Síndrome uveomeningoencefálico Vogt Koyanagi-Harada con desprendimiento de la capa bacilar de la retina / Vogt Koyanagi-Barada uveomeningoencephalic syndrome with detachment of the bacillary layer of the retina

Introducción: El síndrome de Vogt-Koyanagi-Harada pertenece a los síndromes uveomeníngeos y es una de las principales enfermedades que amenazan la visión. Se caracteriza por una uveítis bilateral que se asocia frecuentemente con manifestaciones neurológicas, auditivas y tegumentarias. Recientemente un fenotipo particular de engrosamiento macular se ha descrito como desprendimiento bacilar asociado a esta enfermedad. Objetivo: Describir el desprendimiento bacilar de la retina mediante la tomografía de coherencia óptica de dominio espectral en un caso de Vogt Koyanagi Harada en fase uveítica. Presentación de caso: Paciente femenina de 46 años de edad atendida en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" con disminución de agudeza visual en ambos ojos y panuveitis bilateral. Fue diagnosticada con síndrome de Vogt-Koyanagi-Harada en su fase uveítica aguda con presencia de manifestaciones neurológicas y desprendimiento de la capa bacilar de la retina identificado mediante la tomografía de coherencia óptica de dominio espectral. Conclusiones: El síndrome de Vogt-Koyanagi-Harada aguda y el desprendimiento bacilar de la capa de la retina pueden diferenciarse de otros signos mediante la tomografía de coherencia óptica de dominio espectral. Su desaparición pudiera tener una relación con la mejoría de la agudeza visual(AU)

Introduction: Vogt-Koyanagi-Harada syndrome belongs to the uveomeningeal syndromes and is one of the major vision-threatening diseases. It is characterized by bilateral uveitis, which is frequently associated with neurological, auditory and integumentary manifestations. Recently a particular phenotype of macular thickening has been described as bacillary detachment associated with this disease. Objective: To describe bacillary retinal detachment using spectral domain optical coherence tomography in a case of Vogt Koyanagi Harada in uveitic phase. Case presentation: 46-year-old female patient attended at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" with decreased visual acuity in both eyes and bilateral panuveitis. She was diagnosed with Vogt-Koyanagi-Harada syndrome in its acute uveitic phase with presence of neurological manifestations and detachment of the bacillary layer of the retina identified by spectral domain optical coherence tomography. Conclusions: Acute Vogt-Koyanagi-Harada syndrome and bacillary retinal layer detachment can be differentiated from other signs using spectral-domain optical coherence tomography. Their disappearance could be related to the improvement of visual acuity(AU)

Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India

Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.

An analysis of the clinical profile of patients with uveitis following COVID-19 infection

Purpose: To describe the clinical profile of patients presenting with uveitis following COVID?19 infection at a tertiary care eye hospital in South India. Methods: In this retrospective chart review, all consecutive cases presenting with an acute episode of intraocular inflammation and a history of COVID?19 infection diagnosed within the preceding 6 weeks, between March 2020 and September 2021, were included. Data retrieved and analyzed included age, sex, laterality of uveitis, and site of inflammation. The diagnosis was categorized based on the SUN working group classification criteria for uveitis. Details regarding clinical features, investigations, ophthalmic treatment given, response to treatment, ocular complications, and status at last visit were also accessed. Statistical analysis of demographical data was done using Microsoft Excel 2019. Results: Twenty?one eyes of 13 patients were included in this hospital?based retrospective observational study. The study included six male and seven female patients. The mean age was 38 ± 16.8 years. Eight patients had bilateral involvement. Seven patients were diagnosed with anterior uveitis, three with intermediate uveitis, one with posterior uveitis, and two with panuveitis. All patients responded well to treatment and were doing well at their last visit. Two patients had complications that necessitated surgical treatment, following which they recovered good visual outcomes. Conclusion: With prompt diagnosis and appropriate management, all the patients with uveitis post?COVID?19 infection recovered with good visual outcomes. Thus, ophthalmologists must be aware of the possible uveitic manifestations following even uneventful COVID?19 infection

