 eyes (40.2%) in the orbital wall fracture group and 75 of 102 eyes (73.5%) in the orbital contusion group; ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group (p < 0.001). Among causes of the accident, 'flying object' showed the highest incidence of ocular complication at 40 of 48 eyes (85.1%). In the orbital wall fracture group, there was no significant difference in orbital fracture location, length, width or area between the ocular complication group and the non-ocular complication group. CONCLUSIONS: Ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group, and 'flying object' showed the highest incidence of ocular complication among causes of the accident.

Effect of Age and Early Intervention with a Systemic Steroid, Intravenous Immunoglobulin or Amniotic Membrane Transplantation on the Ocular Outcomes of Patients with Stevens-Johnson Syndrome

PURPOSE: This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN. METHODS: All patients were classified by age (18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (< or =5 days), IVIG (< or =6 days), or amniotic membrane graft transplantation (AMT) (< or =15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage. RESULTS: The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS). CONCLUSIONS: Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.

Herpes Zoster Ophthalmicus in Patients Younger than 50 Years Versus 50 Years and Older

PURPOSE: To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients under 50 years of age versus patients 50 years of age or older at the time of diagnosis. METHODS: A retrospective chart review was performed of 102 patients who were diagnosed with HZO between January 1, 2008 and December 31, 2010. Baseline demographics and clinical characteristics between patients with an onset of HZO under the age of 50 years and patients with an onset of HZO at the age of 50 years or older were compared. RESULTS: Similar numbers of patients were affected with HZO in the younger and older age groups (n = 44, 43.1%, vs. n = 58, 56.9%). The mean +/- SD of age was 50.6 +/- 21.8 years (range, 3-89 years) and the most common decade of HZO onset was between 50 and 59 years. Gender and disease laterality were not statistically different between the 2 groups. No significant difference was found regarding the presence of any ocular manifestation between the groups; however, anterior uveitis was more frequent in the younger patients (p = 0.04). The number of patients with immunosuppressive therapy was higher in the younger age group (p = 0.01). CONCLUSIONS: HZO-affected patients under the age of 50 years and older than 50 years were equally distributed, with the most common decade of onset between the age of 50 and 59 years. Younger patients had a higher incidence of anterior uveitis and immunosuppressive therapy due to underlying systemic diseases.

Activity and expression of aldehyde dehydrogenases in the ocular tissue of diabetic rats / 中华实验眼科杂志

Background Diabetic complication is associated with lipid peroxidation.Aldehyde dehydrogenases (ALDH) catalyze the irreversible oxidation of a variety of biological aldehydes,including lipid-derived aldehydes (LDAs),and thus protect organs and tissues from toxic LDAs.Understanding the activity of ALDH in different ocular tissues in diabetic subjects is very important for prevention and treatment of diabetic ocular complications.Objective This research aimed to investigate the activity and expression of ALDH in different ocular tissues in diabetic rats and to explore the mechanism of ALDH in diabetes-induced eye disease.Methods Twenty-eight healthy SPF male Sprague-Dawley(SD) rats weighted 170-180 g were randomly divided into the normal control group and diabetic group.The diabetic animal model was established by intraperitonial injection of 4％ streptozotocin at 65 mg/kg.Isometric citric acid buffer was injected in the rats of the normal control group.The rats were sacrificed in each group 2 and 4 months after the establishment of the diabetic models,and eyeballs were obtained for the preparation of corneal,lens and retinal homogenates.ALDH activity was detected using a multifunctional microplate reader SpectraMax M5,and ALDH content was measured by ELISA at the wavelength of 450 nm with the SpectraMax M5 ELISA reader.Results The blood glucose level in diabetic rats was significantly elevated at various time points compared with the normal control group(P=0.000),and body weights were evidently lower in the diabetic group than in the normal group (P =0.000).The activities of ALDH (A340) in corneal,lens and retinal tissues in the diabetic group were increased in comparison with the normal control group (F =396.601,P=0.000),and showed an enhancement with the lapsing of time (F =53.139,P =0.000).In addition,the highest level of ALDH was found in the cornea and the lowest level in the lens(F =6973.000,P=0.000).The expression level of ALDH in the corneal,lens and retinal homogenates was significantly higher in the diabetic group compared with the normal control group (F=312.985,P =0.000) and showed a considerable increase over the course (F =19.203,P=0.000).The highest expression level was seen in the cornea and the lowest was in the lens,with a significant difference among these three kinds of tissues (F =3243.000,P =0.000).Conclusions ALDH can protect ocular tissue from the damage of lipid peroxidation.Thess results suggest that ALDH plays a role in preventing diabetes-related ocular complications.

Transient diplopia in dental outpatient clinic: An uncommon iatrogenic event.

