Research advance in the correlation between diabetes mellitus and the non-retinal eye diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Diabetes mellitus(DM)is a chronic metabolic disease characterized by sustained hyperglycemia, which can cause systemic macrovascular, microvascular and nervous system complications. The eye is one of the main organs affected by this disease. The ocular complications of DM include DR, however, non-retinal complications are also contained. This review provides an overview of the non-retinal eye diseases associated with DM, including diabetic keratopathy, dry eye, iridocyclitis, glaucoma, cataract, refractive error, optic neuropathy, iridocyclitis, asteroid hyalosis and so on. These ocular diseases may also lead to vision loss and should be taken seriously in diabetic patients.

Corneal endothelium in unilateral Fuchs heterochromic iridocyclitis

Purpose: To assess the corneal endothelium in patients with Fuchs heterochromic iridocyclitis (FHI) and compare it with the normal fellow eye. Methods: Retrospective, observational, cross-sectional study of 31 patients seen between Jan 2016 to Dec 2018, with clinical diagnosis of Fuchs heterochromic iridocyclitis, was performed. Specular microscopic examination was documented in both eyes. The affected eyes formed the study group and the fellow healthy eyes served as controls. Results: The mean age of the patients was 29.9 ± 8.2 years. The endothelial cell density (P = 0.0001) was significantly lower, whereas average cell size (P = 0.0001), coefficient of variation (P = 0.004), and maximum cell area (P = 0.01) were significantly higher in the affected eye compared to the control eye. In three patients, the affected eye showed guttae, while the healthy fellow eye revealed a normal specular mosaic. Conclusion: Specular microscopic analysis shows endothelial alterations in the affected eyes in FHI.

Astigmatismo y aberraciones corneales en ojos con Iridociclitis Heterocrómica de Fuchs / Corneal astigmatism and aberrations in patients with Fuchs heterochromic iridocyclitis

Introducción: La Iridociclitis Heterocrómica de Fuchs (IHF) es la causa del 2 a 7% de las uveítis anteriores, el astigmatismo corneal como condición de la IHF y como posible causa de la disminución de la visión, ha sido una entidad muy poco estudiada hasta el momento, tiene una gran importancia debido a que por la anisometropía que podría generar, puede llevar a alteraciones de la agudeza visual. Objetivo: Evaluar la existencia de astigmatismo corneal y/o aberraciones corneales inherentes a los ojos con Iridociclitis Heterocrómica de Fuchs. Diseño del estudio: Estudio transversal, analítico, de fuentes primarias. Método: Se realizó muestreo por conveniencia, en el cual se incluyeron 44 ojos de 22 pacientes con diagnóstico de IHF unilateral o bilateral. Para cada caso, se realizó tomografía corneal (Pentacam® AXL - OCULUS) y aberrometria (OPD-Scan III® - NIDEK) y se compararon ojos enfermos con los ojos sanos. Resultados: Se encontró una mediana de 1.35 (RIC: 0.50 ­ 1.70) para el astigmatismo de la cara anterior de los ojos enfermos .vs. 0.8 (RIC: 0.7 ­ 1.1) para el astigmatismo de la cara anterior de los ojos sanos (p= 0.135). Se identificó un astigmatismo en cara anterior >1.00 D en el 61.5% de los ojos enfermos .vs. 27.8% de los ojos sanos (p= 0.027) con un RR de 2.15. No se encontró una diferencia estadísticamente significativa entre los ojos enfermos y los ojos sanos para las aberraciones analizadas. Conclusión: El presente estudio no demuestra la existencia de astigmatismo o aberraciones inherentes a la IHF, pero evidencia una tendencia de mayor astigmatismo en los ojos con IHF, que posiblemente podría lograr significancia estadística con una muestra mayor.

Background: Fuchs heterochromic iridocyclitis (FHI) represents 2 to 7% of cases of anterior uveitis. To date, few studies have addressed corneal astigmatism as an inherent condition and as possible cause of decreased visual acuity in FHI patients. This may be relevant since the generated anisometropia may lead to alterations in visual acuity. Objective: To evaluate the presence of corneal astigmatism and/or corneal aberrations in patients with FHI. Study design: Analytic cross sectional study. Method: A convenient sampling was performed. The sample included 44 eyes of 22 patients with unilateral or bilateral FHI. All participants were studied by corneal tomography (Pentacam® AXL ­ OCULUS) and aberrometry (OPDScan III® - NIDEK); measurements of diseased and healthy eyes were compared. Results: Twenty-two patients were enrolled in this study. The mean age at diagnosis was 46.9 +/- 12 years, and 40.9% were men. FHI eyes exhibited a median astigmatism of the anterior surface of 1.35D (IQR: 0.50 ­ 1.70), compared to 0.8D (IQR: 0.7 ­ 1.1) observed in healthy eyes (p= 0.135). Anterior surface astigmatism >1.00 diopters (D) was found in 61.5% of diseased eyes compared to 27.8% of healthy eyes, with a risk ratio of 2.15. Regarding corneal aberrations, no statistically significant differences were identified between diseased and healthy eyes for the analyzed aberrations. Conclusion: While our current data does not show statistically signifi cant differences between groups that support that corneal astigmatism or aberrations are inherent to FHI-aff ected eyes, our study does show a trend that suggests increased presence of clinically relevant astigmatism in eyes with FHI. Statistical significance may be achieved with a larger sample size.