Infección ocular invasora por Scedosporium apioespermum en un paciente inmunocomprometido / Invasive ocular fungal infection by Scedosporium apiospermum in an immunocompromised patient

Resumen Presentamos el caso clínico de una infección fúngica invasora con una conjuntivitis necrosante, escleritis y panuveitis unilateral por Scedosporium apiospermum en una mujer de 78 años con artritis reumatoidea con neutropenia secundaria a fármacos. El diagnóstico etiológico fue confirmado por cultivo micológico de secreción ocular con apoyo de MALDI-TOF-TOF e histopatología. El tratamiento incluyó aseos quirúrgicos asociado a terapia tópica y sistémica con voriconazol y corticoesteroides, con una evolución favorable a los dos meses de tratamiento. Una recaída obligó a un segundo curso terapéutico por 12 meses adicionales con mejoría y erradicación del agente. La conjuntivitis fúngica por S. apiospermum es un evento infrecuente asociado a pacientes inmunocomprometidos. Su tratamiento involucra desbridamientos quirúrgicos y terapia antifúngica prolongada.

Abstract We report a case of invasive fungal infection with necrotizing conjunctivitis, scleritis and unilateral panuveitis caused by Scedosporium apiospermum in a 78-year-old woman that developed neutropenia by drugs indicated for rheumatoid arthritis. The etiological diagnosis was confirmed by mycological culture of an ocular secretion with the support of MALDI-TOF-TOF analysis and histopathological findings. The treatment involved surgical debridements together with topical solution and systemic therapy with voriconazole and steroids with a favorable evolution after 2 months of treatment. A relapse required a second therapeutic course for an additional 12 months with improvement and eradication of the agent. Fungal conjunctivitis due to S. apiospermum is a rare event associated with immunosuppressed patients. Its treatment involves surgical debridements and prolonged antifungal therapy.

Clinical features of cytomegalovirus retinitis-associated uveitis in patients undergoing hematopoietic stem cell transplantation / 中华眼底病杂志

Objective:To observe the clinical features of cytomegalovirus (CMV) retinitis (CMVR)- related uveitis after hematopoietic stem cell transplantation (HSCT).Methods:A retrospective clinical study. From October 2015 to May 2020, 14 cases of 21 eyes of CMVR patients with CMVR after HSCT confirmed by the ophthalmological examination of The First Affiliated Hospital of Soochow University were included in the study. Among them, there were 5 males with 8 eyes and 9 females with 13 eyes. The average age was 35.12± 12.24 years old. All the affected eyes were examined by slit lamp microscope combined with front lens and fundus color photography. At the same time, fluorescein fundus angiography (FFA) was performed to examine 10 eyes of 5 cases; 3 cases of 3 eyes were examined for inflammatory cytokines in aqueous humor. All eyes received intravitreal injection of ganciclovir; patients with a history of systemic CMV infection received intravenous infusion of ganciclovir/foscarnet. The retinal lesions in the eye were completely resolved or the aqueous CMV-DNA was negative as a cure for CMVR. The uveitis symptoms, signs, FFA manifestations and the test results of inflammatory factors in aqueous humor before and after the CMVR cure was observed. The follow-up time after CMVR was cured was 3-42 months, and the average follow-up time was 14.28±13.12 months.Results:All eyes with CMVR were diagnosed with retrocorneal dust and/or stellate keratic precipitates (KP), anterior chamber flare and cells, and varying degrees of vitreous flocculent opacity; the retina was typical of a mixture of hemorrhage and yellow-white necrosis like "scrambled eggs with tomatoes". After CMVR was cured, there were 16 eyes (71.4%, 10/14) in 10 cases with KP, anterior chamber flare, cell and vitreous opacity. FFA examination revealed that the majority of retinal leakage during the active period of CMVR was necrotic foci and surrounding tissues; after CMVR was cured, the majority of retinal leakage was the retina and blood vessels in the non-necrotic area. The test results of inflammatory factors in aqueous humor showed that interleukin (IL)-6, IL-8, and vascular endothelial cell adhesion molecules were significantly increased in the active phase of CMVR; after 3 months of CMVR cured, inflammatory factors did not increase significantly.Conclusion:CMVR-associated uveitis after HSCT show as chronic panuveitis, with no obvious eye congestion, KP, anterior chamber flare, cell and vitreous opacity, and retinal vessel leakage which could exist for a long time (>3 months).

