Advances in the Diagnosis and Treatment for Ocular Complication on Mucopolysaccharidosis / 罕见病研究

Mucopolysaccharidosis is a series of rare diseases where a lack of an enzyme affecting mucopolysaccharides metabolism in the patients′ lysosome induces the intracellular deposition of the mucopolysaccharides, and causes ocular and organ-related complications. Ocular complications included corneal opacity, glaucoma, ametropia, strabismus, and chorioretinopathy. This review summarizes the mechanisms, clinical manifestations, specific ophthalmological examinations, and treatments for offering the ophthalmological knowledge to diagnose and begin treatment earlier.

Ocular complications of HIV infection / 国际眼科杂志(Guoji Yanke Zazhi)

@#In recent years,with the widespread application of highly effective antiretroviral therapy(HAART), the incidence of human immunodeficiency virus(HIV)and acquired immunodeficiency syndrome(AIDS)related eye complications was significantly reduced. The absolute number of patients infected with HIV and AIDS increased year by year, and the survival rate increased and the survival time prolonged. The clinical manifestations of associated ocular complications in these patients are variable, affecting almost all ocular structures. At present, there is a lack of large-scale and long-term systematic observation of eye lesions in HIV-infected and AIDS patients in China. Misdiagnosis and missed diagnosis occur in many hospitals and even in some of the top-three hospitals. This not only delays the treatment of patients, but also easily cause iatrogenic transmission. Therefore, ophthalmologists and even other medical workers should enhance their knowledge of HIV/AIDS. This paper reviews the common complications of non-infection, opportunistic infection, and immune reconstitution inflammatory response syndrome(IRIS)in the HIV/AIDS patients, and discusses the manifestations and research progress of posterior ocular complications of HIV/AIDS.

Clinical analysis of nine patients with presumed tubercular retinal vasculitis / 中华眼底病杂志

Objective To observe the clinical features and treatment outcomes of presumed tubercular retinal vasculitis.Methods This is a retrospective non-comparative interventional clinical research.A total of nine patients (11 eyes) with major presentation of retinal vasculitis were included in this study.Patients first consulted the eye clinic and were diagnosed presumed tubercular retinal vasculitis.The patients,seven males and two females,aged from 19 to 66 years,with an average of 43.89 years.The time interval from symptoms to diagnosis ranged from two weeks to six months with an average of 76.27 days.Visual acuity,slit lamp ophthalmoscopy,fundus fluorescein angiography (FFA),optical coherence tomography (OCT),hematological and tuberculosis related investigations were examined and analyzed.All patients had standard anti-tuberculosis treatment.Treatment outcomes were followed for six to 37 months with an average of 14.11 months.Results Baseline visual acuity ranged from hand movement to 0.8 with an average of 0.28.Among 11 eyes,six presented mild to moderate vitritis,five presented as retinal vein occlusion with no obvious vitirits.Fundus examination showed six cases with retinal hemorrhage,four cases with macular edema,two with macular epiretinal membrane,and two with vitreous hemorrhage.FFA revealed 11 cases with leakage of vessels,11 with nonperfusion area,four with macular edema,three with retinal neovascularization,and two with choroidal lesions.OCT of nine eyes suggested six eyes with retinal edema,three with macular edema,three with macular epiretinal membrane.TST of seven patients were all strong positive.T-SPOT.TB of four patients were all positive.Three of eight patients who had chest X-ray or chest CT were suggested tuberculosis infection.Four to six weeks after the start of anti-tuberculosis treatment,vitritis,exudates,retinal and macular edema subsided.During follow up,inflammation was stable with no recurrence observed.The visual acuity of last follow-up ranged from 0.15 to 0.8 with an average of 0.51.Conclusions The main presentations of presumed tubercular retinal vasculitis are vitritis,retinal vein occlusion,and retinal hemorrhage.Standard anti-tuberculosis treatment can improve inflammation and retinal hemorrhage.

