Trauma ocular a globo cerrado en la edad pediátrica / Closed globe injuries in pediatric age

Los traumas oculares son frecuentes en las urgencias de oftalmología. El tratamiento constituye un reto para el oftalmólogo, pues se enfrenta a un daño integral y complejo. Se presenta un paciente de 16 años, el cual fue hospitalizado en el Instituto Cubano de Oftalmología Ramón Pando Ferrer hace cuatro años por haber recibido un trauma contuso en ojo derecho el cual provocó hifema total. Durante su estadía hospitalaria se realiza lavado de cámara anterior ya que no se logró la reabsorción espontánea del mismo. Al visualizarse todas las estructuras oculares se diagnostican complicaciones como subluxación del cristalino, catarata, panuveítis, hemovítreo, desgarro retiniano y glaucoma traumáticos. Se bloquea el desgarro con láser y una vez compensado el cuadro inflamatorio, es egresado bajo tratamiento y seguimiento por oftalmología pediátrica. No se logra controlar el glaucoma y se implanta dispositivo de drenaje Molteno lo que estabiliza la tensión ocular. Se realiza posteriormente cirugía de catarata, manteniéndose compensado del glaucoma sin tratamiento y con calidad visual(AU)

Ocular traumas are frequent in ophthalmology emergencies. Treatment is a challenge for the ophthalmologist, as he faces a comprehensive and complex damage. A 16-year-old patient is presented, who was hospitalized at the Cuban Institute of Ophthalmology Ramón Pando Ferrer 4 years ago for having received a blunt trauma to the right eye which caused total hyphema. During his hospital stay, anterior chamber lavage was performed since spontaneous reabsorption was not achieved. When all ocular structures are visualized, complications such as lens subluxation, cataract, panuveitis, hemovitreous, traumatic retinal tear and glaucoma are diagnosed. The tear was blocked with a laser and once the inflammatory condition was compensated, he was discharged under treatment and monitoring by pediatric ophthalmology. The glaucoma could not be controlled and a Molteno drainage device was implanted, which stabilizes the ocular tension. Cataract surgery was subsequently performed, keeping the glaucoma compensated without treatment and with visual quality(AU)

Sarcoidosis asociada a panuveítis en el área de un tatuaje: Reporte de caso / Sarcoidosis associated with panuveitis in the area of a tattoo: Case report

RESUMEN Antecedentes: la sarcoidosis es una de las reacciones cutáneas asociadas con los tatuajes. Lo más frecuente es que se presente una afección sistémica; dentro de ésta, el compromiso por uveítis y las reacciones sarcoidales asociadas a los tatuajes han sido poco descritas. Caso clínico: hombre de 27 años con cuadro clínico de seis meses de evolución constituido por malestar general, fiebre subjetiva, escalofríos, mialgias, artralgias, tos con expectoración hemoptoica y edema en los miembros inferiores. Se encontró ojo izquierdo rojo, disminución de la agudeza visual y pápulas que infiltraban uno de los tatuajes que se había realizado seis meses antes en el brazo derecho y antebrazo izquierdo. Conclusión: la sarcoidosis asociada a los tatuajes es una condición que requiere de un alto índice de sospecha; donde la infiltración del tatuaje debe hacer pensar al clínico en el diagnóstico para realizar la búsqueda activa del daño orgánico visceral, mucho más en un paciente con uveítis que puede llevar a la ceguera. Aunque inusual, existe esta triple asociación: tatuaje, sarcoidosis sistémica y panuveítis.

SUMMARY Background: One of the cutaneous reactions associated with tattoos is sarcoidosis and the most frequent presentation is systemic involvement; within this, the manifestation of uveitis and sarcoidal reactions associated with tattoos is little described. Clinical case: A 27-year-old man with a clinical picture of six months of evolution consisting of general malaise, subjective fever, chills, myalgias, arthralgias, cough with hemoptysis, edema in lower limbs, and in whom red eye, diminution of visual acuity, and papules that infiltrated one of the tattoos that were placed, six months earlier, on the right arm and left forearm, were found. Conclusion: Sarcoidosis associated with tattooing is a disease that requires a high index of suspicion, where its infiltration should make the clinician suspect the disease and make an active search for systemic involvement, especially in a patient with a uveal compromise that can lead to blindness. It must keep in mind that, although rare, this triple association is possible (tattoo, systemic sarcoidosis, and panuveitis).