Toxoplasmosis ocular: aspectos clínico-epidemiológicos en edad pediátrica / Ocular Toxoplasmosis: clinical-epidemiological aspects in pediatric age

RESUMEN Introducción: a nivel mundial la toxoplasmosis ocular es la causa más frecuente de uveítis posterior, se detecta principalmente en niños y adultos jóvenes. Objetivo: determinar las características clínico-epidemiológicas de la toxoplasmosis ocular en pacientes de edad pediátrica de la provincia Pinar del Río, en el período 2012-2018. Métodos: se realizó un estudio observacional analítico transversal en 39 pacientes con toxoplasmosis ocular, atendidos en consulta de Uveítis del Hospital General Docente "Abel Santamaría" entre enero 2012 y diciembre de 2018. Se estudiaron las variables: edad, sexo, factores de riesgo, síntomas, hallazgos clínicos, complicaciones y agudeza visual. Se resumieron los datos con porcentajes y se estableció asociación estadística. Resultados: la enfermedad resultó más frecuente en pacientes de 15 a 18 años (46,2 %). Las condiciones de riesgo resultaron la mala calidad del agua de consumo (100 %), y la inadecuada manipulación los de alimentos (89,7 %). Existe asociación con un nivel de significancia del 10 % (p=0,066) entre síntomas y tipo de uveítis según localización anatómica. También se detectó asociación entre MAVC con localización anatómica (p=0,001), tamaño de la lesión (p=0,011) y en menor grado con clasificación anatómica (p=0,083). La presencia de cicatriz en área macular y vasculitis se presentó en un 33,3 % y 12,8 % respectivamente. Conclusiones: la presencia de malas condiciones higiénicas resultó frecuente. Las lesiones retinianas en el área macular contribuyeron a las complicaciones y secuelas reportadas. La prevención y el tratamiento oportuno, son las mejores maneras de disminuir la ceguera por toxoplasmosis en edad pediátrica.

ABSTRACT Introduction: ocular toxoplasmosis is the most frequent cause of posterior uveitis of known etiology in the world, mainly in children and young adults. Objective: to determine the clinical-epidemiological characteristics of ocular toxoplasmosis in pediatric patients in Pinar del Río province in the period 2012-2018. Methods: an analytical cross-sectional, observational study was conducted on 39 patients with ocular toxoplasmosis, who were treated at the Uveitis clinic of Abel Santamaría Cuadrado General Teaching Hospital between January 2012 and December 2018. The variables studied were: age, sex, risk factors, symptoms, clinical findings, complications and visual acuity. Results: the disease was more frequent in patients between 15 and 18 years old (46,2 %). Risk conditions were poor quality of drinking water (100 %), and inadequate food handling (89,7%). There is association with a significance level of 10% (p=0,066) between symptoms and type of uveitis according to anatomical location. There was also association between CVMA with anatomical location (p=0,001), extent of the lesion (p=0,011) and to a lesser extent with anatomical classification (p=0,083). The presence of scar in macular area and vasculitis was evident in 33,3 % and 12,8% respectively. Conclusions: the presence of poor hygienic conditions was frequent. Prevention and timely treatment are the best ways to reduce blindness due to toxoplasmosis in children.