Clinical study of ocular damnification after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma / 国际肿瘤学杂志

Objective To study the effect on normal ocular tissues after intensity-modulated radiotherapy (IMRT) in the patients with nasopharyngeal carcinoma.Methods Nineteen nasopharyngeal carcinoma patients confirmed by pathology were enrolled (38 eyes).All Patients tnderwent visual acuity,slit lamp,fundus,visual evoked potential (VEP) and eleetroretinograms (ERG) examination before IMRT,at the end of IMRT,6 months and 12 months after IMRT.Results ① There was no statistically difference in uncorrected and corrected visual acuity at the various examination time points before and after radiotherapy ( P ＞ 0.05 ).② The average latency of VEP P100 before IMRT,at the end of IMRT,at 6 months after IMRT and 12 months after IMRT was ( 99.684 ± 2.484) μV,( 99.947 ± 2.277 ) μV,( 104.000 ± 3.952 ) μV and ( 101.316 ±2.462) μV respectively.The average latency of VEP P100 was significantly prolonged at 6 months after IMRT compared with the time points of before IMRT,the end of IMRT and 12 months after IMRT ( P ＜ 0.05 ).③ The average latency of ERG b wave before IMRT,at the end of IMRT,at 6 months after IMRT and 12months after IMRT was (44.974 ±3.774) ms,(44.816 ±3.368) ms,(43.184 ±2.837) ms and (44.000 ±3.154) ms respectively. The average amplitude of ERG b wave before IMRT,at the end of IMRT,at 6 months after IMRT and 12 months after IMRT was (421.237 ±27.353) μV,(414.763 ±26.188) μY,(419.026 ±24.876) μV,and (419.974 ± 25.894) μV respectively.No statistically difference was found in average latency and amplitude of ERG b wave at the various examination time points before and after radiotherapy ( P ＞0.(05).④ The average amplitude of Op2 wave before IMRT,at the end of IMRT,at 6 months after IMRT and 12 months after IMRT was (63.184 ± 6.028 ) μV,(48.605 ± 6.872 ) μV,( 50.421 ± 6.769 ) μV and (53.026 ±6.074) μV respectively.At the various time points after IMRT,the average amplitude of Op2 wave was significandy lower than before IMRT (P ＜ 0.05 ).Conclusion IMRT can significantly reduce the incidence of ocular complications.There is a good clinical application value of ERG and VEP for evaluating retina and optical nerve functional changes induced by IMRT.

Clinical observation of the ocular complications in Leprosy patients / 나학회지

PURPOSE: To determine the prevalence of ocular complications in leprosy patients. METHODS: Screening ocular examinations were performed in 572 leprosy patients, who resided in National sorokdo hospital from May to October, 2011. RESULTS: Overall prevalence of ocular complications was 87.1%. Ocular complication was significantly associated with increasing age. There was no statistically significant difference in the incidence of the ocular complication among males and females. Lepromatous leprosy patients had the greatest prevalence of ocular lesion. CONCLUSIONS: There is a significant rate of ocular complications in leprosy patients in the National sorokdo hospital, and had a potentially sight-threatening ocular complication. Health professionals need to be new eye symptoms and signs require prompt ophthalmology review to prevent avoidable blindness, due to the life-long risk of sight-threatening ocular complications.

Relato de dois casos de toxoplasmose em gestantes atendidas no noroeste do Paraná, Brasil / Report of two cases of toxoplasmosis in pregnant women from the northwest of Parana state, Brazil

Paraná em acompanhar adequadamente gestantes com suspeita de toxoplasmose aguda, como observado nestes relatos, com um caso de toxoplasmose congênita e outro de reagudização ocular severa. Descrição dos casos: no primeiro caso, a gestante apresentou IgM, IgG e IgA Toxoplasma gondii-específicas reagentes e líquido amniótico com pesquisa de DNA e inoculação em camundongos positivas para Toxoplasma gondii. Houve acometimento fetal, com achados ultrassonográficos de placentomegalia e calcificações cerebrais. O recém-nascido apresentou a tétrade de Sabin. No outro caso, uma gestante imunocompetente, IgG anti-Toxoplasma gondii reagente e IgM não reagente, apresentou reagudização ocular grave. Ambas procuraram o serviço de saúde no primeiro trimestre de gestação, mas os encaminhamentos ocorreram entre 20 e 32 semanas de gestação. Conclusões: a falta de agilidade e de conhecimento entre os vários níveis de assistência no controle da toxoplasmose gestacional retardaram a tomada de decisão por parte dos profissionais de saúde. A ocorrência desses casos de toxoplasmose em gestantes evidencia a importância de integração vertical e aplicação de medidas que possam proporcionar a formação de uma rede de controle ágil e com infra-estrutura adequada para sua gestão.