Methotrexate for sympathetic ophthalmia: A report of 3 cases

@#OBJECTIVE: To describe the visual and clinical outcomes of 3 patients with sympathetic ophthalmia treated with a combination of systemic steroids and methotrexate. METHODS: This was a small, descriptive case series. RESULTS: We reported 3 cases of post-traumatic sympathetic ophthalmia treated with steroids and methotrexate. Two patients had inciting eyes with no light perception on presentation, while one had a best-corrected visual acuity (BCVA) of counting fingers. The initial BCVA of the sympathizing eyes ranged from 20/20 to 20/50. Control of ocular inflammation was achieved using methotrexate (12.5 to 15 mg weekly) in addition to oral steroids and topical therapy. The final BCVA of the sympathizing eyes ranged from 20/20 to 20/30, indicating that good visual outcomes were attainable with steroids and methotrexate as part of the maintenance regimen. None of the patients developed adverse side-effects from methotrexate. CONCLUSION: This small case series demonstrated the effectiveness and safety of methotrexate for control of intraocular inflammation in sympathetic ophthalmia.

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.

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.

Sífilis ocular en una población Colombiana: manifestaciones clínicas y resultados del tratamiento / Ocular syphilis in a Colombian population: clinical manifestations and treatment outcomes

Diseño de estudio: Retrospectivo observacional descriptivo. Método: Se recolectaron datos de pacientes con sífilis ocular evaluados en un centro de referencia de oftalmología en Colombia desde marzo de 2015 hasta febrero de 2017. Resultados: Dieciséis pacientes fueron diagnosticados con sífilis ocular durante el período estudiado. Cuatro (25%) pacientes tuvieron afectación de ambos ojos, para un total de 20 ojos. Hubo 11 (68.8%) hombres y 5 (31.3%) mujeres. La edad media de presentación fue de 51.1 años (23-86 años). Cuatro pacientes masculinos estaban coinfectados con VIH. La manifestación más frecuente fue la panuveítis en ocho ojos (40%). Seis pacientes (37.5%) presentaron hallazgos dermatológicos sistémicos. El tratamiento incluyó penicilina cristalina y esteroides sistémicos. El seguimiento medio fue de 16.2 meses (12-21 meses). La agudeza visual media mejoró de 1,01 ± 0,71 logMAR a 0,58 ± 0,64 logMAR después del tratamiento. Conclusión: La sífilis es una causa poco común de infl amación intraocular. Sin embargo, la incidencia ha venido en aumento en los últimos años tanto en pacientes VIH positivo como VIH negativo. La panuveítis es el hallazgo ocular más frecuente. El pronóstico visual es bueno si hay un diagnóstico y tratamiento temprano.

Background: Syphilis is a sexually transmitted disease caused by Treponema pallidum. It can remain dormant in the individual throughout life. The manifestations of ocular involvement are similar to other infl ammatory eye conditions. It is crucial to make an early diagnosis and management in order to avoid complication. Objective: to describe the clinical characteristics and the results of the treatment of patients with ocular syphilis. Study design: observational retrospective study. Method: Retrospective cohort of patients with ocular syphilis evaluated in an ophthalmology reference center in Colombia from March 2015 to February 2017. Results: Sixteen patients were diagnosed with ocular syphilis during the studied period. Four (25%) patients had involvement of both eyes, for a total of 20 eyes. There were 11 (68.8%) men and 5 (31.3%) women. The mean age of presentation was 51.1 years (23-86 years). Four male patients were coinfected with HIV. Th e most frequent manifestation was panuveitis in eight eyes (40%). Six patients (37.5%) presented systemic dermatological fi ndings. Treatment included crystalline penicillin and systemic steroids. The mean follow-up was 16.2 months (12-21 months). The mean visual acuity improved from 1.01 ± 0.71 logMAR to 0.58 ± 0.64 logMAR after treatment. Conclusion: Syphilis is a rare cause of intraocular inflammation. However, the incidence has been increasing in recent years in both HIV positive and HIV negative patients. Panuveitis is the most frequent ocular finding. The visual prognosis is good if there is an early diagnosis and treatment.