Sífilis ocular como manifestación de neurolues: a propósito de un caso clínico / Ocular syphilis as a manifestation of neurolues: about a clinical case / Sífilis ocular como manifestação de neurolores: sobre um caso clínico

Resume: La sífilis ocular es una forma infrecuente de neurosífilis, que se puede presentar en cualquier estadio de la enfermedad. La presentación clínica puede ser heterogénea, siendo la forma más frecuente la uveítis. El diagnóstico se confirma con serología, debiéndose realizar estudio del líquido cefalorraquídeo para descartar compromiso meníngeo. Su detección y tratamiento precoz permiten la prevención de complicaciones neurológicas como la ceguera irreversible. Presentamos el caso clínico de un paciente que se presenta con panuveítis y diagnóstico serológico de sífilis presentando excelente respuesta al tratamiento instaurado.

Abstract. Ocular syphilis is an uncommon type of neurosyphilis, which can occur at any stage of the disease. The clinical presentation can be heterogeneous, with uveitis being the most frequent form. The diagnosis is confirmed with serology and a study of the cerebrospinal fluid should be performed to rule out meningeal involvement. Its diagnosis and early treatment allow the prevention of neurological complications such as irreversible blindness. We present a clinical case of a patient who presents with panuveitis and serological diagnosis of syphilis presenting an excellent response to treatment.

Resumo: A sífilis ocular é uma apresentação atípica do neurosífilis, que pode ocorrer em qualquer estágio da doença. A apresentação clínica pode ser heterogênea, sendo a uveíte a forma mais frequente. O diagnóstico é confirmado com sorologia e um estudo do líquido cefalorraquidiano deve ser realizado para descartar o compromisso meníngeo. Seu diagnóstico e tratamento precoce permitem prevenir complicações neurológicas como cegueira irreversível. Apresentamos um caso clínico de um paciente com panuveíte e diagnóstico sorológico de sífilis e excelente resposta ao tratamento.

Panuveítis asociada a la enfermedad de Lyme en un paciente colombiano. Reporte de caso / Panuveitis due to Lyme disease in a Colombian patient: Case report

RESUMEN La enfermedad de Lyme es una zoonosis transmitida por la picadura de garrapatas del género Ixodes sp. Ha sido descrita con más frecuencia en zonas endémicas de países meridionales. Sus manifestaciones clínicas son muy variables y se presentan de acuerdo con el estadio clínico de la enfermedad, teniendo así el compromiso ocular un espectro clínico muy variado que incluye manifestaciones desde la superficie ocular hasta la inflamación del segmento posterior. Se presenta el caso de un paciente de 72 años con un viaje reciente a los Estados Unidos (EE. UU.), atendido en la consulta particular por un oftalmólogo supraespecialista en uveítis de la ciudad de Medellín. El paciente hacía un mes refería una disminución de la agudeza visual (AV) en su ojo izquierdo y al examen oftalmológico presentó signos clínicos de panuveítis no granulomatosa asociada a un edema macular y vasculitis retinal. Se confirmó la enfermedad de Lyme en fase tardía por la presencia de anticuerpos en sangre por Western blot. Se realizó tratamiento exitoso con antibióticos (doxiciclina), con recuperación de la AV y la mejoría completa de los signos inflamatorios intraoculares.

SUMMARY Lyme Disease is a zoonosis transmitted by arthropods that has been described with more frequency in endemic zones of meridional countries. Its clinical manifestations vary according to the clinical stage of the disease. The eye can be affected in many forms including the involvement of the ocular surface and the posterior segment, with more severe inflammation of the retina and the choroid. We present a case of a 72-year male with a recent trip to EEUU who complained of decreasing vision in his left eye had clinical signs of non-granulomatous panuveitis with macular edema and retinal vasculitis. Lyme disease was confirmed with positive antibodies in blood and Western blot test, and the patient was successfully treated using oral Doxycycline. His visual acuity improved and had a resolution of the intraocular inflammation after the specific treatment.