Aims: To highlight the difficulty of the various services that comprise the public health system from the Northwest of Paraná in the monitoring of pregnant women with suspected toxoplasmosis, as observed in the present reports, one of a case of congenital toxoplasmosis and the other of severe ocular reagudization. Cases description: In the first case, the pregnant women had positive serum Toxoplasma gondii-specific IgM, IgG and IgA, and PCR and inoculation in mice positive for Toxoplasma gondii in amniotic fluid. The fetus had ultrasound findings of placentomegalia and cerebral calcifications, and the newborn presented the Sabin tetrad. In the other case, an immunocompetent pregnant woman, with positive Toxoplasma gondii-specific IgG and negative IgM from serum, presented with severe ocular reagudization. Both patients sought the health service in the first trimester of pregnancy, but the referrals occurred between 20 and 32 weeks of gestation. Conclusions: The lack of agility and knowledge between the various levels of assistance in the control of gestational toxoplasmosis delayed a decision on the part of health professionals. The occurrence of toxoplasmosis in these pregnant women highlights the importance of vertical integration and of implementing strategies that can provide the development of a network of control and adequate management.

Compreensão da importância do exame ocular preventivo entre hansenianos de duas Instituições de referência / Comprehension of the importance of preventive ocular exam among Hansen´s disease patients from two referral centers

Objetivo. Avaliar o conhecimento dos pacientes portadores de morbus Hansen, da necessidade da realização de exames oftalmológicos periódicos, visando à prevenção das complicações oculares relacionadas à sua patologia. Métodos. Avaliados 113 pacientes ambulatoriais com diagnóstico prévio de hanseníase, sendo 57 casos provenientes do Hospital Universitário de Brasília, e 56 pacientes provenientes da Fundação Instituto de Dermatologia Tropical e Venereologia Alfredo da Mata FUAM (centros de referência regional em dermatoses e hanseníase). Após assinatura de termo de consentimento livre e esclarecido, foram estimulados a responder questionário elaborado especificamente para este estudo. Também foram examinados os prontuários desses doentes para averiguar os dados de identificação, o nível de escolaridade, a forma clínica, e a duração da hanseníase. Resultados. Quando questionados se sabiam que sua doença pode levar ao aparecimento de complicações oculares, 24,8% dos entrevistados afirmaram que têm conhecimento dessa associação, 23% afirmaram desconhecer tal associação e 52,2% não souberam responder. Conclusões. Este estudo mostra ser inadequado o nível de compreensão dos enfermos com hansenníase com relação à sua doença quanto à possibilidade do aparecimento de complicações oculares. Enfatiza a necessidade que os profissionais de saúde envolvidos no tratamento de hanseníase informem aos pacientes, de forma clara, incisiva e objetiva, que a doença é potencialmente causadora de graves complicações oculares.

Objective. To evaluate the knowledge of Hansen disease patients on the demand of periodical ocular exams aiming at preventing eye complications related to their disease. Methods. A total of 113 outpatients with previous leprosy’s diagnostic, 57 from Hospital Universitário de Brasília and 56 from Fundação Instituto de Dermatologia Tropical e Venereologia Alfredo da Mata (both regional reference centers for dermatological diseases and leprosies), after signing an informed consent, the patients were stimulated to answer a specially elaborated questionnaire. Their records were examined to access personal information, school level, the clinic type of Hansen disease, and the length of the disease. Results. When asked if they knew that their disease could lead to the emergence of eye complications, 24.8% of the subjects answered they knew about this relationship, 23% answered there was no such association to their knowledge and 52.2% answered they did not know how to answer the question. Conclusions. This study demonstrates an inadequate level of understanding on part of the studied Hansen disease patients regarding the risk of their disease to lead to further ocular complications. It also emphasizes the necessity that all health professionals who take part in treatment of Hansen disease patients should tell them clearly and objectively their disease is potentially related to important eye complications, being such information a basic and extremely helpful procedure in preventing these problems.