A healthy 32-year-old female patient required an extraction of the right maxillary third molar. Lidocaine containing 1:80,000 epinephrine for right posterior superior alveolar nerve block was administered in the mucobuccal fold above the third molar to be extracted at our hospital. After few minutes of posterior superior alveolar block anesthesia, patient felt double vision. The condition was subsequently diagnosed as transient diplopia due to temporary paralysis of lateral rectus muscle due to involvement of the VI cranial nerve. The patient recovered in 30 minutes and the treatment was performed successfully. This article discusses the possible scientific explanation for this phenomenon.

The Clinical Characteristics of Facial Herpes Zoster in Korean Patients

PURPOSE: To investigate the clinical characteristics of Korean patients with facial herpes zoster. METHODS: The present study enrolled patients with facial involvement among the patients with herpes zoster. The percentage of involved branches of the trigeminal nerve, types and frequency of ocular complications, and changes in visual acuity depending on systemic treatment were analyzed. RESULTS: A total of 146 patients (15.9%) out of 916 patients with herpes zoster were diagnosed with facial herpes zoster. The ophthalmic branch was the most frequently involved (55.5%), and coinfection with the ophthalmic and maxillary branch was also common (31.5%). Ocular complications developed in 82 eyes (56.2%) and were most common in the group of coinfection with the ophthalmic and maxillary branch (Fisher's exact test, p=0.003). Conjunctivitis (72.0%) was the most commonly observed ocular complication, while punctate keratitis and endothelitis were also frequent. After treatment with a systemic antiviral agent, visual acuity was significantly improved (paired t test, p=0.001). CONCLUSIONS: A higher incidence of ophthalmic complications was observed in facial herpes zoster patients with a wider area of involvement, including the ophthalmic branch. There was significant improvement of visual acuity and ocular complications after systemic treatment. Therefore, systemic antiviral treatment should be considered when a broad herpes zoster skin lesion is observed.

HIV/AIDS and ocular complications / 国际眼科杂志(Guoji Yanke Zazhi)

The introduction of highly active antiretroviral therapy (HAART) has greatly changed the pattern and natural history of ocular diseases of HIV-infected patients, resulting from the immune recovery and reduction of opportunistic infections. However, ophthalmic complica-tion continues to be concern in AIDS even in the HAART era, especially in developing areas, where absolute majority of HIV-positive patients live. Lack of test facilities and experience, poor conditions of hygiene, different microbiological environment, absence of effective treatment etc., characterize the ophthalmic manifestation of HIV-infected patients in developing countries from that in developed regions and thus pose a great challenge to the ophthalmic treatment in developing area. Not only varied from region to region, ocular complications are distinctive between adults and children. At the same time, the side effects due to the application of HAART pose their own risks of ocular complication and should, therefore, be given more research attention.

Ocular Manifestations of Paranasal Sinus Malignancies

PURPOSE: To investigate ocular complications that occur after orbital preservation surgery for paranasal malignancies and to identify the early clinical features of ophthalmic manifestations in paranasal malignancy patients. METHODS: We reviewed the clinical charts of patients following ophthalmic consultation after orbital preservation surgery for paranasal malignancies. We also investigated the early clinical features of ophthalmic manifestations in patients with paranasal malignancies. RESULTS: In our study, 54 patients had paranasal malignancies. Among them, 41 had undergone orbital preservation surgery, and 19 patients sought an ophthalmology consultation. There were seven patients who presented with eye symptoms caused by paranasal malignancies before the diagnosis. Paranasal malignancies included squamouscell carcinoma (13 cases), adenocarcinoma (3 cases), plasmocytoma (1 case), malignant schwannoma (1 case), and undifferentiated carcinoma (1 case). The locations of the origin of the tumor included the maxillary sinus (16 cases) and the ethmoid sinus (3 cases). The most common eye symptoms after orbital preservation surgery were enophthalmos, lid retraction, tearing, strabismus, inflammation, dry eyes, and cataracts, in order of frequency. Patients who visited the ophthalmic clinic due to paranasal malignancies had eye symptoms such as proptosis, nonspecific ocular pain, strabismus, tearing, eyelid swelling, and relative afferent pupillary defects, in order of frequency. CONCLUSIONS: Ocular complications were more common if the paranasal malignancy had invaded the orbital bone. However, many of the patients with disease invasion of the periosteum had no nasal or ocular symptoms upon presentation. Therefore, these patients should be managed carefully since symptoms may initially be vague and nonspecific.

The Clinical Evaluation of Ocular Complications from Electrical Burn Injury

PURPOSE: This current study determined the type, incidence, characteristics of ocular complications from electrical burn and associated risk factors. METHODS: The authors retrospectively reviewed ocular complications from electrical injury on ninety-seven consecutive electrical burn patients. RESULTS: Of the ninety-seven patients with electrical burns, twelve patients (12%) had ocular complications (cataract, uveitis, macular hole, corneal opacity, and optic atrophy). The relationship between voltage and development of ocular complication was not statistically significant. The relationship between wound size and development of ocular complication was not significant. However, the relationship between entry site and development of ocular complication was statistically significant (P=0.00). CONCLUSIONS: The patient who had electrical injury at any voltage with any wound size, especially electrical head injury for at least 6 months should be evaluated carefully.