Clinicopathological and immunohistochemistry correlation in a case of Vogt-Koyanagi-Harada disease

Vogt-Koyanagi-Harada (VKH) disease is a systemic disorder causing bilateral panuveitis. Histopathological documentation along with molecular diagnostic evidence in VKH eye is a rarity. We present a 46-year-old woman with VKH with several ocular complications and subsequently enucleation of the right eye was done because of painful blind eye. Patient had clinical complications of VKH and some of the complications were observed in histopathology. Pathology of the case showed nongranulomatous uveitis, indicating the disease in chronic recurrent stage. Immunohistochemistry showed predominant T-cell involvement in this case. The case showed clinicopathological and immunohistochemistry correlation in a case of VKH disease.

Descolamento seroso de coroide como manifestação tardia da síndrome de Vogt-Koyanagi-Harada / Serous choroidal detachment in chronic stage of Vogt-Koyanagi-Harada syndrome

Resumo Relatamos um caso atípico de uma paciente de 40 anos com apresentação completa da Síndrome de Vogt-Koyanagi-Harada (SVKH) que após 17 anos do diagnóstico inicial evoluiu com descolamento seroso de coroide. A paciente procurou atendimento com queixa de dor em olho esquerdo (OE). O exame oftalmológico revelou acuidade visual (AV) igual a de movimento de mãos, à biomicroscopia foi observada reação inflamatória granulomatosa na câmara anterior, a tonometria foi igual a 0 mmhg, e a fundoscopia indevassável pela pouca midríase e turvação de meios em OE. O descolamento seroso de coroide foi avaliado através de ultrassonografia ocular. A abordagem terapeutica intituida para paciente consistiu em prednisona 1mg/kg/dia via oral, dexametasona 1mg/mL e atropina 1% colírios. A evolução do quadro foi satisfatória, com melhora da AV para 20/40, ausência de reação inflamatória em câmara anterior, normalização da pressão intraocular e resolução do descolamento seroso de coroide em OE. Concluimos que a fase crônica da SVKH, apesar da manifestação classicamente descrita ser uveíte anterior, pode ter outras apresentações e o descolamento seroso da coroide é uma rara complicação.

Abstract We report an atypical case of a 40-year-old woman with complete presentation of Vogt-Koyanagi-Harada Syndrome (VKH) who presented with unilateral serous choroidal detachment 17 years after the diagnosis. The patient complained of pain in the left eye, the ophthalmologic examination revealed visual acuity (VA) equal to hand motion; biomicroscopy revealed a granulomatous inflammatory reaction in the anterior chamber, tonometry was equal to 0 mmhg, and the fundoscopy was impracticable. Serous choroidal detachment was assessed by ocular ultrasonography. The therapeutic approach proposed for the patient consisted of prednisone 1mg / kg / day orally, dexamethasone 1mg / mL and atropine 1% eye drops. The evolution of the condition was satisfactory, with VA improvement to 20/40, absence of inflammatory reaction in anterior chamber, normalization of intraocular pressure and resolution of serous choroidal detachment in OS. We conclude that the chronic phase of VKH, although classically described as anterior uveitis, may have other presentations and the serous choroid detachment is a rare complication.

Active uveitis induces transient refractive error changes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the impact of active uveitis on refractive error changes.<p>METHODS: A prospective cohort study was conducted on 66 patients(88 eyes)with active uveitis. The subjects were classified based on the anatomical location of their disease activity as anterior, intermediate, posterior and pan-uveitis. Cycloplegic refraction was performed in both active and quiescent phases, and the results were compared. <p>RESULTS: Spherical changes in active anterior non-granulomatous uveitis resulted in an average of -0.25(0.77)D(95%<i> CI</i>: -0.5 to 0)shift toward myopia(<i>P</i>=0.039)and in active intermediate uveitis, an average of +0.39(0.8)D(95% <i>CI</i>: 0.09-0.69)shift toward hyperopia(<i>P</i>=0.003). Spherical equivalent changes in active intermediate uveitis resulted in hyperopic shift \〖+0.43(0.94)D, 95% <i>CI</i>: 0.08-0.79, <i>P</i>=0.005\〗. Cylinder had only significant changes in pan-uveitis \〖-0.3(0.39)D, 95% <i>CI</i>: -0.58 to -0.02, <i>P</i>=0.043\〗. In multivariate analysis, we noted that course of disease activity(acute versus recurrent)and anatomical location of disease activity had statistically significant effects on spherical equivalent changes(<i>P</i>=0.003 and <i>P</i>=0.004, respectively).<p>CONCLUSION: Active uveitis has a significant effect on the refractive status of the eye, the changes of which depend on the inflamed anatomical area.