The Changes on Electroretinogram Following Sildenafil Ingestion

PURPOSE: Sildenafil citrate (Viagra(R)) acts as a relatively specific inhibitor of the type 5 phosphodiesterase isoenzyme (PDE5) in the corpus cavernosum. But, it also has a mild inhibitory effect on PDE6 in the retinal photoreceptor. Therefore, we studied the ocular side effects of sildenafil. METHODS: We tested the visual acuity, intraocular pressure, color vision, visual evoked potential (VEP), electroretinogram (ERG), anterior segment and fundus appearance. All tests were done before and after medication of 50 mg and 100 mg sildenafil, respectively. RESULTS: There was no significant effect of sildenafil on visual acuity, intraocular pressure, color vision, VEP, anterior segment and fundus appearance. ERG changes after 50 mg sildenafil were not significant. The a-wave amplitude of the maximal combined response after 100 mg sildenafil showed significant changes (p=0.021). The b-wave amplitude of the maximal combined response after 100 mg sildenafil showed changes with borderline significance (p=0.059). CONCLUSIONS: In considering the fact that even single dose of 100 mg sildenafil showed changes on ERG, it seems that retinal function in patients receiving sildenafil for a longer period, especially in patients with underlying vascular abnormalities should be monitored by clinical and electrophysiologic tests.

Ocular Complications after Injection of Intra-arterial Carboplatin in Gliomas

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma: 3, Grade III Astrocytoma: 1, Grade IV Astrocytoma: 5, Gliofibroma: 1, Oligodendroglioma: 1) underwent IAC regimen with carboplatin(300mg/m2) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.

Characteristics of Atopic Dermatitis Related to Ocular Complications / 대한피부과학회지

BACKGROUND: Long-standing atopic dermatitis patients frequently predispose to ocular complications. The ectodermal origin of the epidermis and of many eye structures explain the frequent associations observed in atopic dermatitis. OBJECTIVE: This study may help in evolving early diagnosis and in formulating standard therapeutic strategies to prevent and treat ocular complications by studying the types, frequency and dermatological characteristics of each ocular complication in atopic dermatitis. METHODS: We evaluated the ocular complications of 41 typical atopic dermatitis patients(26 males, 15 females) who had skin lesion around eyelids or complained of ocular symptoms. RESULTS: Mean age of the patients was 17.7 years. The onset of atopic dermatitis was during infancy in 21 patients, during childhood in 15 patients, and during adult in 5 patients and their mean duration of disease was 13.8 years. Mild ocular involvements including blepharitis in 29 patients(58 eyes, 70.7%), keratoconjunctivitis in 29 patients(58 eyes, 70.7%) were seen. More serious complications which may lead to decreased visual function including cataracts in 5 patients(10 eyes, 12.1%), retinal detachments in 3 patients(5 eyes, 6.0%) were seen. All the patients who had these two serious complications had facial dermatitis. And other ocular involvements including keratoconus in 2 patients(2 eyes, 2.4%), ocular herpes simplex in 1 patient(2 eyes, 2.4%), uveitis in 2 patients(2 eyes, 2.4%) were seen. CONCLUSION: It is important to perform an ophthalmologic examination in the early period of disease in long-standing atopic dermatitis patients especially those who have facial dermatitis for the early diagnosis and treatment of serious sight-threatening complications.

Clinical Analysis for Complications of Nd-YAG Laser Posterior Capsulotomy in Uveitis Patients

Nd-YAG laser is known as a safe and effective treatment for posterior capsular opacity after cataract surgery. We studied the ocular complications after Nd-YAG laser treatment in uveitis patients. From January 1991 to December 1996, we retrospectively investigated the complications of uveitis in 22 persons(25 eyes) after Nd-YAG laser posterior capsulotomy, and also investigated that of nonuveitis in 563 persons(635 eyes) as a control group. The uveitis cases consisted of six anterior uveitis, eight intermediate uveitis, seven Behcet`s syndromes, three panuveitis, and one posterior uveitis. In the uveitis group, the complications(18 eyes) consisted of three retinal detachments, one giant retinal tear, three glaucoma, two aggravations of uveitis, two vitreous opacities, one retinal emorrhage, one proliferative vitreoretinopathy, one hyphema, and four transient high intraocular pressures(IOP), and in the control group, it consisted of two subluxations of intraocular lens(IOL), three glaucomas, one retinal tear, three transient high IOPs, two vitreous opacities, two retinal hemorrhages, three macular holes, two retinal detachments, and five cystoid macular edemas. From our experience, the incidence of complications after Nd-YAG laser posterior capsulotomy in uveitis was higher than that in nonuveitis. It was also noted that it is necessary to follow up thoroughly the complications after Nd-YAG laser posterior capsulotomy in uveitis patients.