A Case of Cytomegalovirus Retinitis Following Intravitreal Dexamethasone Implant in an Immunocompetent Patient with Uveitis

PURPOSE: We report a case of cytomegalovirus (CMV) retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient diagnosed with non-infectious uveitis. CASE SUMMARY: A 60-year-old woman was referred to our hospital for recurrent anterior uveitis. Fundus examination and fluorescein angiography showed dense vitritis, but no definite retinal infiltration. After laboratory examinations, the patient was diagnosed with non-infectious panuveitis. Uveitis was much improved after the patient started taking oral steroid medication. However, the patient complained of systemic side effects from the oral steroids. Medication was stopped, and an intravitreal dexamethasone implant was fitted to address worsening inflammation. Two months later, perivascular retinal infiltration developed and vitritis recurred. Viral retinitis was suspected, and the patient underwent diagnostic vitrectomy adjunctive with intravitreal ganciclovir injection. Polymerase chain reaction of vitreous fluid confirmed the diagnosis of CMV retinitis. The patient has remained inflammation-free for more than 20 months after vitrectomy, single ganciclovir injection, and 2 months of oral valganciclovir medication. CONCLUSIONS: This is a case report of CMV retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient without any risk factors or previous history of immunosuppression. Potential risk factors for CMV retinitis should be evaluated and careful follow-up should be performed when intravitreal dexamethasone injections are unavoidable for the treatment of non-infectious uveitis.

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.

Roth Spots and Panuveitis in a Patient with Infectious Mononucleosis

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.

Doença de Behçet ocular: a nossa realidade / Behçet disease: our experience

Resumo Objetivo: A doença de Behçet é uma vasculite inflamatória sistémica, de etiologia desconhecida. Pode atingir virtualmente todos os sistemas, sendo as manifestações oculares comuns. O objectivo deste trabalho foi analisar doentes com doença de Behçet ocular quanto aos parâmetros demográficos, manifestações clinicas, terapêutica e principais complicações. Métodos: Estudo descritivo e retrospetivo, que incluiu 11 doentes com o diagnóstico de doença de Behçet ocular, segundo os critérios do ISG, observados na consulta de Inflamação Ocular do Hospital Prof. Doutor Fernando da Fonseca nos últimos 3 anos. Resultados: Identificaram-se 11 doentes, 5 homens e 6 mulheres, todos caucasianos. A idade média ao diagnóstico foi de 33,45±6,49 anos. A manifestação ocular foi o primeiro sinal da doença em 2 doentes. Em 72,7% dos casos as manifestações oculares foram bilaterais. Identificaram-se 4 casos de panuveíte, 3 de uveíte posterior, 2 de uveíte anterior, 1 de queratite e 1 caso de episclerite. O glaucoma e a catarata foram a complicação ocular mais frequente. O tratamento sistémico incluiu a corticoterapia oral em associação com terapêutica adjuvante imunossupressora, sendo os mais utilizados a azatioprina e a ciclosporina. Em 3 doentes houve necessidade de terapêutica biológica com infliximab para controlo da doença. Conclusão: A manifestação ocular mais frequente foi a panuveíte. Esta doença pode condicionar complicações oculares com diminuição irreversível da acuidade visual. A orientação destes doentes exige uma abordagem global e interdisciplinar.

Abstract Objective: Behçet's disease is a systemic inflammatory vasculitis of unknown etiology. It can virtually reach all systems, being common ocular manifestations. The aim of this study was to analyze patients with ocular Behcet's disease regarding demographic parameters, clinical manifestations, therapeutic approach and main complications. Methods: Descriptive and retrospective study, including 11 patients diagnosed with ocular Behcet's disease, according to the ISG criteria, observed in the Ocular Inflammation appointment of the Hospital Prof. Doutor Fernando da Fonseca in the last 3 years. Results: We identified 11 patients, 5 males and 6 females, all caucasian. The mean age at diagnosis was 33.45 ± 6.49 years. Ocular manifestation was the first sign of the disease in 2 patients. In 72.7% of the cases, ocular manifestations were bilateral. There were four cases of panuveitis, 3 of posterior uveitis, 2 of anterior uveitis, 1 of keratitis and 1 case of episcleritis. Glaucoma and cataract were the most frequent ocular complications. Systemic treatment included oral corticosteroid therapy in combination with adjuvant immunosuppressive therapy, and the most commonly used was azathioprine and cyclosporine. In 3 patients there was a need for biological treatment with infliximab to control the disease. Conclusion: The most frequent ocular manifestation was panuveitis. This disease can promote eye complications with an irreversible decrease in visual acuity. Orientation of these patients requires a global and interdisciplinary approach.