Progressive, subretinal fibrosis mimicking retinal necrosis with poor visual prognosis in sympathetic ophthalmia: A rare finding

We report a rare finding of progressive subretinal fibrosis mimicking retinal necrosis in 2 cases of sympathetic ophthalmia. Histopathology of the inciting eye and vitreous biopsy of the sympathizing eye ruled out infections and masquerades. Progression of inflammation and rapid deterioration of vision inspite of maximum immunosuppression are key findings in this variant of sympathetic ophthalmia.

Topiramate-induced acute angle closure with severe panuveitis: A challenging case report

A 36-year-old female presented with the complaints of pain, photophobia, redness, and sudden diminution of vision in both the eyes following topiramate for migraine treatment. On examination, there was panuveitis with angle-closure glaucoma in both the eyes with fibrinous exudate with pigments in the anterior chamber of the left eye. B scan revealed increased choroidal thickness in both the eyes. Serial anterior segment optical coherence tomography scans were done in the left eye to demonstrate the gradual resolution of the fibrin material from the anterior chamber. There was complete resolution of inflammation in both eyes following discontinuation of topiramate and treatment with systemic and topical steroids. There was an improvement in visual acuity in the left eye following complicated cataract surgery.

Síndrome de Vogt-Koyanagi-Harada: Avaliação da fase da doença na qual os pacientes recebem o primeiro atendimento em serviço especializado / Vogt-Koyanagi-Harada syndrome: evaluation of the disease phase in which patients receive the first specialized attendance

Resumo Objetivo: Avaliar em qual fase da síndrome de Vogt-Koyanagi-Harada (SVKH) os pacientes recebem o primeiro atendimento em serviço especializado. Métodos: Foram analisados prontuários de 14 pacientes atendidos no Setor de Uveítes do Hospital Universitário Clementino Fraga Filho da UFRJ no período de janeiro de 2014 a março de 2017. Nesta análise, foram observados o sexo, a idade, a fase da doença e a acuidade visual destes pacientes com ao menos doença provável da SVKH. Resultados: Observamos que 35,4% dos pacientes apresentavam a doença ainda na fase uveítica e que 78,5% destes pacientes apresentava acuidade visual igual ou pior que 0,05. Destes pacientes, 78,5% eram do sexo feminino e 21,5% do sexo masculino e a mediana de idades foi de 34 anos. Conclusão: Os pacientes analisados obtiveram dificuldade em ter acesso precoce a um setor especializado, afetando assim, diretamente o tratamento e prognóstico visual.

Abstract Objective: To evaluate in which phase of Vogt-Koyanagi-Harada (VKH) syndrome the patients receive the first attendance in specialized service. Methods: A retrospective study was conduted to evaluate medical records of 14 patients with VKH in the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro from January 2014 to March 2017. In this analysis, gender, age, stage of disease and visual acuity of these patients with at least probable VKH were recorded. Results: Of these patients, 78.5% were female and 21.5% male and the median age was 34 years. We observed that 35.4% of the patients had the disease still in the uveitic phase and that 78.5% of these patients had visual acuity equal to or worse than 0.05. Conclusion: There is a delay in the admission of these patients to a specialized sector, thus affecting directly the treatment and visual prognosis.

Behcet’s Syndrome Associated Manifestations and its Treatment Response: A Case Report.