Prevalencia de complicaciones oculares en pacientes pre y post trasplante Renal, Unidad Renal del HUSVP 1994-1995 / Pre and post renal transplant ocular complication prevalence, renal unit, HUSVP, Medellín, 1994-1995

PROPÓSITO: Determinar la prevalencia de complicaciones oculares pre y postrasplante renal, en los pacientes con Insuficiencia Renal Crónica de la Unidad Renal del Hospital Universitario San Vicente de Paul, Medellín, entre VI/94 y VII/96, para establecer un protocolo de manejo oftalmológico. MÉTODOS: Ingresaron al estudio 44 pacientes con insuficiencia renal crónica y 40 pacientes entre uno y dos meses postrasplante. Fueron evaluaron semestralmente por un año. RESULTADOS: Se detectó relación entre ojo seco e insuficiencia renal crónica no reportada previamente, p<0.000684. En los no trasplantados hubo una mayor prevalencia de queratopatía, alteraciones en pruebas lagrimales y retinopatía hipertensiva. En los trasplantados se encontró mayor prevalencia de alteraciones conjuntivales, catarata y hipertensión ocular. CONCLUSIONES: Tanto los pacientes trasplantados como los no trasplantados presentan complicaciones oculares que amenazan su visión y requieren evaluación oftalmóloga frecuente. Las alteraciones lagrimales en la falla renal crónica pueden tener un origen hormonal y metabólico mediado por andrógenos y progesterona...

PURPOSE: To determine pre and post renal transplant ocular complications, for pacients with chronic renal failure at the Renal Unit from Hospital Univeristario San Vicente de Paul, Medellín, between 06/94 and 07/96 in order to establish an ophthalmic follow up protocol. METHODS: 44 patients with chronic renal failure and 40 patients between one and two months after renal transplant were included. They were evaluated every six months for one year. RESULTS: A relation between dry eye and chronic renal failure not previously reported, was identified, p<0.000684. The main complications found within non-transplant patients were: keratopathy, abnormal lacrimal function tests, and hypertensive retinopathy; and within post-transplant patients were: conjuntival pathology, cataracts, and ocular hypertension. CONCLUSIONS. Both transplanted and non-transplanted patients present ocular complications which endanger their vision and require close ophthalmic follow up. Alterations found in lacrimal function tests, may have metabolic and hormonal causes, mediated by androgens and progesterone.

Clinical Results of Q-Switchd Nd: YAG Laser Posterior Capsulotomy

From February 1987 to January 1991, We performed posterior capsulotomy on after cataract patients(400 eyes)by using Q-Switched Nd: YAG Laser. The results were as follow; 1. 226 aphakic eyes and 174 pseudophakic eyes(22 anterior chamber IOLs, 152 posterior chamber IOLs) were followed. 2. 335 adult and senile cataracts, 47 traumatic cataracts, and 18 congenital cataracts were followed. 3. The power setting of Nd: YAG Laser ranged from 1.0 to 2.4 mJ in 261 eyes(65.3%); less than 40 pulses were used in 298 eyes(74.5%). 4. Postoperative corrected visual acuity of 0.7 or better was achieved in 207 eyes(51.8%) and 1.0 or better in 112 eyes(28%). 5. Frequent ocular complications were a transient increase of intraocular pressure(15.8%) and vitreous prolapse(l3.5%).

A Study on the Incidence of the Ocular Complications of Leprosy in Resttlement Villages

Screening ocular examinations were performed in 509 leprosy patients(84%) among 605 lepers, who resided in 8 resettlement villages of Kyungpook Province f rom Oct. till Dec., 1988. The results were as follows: 1. Of the 496 patients studied, excluding the 13 patients who did not check visual acuity, 241 were males(48.6%), and 255 were females(51.4%). The patients' ages were varied from 26 to 80 years old and the peak age group was from 61 to 70 years old, which comprised of 160 patients(32.3%) among 496 patients. 2. The types of leprosy were L type in 379(76%), T type in 103(21%), B type in 5(1%), and I type in 9 patients(2%). 3. Among 992 eyes, 59 eyes were blind states(visual acuity, below 0.02) and 12 patients(2.4%) were binocular blind states. The numbers of blind eyes were the most from 71 to 80 years old as 25 eyes. 4. The ocular complications in leprosy, in order of frequency, were chronic anterior uveitis(23.8%), lagophthalmos(21.8%), corneal disease(20.8%), aphakia(5.2%), trichiasis(4.6%), complicated cataract(4.6%), phthisis bulbi(1.3%), and anophthalmos(0.5%). 5. Surgical treatment was necessary in 48 patients(9.7%) with lagophthalmos, and in 16 patients(3.2%) with cataract.