Mycophenolate Mofetil for Chronic Uveitis in Koreans

PURPOSE: To evaluate the therapeutic effect and safety of mycophenolate mofetil (MMF) on chronic uveitis in Korean patients. METHODS: This study included 25 patients with chronic uveitis who used MMF and were followed up more than 6 months in 2 referral centers from 2010 to 2014. The medical records were analyzed retrospectively. The therapeutic effect was assessed based on control of inflammation, corticosteroid sparing effects, and discontinuation of MMF, and the safety was assessed based on side effects. Control of inflammation was defined as no active inflammation observed on at least 2 consecutive visits 28 days apart or more. RESULTS: The 25 patients consisted of 18 males and 7 females. The mean age of the patients was 47.52 years. The etiology of uveitis was as follows: Behcet's disease in 15 patients (60%), Vogt-Koyanagi-Harada disease in 4 (16%), sympathetic ophthalmia in 2 (8%), systemic lupus erythematosus in 1 (4%), and idiopathic uveitis in 3 (12%). Anatomic classification was anterior uveitis in 20% and posterior uveitis or panuveitis in 80% of patients. Complete control of inflammation was achieved in 44% and 50% of patients within 6 months and 1 year, respectively. Systemic corticosteroid dosage was reduced to 10 mg of prednisone or less while maintaining sustained control of inflammation in 36% and 45% of patients for 6 months and 1 year, respectively. MMF was discontinued in 3 patients (12%) due to side effects and in 2 patients (8%) due to lack of effectiveness. CONCLUSIONS: MMF was effective and side effects were uncommon when managing chronic uveitis in Korean patients.

Ocular Manifestations of Sarcoidosis: An Ophthalmologist's View / 한양의대학술지

Sarcoidosis is a granulomatous disease which frequently involves eyes and adnexal tissues. Its prevalence of ocular involvement is reported as about 20%, although it varies widely according to authors, from 12% to 73%. Ocular sarcoidosis is present as various forms - uveitis, conjunctival involvement, optic nerve involvement, and orbital involvement. All the forms of uveitis - anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis - can be shown in sarcoidosis. Because clinical manifestation, prognosis and treatment are determined by the location of uveitis, it is important to classify uveitis. Conjunctival involvement is not a sight-threatening condition in general, its diagnostic value may be of use. Optic nerve is the most commonly involved cranial nerve, which can impair vision. Subjects with visual impairment without any evidence of uveitis, optic nerve involvement should be suspected. Orbital involvement, especially lacrimal gland involvement is common, and it may cause mass-effect. Besides systemic administration of drugs, there are several localized treatments for ocular sarcoidosis - topical eye drops, intra/peri-ocular injection of agents.

Successful treatment of tubulointerstitial nephritis and uveitis with steroid and azathioprine in a 12-year-old boy / 소아과

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, often underdiagnosed or misdiagnosed in children. We describe the case of a 12-year-old boy who presented to Severance Hospital with a 1-month history of bilateral conjunctival injection. He was first evaluated by an Ophthalmologist in another hospital and diagnosed with panuveitis. Laboratory tests indicated renal failure, and a renal biopsy confirmed the diagnosis of acute tubulointerstitial nephritis. An extensive exclusion of all possible causes allowed a diagnosis of TINU syndrome. The patient was treated with a systemic corticosteroid (initially prednisolone, 2 mg/kg and later deflazacort 1 mg/kg) and topical steroid drops for 1 month. Azathioprine was later added to the treatment regimen and the systemic steroid was slowly tapered. The final outcome of renal-ocular disease was favorable in the patient. However, long-term follow-up is necessary to properly manage frequent relapses and incomplete renal recovery. TINU should be considered as a differential diagnosis in children with uveitis or acute renal failure.