Behçet’s syndrome (BS) or Behcet’s disease (BD) is a chronic multisystem disorder of unknown etiology that is characterized mainly by recurrent mucocutaneous, articular, neurological, gastrointestinal, and ophthalmological lesions. A 20-year-old unmarried, Hindu, male patient presented with a history of recurrent oral and genital ulcers, large joint infl ammatory oligoarthritis predominantly in right knee joint, folliculitis (dermatographia) on the legs, epididymitis, acneiform lesions over face, and panuveitis with associated constitutional symptoms. His Laboratory examinations were nonrevealing except for a moderate rise in erythrocyte sedimentation rate and C-reactive protein. Th is patient meets, in 1990, the International Study Group criteria for BD/BS. Th e main clinical manifestations of this disease are discussed and its early recognition and treatment response is emphasized.

Yellowish dots in the retina: a finding of ocular syphilis? / Pontos amarelados na retina: um achado da sífilis ocular?

Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study.

Relatar a ocorrência de pontos amarelo-esbranquiçados perivasculares pré-retinianos em 12 pacientes com sífilis ocular. Série de casos de 12 pacientes examinados entre março e outubro de 2012 no setor de uveítes da UNIFESP. Após confirmação diagnóstica de sífilis ocular, retinografias e OCT (optical coherence tomography) foram realizados para verificar a localização dos pontos e os pacientes foram tratados com penicilina cristalina IV por 14 dias. Dados demográficos incluíram 11 homens (91,6%), 19 olhos, mediana de idade de 38,1 anos, e a manifestação clínica principal foi panuveíte (7 pacientes, 58,3%), sendo bilateral em 4. Dez fizeram uso de prednisona oral (83,3%). VDRL (Venereal Disease Research Laboratory) sanguíneo foi positivo em 8 pacientes (66.7%), VDRL no líquor foi negativo em 7 de 9 coletados (77,8%), FTA-Abs sanguíneo foi positivo em 100% e 8 pacientes (66,7%) eram HIV positivos, AV após tratamento melhorou em 10 olhos (55,6%), não se alterou em 7 (38,9%) e piorou em 1 olho (5,6%). Embora ainda não reconhecida na literatura como uma manifestação típica da sífilis ocular, este achado é muito comum na prática clínica. Acreditamos que esses pontos são devidos a perivasculite secundária à infecção pelo treponema. É importante os reconhecer e lembrar que a sífilis pode se apresentar de várias formas, incluindo essa apresentada aqui.

Clinical observation on treating idiopathic panuveitis with integrated traditional Chinese and Western medicine / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To explore the clinical therapeutic effect of the integrated traditional Chinese and Western medicine treatment of idiopathic panuveitis. METHODS: Totally 47 patients ( 69 eyes ) with the idiopathic panuveitis were included in this study, which were randomly divided into control group and treatment group. Twenty-four cases (33 eyes) with the method of Western medicine-glucocorticoid and mydriatic were in control group, while 23 cases (36 eyes) with integrated traditional Chinese and Western medicine were in treatment group. Those patients were followed up 12-36mo, the vision before and after treatment, the therapeutic effects, the complications and the side effects of glucocorticoid were recorded. RESULTS: Both of two groups' vision after treatment were improved, but the vision of treatment group was better than the control group. The effective rate and the cure rate of the treatment group were increased significantly. Of all of the complications, the incidence rate of complicated cataract and secondary glaucoma of the treatment group were reduced significantly. Of all of the side effects of glucocorticoid, the central excitation, hypertension and central obesity of the treatment group were reduced significantly (PCONCLUSlON: Dialectical therapy of integrated traditional Chinese and Western medicine has better therapeutic effect than simple Western medicine treatment of idiopathic panuveitis, and could better reduce the side effect of glucocorticoid long-term use. lt is worthy applying in clinical practice.