A Case of Atopic Dermatitis Accompanied with Blindness in Ocular Complications / 대한피부과학회지

Long-standing atopic dermatitis patients frequently predispose to ocular complications such as blepharitis, keratoconjunctivitis, uveitis, cataract, and retinal detachment. Among these, cataract and retinal detachment are the most serious complications that may cause visual disturbance. Glaucoma has not been reported as the complication of atopic dermatitis, but it is believed that long-term use of topical corticosteroid on face may cause glaucoma. A 26-year-old man presented with generalized severe atopic dermatitis and gradual loss of vision in both eyes. Because of eczema involving the skin of the face including the eyelids, he had been applying various topical corticosteroids since he was 4 years old. Eight years ago, cataracts developed on both eyes and extracapsular cataract extraction and intraocular lens implantation were done. Ophthalmologic examination revealed that his intraocular pressures were 46mmHg right and 38mmHg left, suggesting glaucoma. Three months following presentation, the patient became totally blind in both eyes.

A Case of Nonischemic Central Retinal Vein Occlusion Developed in the course of Ulcerative Colits / 대한소화기내시경학회지

Ulcerative colitis is a chronic, inflammatory disease of colon which is rare in Korea. In the course of ulcerative colitis numerous extraintestinal complication may develop on the joints, skin, liver, kidney, vessel, oral cavity and eyes. The most common ocular lesions complicated in patients with ulcerative colitis are episcleritis and iritis. And the cases of retinal vascular disease in associated with ulcerative colitis are extremely rare. We experienced nonischemic central retinal vein occlusion complicated in a patient with ulcerative colitis, who is 32-year-old male and complained decreased visual acuity and metamorphosis.

Complications Associated with Intravitreal Silicone Oil Injection

A retrospective study is reported on 96 eyes treated by pars plana vitrectomy and intravitreal silicone oil tamponade for treatment of complicated retinal detachment to evaluate ocular complications secondary to intravitreal silicone oil complete retinal reattachment occurred in 59(61.5%) of 96 eyes at initial surgery. Recurrent retinal detachment and recurrent proliferative vitreoretinopathy occurred in 19(32.3%) and 15(25.4%) of 59 eyes respectively. The major complications associated with intravitreal silicone oil were cataract(96.6% of phakic eyes) and keratopathy(29.2%) and their peak onset was around 3 months after intravitreal silicone oil injection. Other complications were intraocular pressme elevation, hypotony, hyphema, fibrin reaction in anterior chamber, etc. These findings suggest that even though intravitreal silicone oil injection is a valid procedure for treatment of complicated retinal detachment, its removal is recommended after about 3 months before development of vision-threatening complicatoins such as cataract and keratopathy.

Clinical Results of Mode-locked Nd:YAG Laser Posterior Capsulotomy

We performed posterior capsulotomy on after cataract(132 eyes) by using Modelocked Nd:YAG Laser from May 1988 to september 1988. The results were as follows; 1. 72 aphakic eyes, 60 pseudophakic eyes(42 senile cataract, 61 adult cataract, 17 traumatic, 12 congenital cataract) were followed. 2. On performing posterior capsulotomy, the power setting of Nd:YAG laser ranged from 1.0 to 2.9mJ in 106 eyes(80.3%). 3. Postoperative visual acuity of 0.7 or better was achieved in 72 eyes(56.1%) and 1.0 or better in 24 eyes(18.2%). 4. Ocular complications after posterior caps ulotomy were transient increase of intraocular pressure(14,4%), intraocular lens damage(33.3%), vitreous prolapse (5.3%), transient anterior uveitis(6.1%) and cystoid macular edema(0.8%).

Clinical Results of Mode-locked Nd:YAG Laser Posterior Capsulotomy

We performed posterior capsulotomy on after cataract(132 eyes) by using Modelocked Nd:YAG Laser from May 1988 to september 1988. The results were as follows; 1. 72 aphakic eyes, 60 pseudophakic eyes(42 senile cataract, 61 adult cataract, 17 traumatic, 12 congenital cataract) were followed. 2. On performing posterior capsulotomy, the power setting of Nd:YAG laser ranged from 1.0 to 2.9mJ in 106 eyes(80.3%). 3. Postoperative visual acuity of 0.7 or better was achieved in 72 eyes(56.1%) and 1.0 or better in 24 eyes(18.2%). 4. Ocular complications after posterior caps ulotomy were transient increase of intraocular pressure(14,4%), intraocular lens damage(33.3%), vitreous prolapse (5.3%), transient anterior uveitis(6.1%) and cystoid macular edema(0.8%).