Non-human Immunodeficiency Virus-related Ocular Syphilis in a Korean Population: Clinical Manifestations and Treatment Outcomes

PURPOSE: To describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection. METHODS: A total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed. RESULTS: The mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis. CONCLUSIONS: Visual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.

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.

Vogt Koyanagi Harada disease: treatment and visual prognosis

Vogt Koyanagi Harada [VKH] disease is a chronic, bilateral, granulomatous panuveitis associated with central nervous system, auditory and integumentary manifestations. The study was conducted from January 2001 to December 2010 at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar. A total of 9 patients with diagnosis of Vogt Koyanagi Harada disease were included in the study. Extracted data included age, gender, duration of disease, initial and final visual acuities, treatment and complications. Initial visual acuity was ranging from 6/24 to perception of light. All the patients were treated with systemic and topical corticosteroids. In addition, one patient also received cytotoxic therapy. Final visual acuity was 6/18 or better in all cases [100%]. One patient developed bilateral cataract, glaucoma and sub-retinal fibrosis at the macula. The cataract and glaucoma were managed as per established protocols. The visual prognosis of Vogt Koyanagi Harada disease is generally favourable if the disease is identified early and adequately treated and the associated complications are addressed properly

Fulminant toxoplasmic retino-choroiditis following intravitreal triamcinolone administration.

We report two cases of fulminant toxoplasmic retinochoroiditis following intravitreal triamcinolone acetonide (IVTA) administration. Case 1: A 42-year-old female received IVTA for presumed non-infectious panuveitis. Within 2 months, she developed diffuse macular retinochoroiditis with optic disc edema. Upon starting anti-toxoplasmic therapy (ATT), her intraocular inflammation resolved with catastrophic damage to the disc and macula. Case 2: A 30-year-old male received IVTA for presumed reactivation of previously scarred toxoplasmic retinochoroiditis. Despite simultaneous ATT, within 6 weeks, he developed extensive, multifocal macular retinochoroiditis. He continued to require ATT for 18 months and later underwent vitrectomy with silicone oil placement for severe epiretinal proliferation. Aqueous tap polymerase chain reactions were found positive for Toxoplasma gondii in both cases. In conclusion, IVTA administration can lead to fulminant toxoplasmic retinochoroiditis even when used with appropriate ATT. Extreme caution should be exercised while administering depot corticosteroids in eyes with panuveitis of unknown origin.

Uveitis and Rheumatic Diseases in a Community Based Practice - Korean Population

OBJECTIVE: We aimed to investigate the frequency of rheumatic diseases within uveitis patients visiting the department of Ophthalmology and evaluated the clinical value of serological testing and ophthalmologic findings in patients with uveitis in a community-based practice in Korean population. METHODS: On a retrospective basis, we reviewed the medical records of patients with uveitis, who had been treated at the Department of Ophthalmology of Inje University Ilsan Paik Hospital between January 2005 and March 2010. All patients with uveitis were reviewed regarding their ocular histories and findings, rheumatologic medical histories and manifestations, and pelvis anteroposterial view of plain radiographies to identify the sacroilitis. In addition, we tested for rheumatoid factor, antinuclear antibody, and HLA-B27. RESULTS: A total of 107 patients with uveitis were included in the study. HLA-B27 associated uveitis was present in 64 patients (59.8%) the number of patients with sacroilitis on plain pelvis radiography was 38 patients (37.8%). Fifty-one patients (47.7%) were diagnosed as having systemic rheumatic diseases. The majority of these patients had anklylosing spondylitis (AS) (70.3%) and Bechet's disease (18.9%). The most common type of uveitis was anterior uveitis (90.7%), followed by panuveitis (3.7%) and posterior uveitis (3.7%). The recurrence rate and number of floating cells were greater in patients with rheumatic diseases than patients without rheumatic diseases. CONCLUSION: The majority of rheumatic disease related with uveitis were AS and Bechet's disease. HLA-B27 and pelvis plain radiography can be useful tools for screening the spondyloarthropathies with uveitis. Recurrent and severe uveitis might represent an accompanying rheumatic disease.