Características clínicas y diagnóstico etiológico de las uveítis virales / Clinical characteristics and etiologic diagnosis of viral uveitis

Objetivo: determinar las características clínicas y epidemiológicas de las uveítis virales según su etiología. Métodos: se realizó un estudio observacional y descriptivo transversal, que determinó el diagnóstico clínico y etiológico, según la reacción en cadena de polimerasa (PCR) de 10 ojos de pacientes atendidos en la consulta de uveítis, en el Instituto Cubano de Oftalmología ®Ramón Pando Ferrer¼, de mayo a noviembre del 2010. Se utilizó una muestra de fluidos intraoculares tomada a los pacientes. Las variables analizadas fueron: edad, sexo, color de piel, antecedentes personales generales u oculares, clasificación anatómica y patológica de la uveítis, curso evolutivo, bilateralidad, agudeza visual y presión intraocular iniciales y finales respectivamente, hallazgos al fondo de ojo y resultados de la PCR. La información fue procesada y los resultados expuestos en tablas. Resultados: la edad promedio de los pacientes estudiados fue de 34,5 años, que presentaron en su mayoría episodios de uveítis anteriores unilaterales. La agudeza visual mejor corregida final mejoró con respecto a la inicial en el grupo de estudio, aunque la presión intraocular se mantuvo elevada sin lograr controlarla. El virus más hallado fue el Herpes simple. Conclusiones: los virus son responsables de producir inflamaciones oculares de presentación variada, lo que en ocasiones retrasa el diagnóstico, empeorando el pronóstico visual. En estos casos el método de PCR ha demostrado ser una herramienta útil para establecer el diagnóstico etiológico

Objective: to identify the clinical and epidemiological characteristics of viral uveitis according to their etiology. Methods: observational, cross-sectional and descriptive study to determine the clinical and etiological diagnosis, according to the plolymerase chain reaction results, of 10 eyes from patients seen at the uveitis consultation service at Ramon Pando Ferrer Cuban Institute of Ophthalmology from May to November 2010. The sample comprised intraocular fluids taken from the patients. The analyzed variables were age, sex and race, general or ocular personal background, anatomical and pathological classification of uveitis, progression, bilaterality, and initial and final visual acuity and intraocular pressure, respectively, funduscopy findings and PCR results. The collected information was processed and expressed in tables. Results: the average age of the studied patients was 34.5 years; most of them had had episodes of unilateral anterior uveitis. The final best corrected visual acuity improved when compared to the initial one of the study group, although the intraocular pressure remained high with no control. The most found virus was Herpes simplex. Conclusions: the viruses are responsible for causing ocular inflammation of varied presentations, which occasionally delays the diagnosis and worsens the visual prognosis. In these cases, the PCR method has proved to be useful tool to set the final etiological diagnosis

Management of recurrent inflammatory choroidal neovascular membrane secondary to Vogt-Koyanagi-Harada syndrome, using combined intravitreal injection of bevacizumab and triamcinolone acetate.

The purpose of this report is to evaluate the efficacy and safety of combined intravitreal injection of bevacizumab and intravitreal triamcinolone acetonide (IVTA) for recurrent inflammatory choroidal neovascular membrane (CNVM). It was a prospective interventional study of a young female, who was a known case of Vogt-Koyanagi-Harada syndrome. She presented with an inflammatory choroidal neovascualar membrane and signs of panuveitis in the right eye. She underwent a complete ophthalmic examination. She was given intravitreal injection of bevacizumab and IVTA at different sites. There was complete regression of CNVM and ocular inflammation within a week. After six months, she had recurrence of CNVM in the same eye, which was treated similarly. There was a complete resolution of CNVM and ocular inflammation after the combination therapy and systemic steroids, until one year of follow-up. No serious systemic or ocular adverse events were noted. Combination therapy appears to be an effective and safe method in the management of recurrent inflammatory CNVM.

Melkersson-Rosenthal syndrome in a patient with tubercular panuveitis.

We report a rare presentation of Melkersson-Rosenthal syndrome in a patient with tubercular panuveitis. A 45-year-old male being treated with antitubercular therapy for tubercular panuveitis presented with unilateral, non-pitting right upper eyelid edema. Excision biopsy showed granulomatous inflammation involving the lymphatics. Immunohistochemistry confirmed the presence of histiocytes around the lymphatics.