Impacto do grau de uveíte em diferentes tipos de úlceras de córneas em cães submetidos ao enxerto pediculado de conjuntiva bulbar - 34 casos / Impact of uveitis score on different types of corneal ulcers in dogs subjected to the bulbar conjunctival pedicle graft - 34 cases

O presente trabalho objetivou avaliar os resultados de 34 olhos submetidos ao enxerto conjuntival pediculado (ECP) em ceratites ulcerativas profundas (n=5), em ceratites ulcerativas com colagenólise (n=2), descemetocele (n=7), perfuração corneal (n=15) e prolapso de íris (n=5). Os impactos do grau de uveíte e da integridade da córnea foram correlacionados com presença e ausência de visão por tabelas de contingência. Raças braquicefálicas foram acometidas em 91,11% dos casos. O número de córneas consideradas perfuradas [20/34 (58,82%)] foi maior que o de córneas íntegras [14/34 (41,17%)]. Ao 50º dia de pós-operatório, o número de olhos visuais que apresentavam córneas íntegras previamente às cirurgias (n=13) não diferiu significativamente dos olhos com córneas perfuradas (n=12) (P=0,05). Avaliações relativas ao grau de uveíte, revelaram que a metade dos casos foi considerada severa [17/34 (50%)] e na outra metade as uveítes foram consideradas discretas. Dos 17 casos que apresentaram uveíte severa, oito recuperaram a visão. Já nos 17 olhos onde a uveíte foi considerada leve, 15 mantiveram a visão ao final do período de avaliação. Apesar de a integridade da córnea não se correlacionar com a severidade da uveíte (P=0,48), constatou-se que o número de olhos visuais com uveíte discreta foi significativamente maior que os olhos com uveíte severa (P=0,006). Neste estudo, a taxa geral de sucesso visual após ECP foi de 73,52% e a integridade da córnea não exerceu impacto significativo sobre a manutenção da visão. Todavia, olhos acometidos por uveítes severas apresentaram menor chance de recuperar a visão.(AU)

The present study aimed to evaluate the results of 34 eyes of dogs presenting deep corneal ulcer (n=5), colagenolytic corneal ulcer (n=2), descemetocele (n=7), corneal perforation (n=15), and iris prolapse (n=5) that were corrected by the bulbar conjuntival pedicle graft (CPG). The uveitis score and the corneal integrity were correlated with the presence or absence of vision by contingency tables. Brachycephalic breeds accounted for 91.11% of all cases. The number of perforated corneas [20/34 (58.82%)] were higher than the non-perforated ones [14/34 (41.17%)]. At post-operative day 50, the number of visual eyes with non-perforated corneas before surgery (n=13) did not differ significantly from the eyes with perforated corneas (n=12) (P = 0.05). In half of the cases, uveitis score was considered severe [17/34 (50%)], and in the other half, mild. Eight out of 17 eyes classified with severe uveitis regained vision. In 17 eyes where uveitis score was considered mild, 16 regained vision at the end of the study. Although corneal integrity was non-correlated with the uveitis score (P = 0.48), the number of visual eyes scored with mild uveitis were significantly larger than the eyes with severe uveitis (P = 0.006). In this study, the overall success visual rate after CPG was 73,52% % and the corneal integrity did not play an important role regarding maintenance of vision. However, eyes presenting severe uveitis score had less chance to regain vision.(AU)

Secondary glaucoma induced by bilateral acute depigmentation of the iris / Glaucoma secundário à despigmentação bilateral aguda da íris

Abstract We report a case of a middle-aged woman who developed acute, bilateral, symmetrical, slightly transilluminating depigmentation of the iris and pigment discharge into the anterior chamber following the use of oral moxifloxacin for bacterial sinusitis. She had been misdiagnosed as having autoimmune uveitis, treated with steroids and tropicamide, and underwent severe ocular hypertension and glaucoma despite posterior correct diagnosis.

Resumo Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentação bilateral simultânea aguda com dispersão de pigmentos na câmara anterior e discreta transiluminação após o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide tópico e tropicamida e evoluiu com hipertensão ocular grave e glaucoma apesar de ,posteriormente, o diagnóstico ter sido correto.

Diagnóstico y tratamiento inicial de la uveítis por médicos no oftalmólogos / Diagnosis and treatment of uveitis by non-ophthalmologist physicians

Resumen Objetivos: Describir los principales signos y síntomas, así como el tratamiento inicial de un paciente con diagnóstico de uveítis con el propósito de evitar retardo en la remisión y el inicio del manejo oportuno de esta patología. Métodos: Se realizó una revisión sistemática de la literatura en la cual se identificaron los principales signos y síntomas que deben ser tenidos en cuenta para sospechar el diagnóstico de uveítis y su tratamiento indicado. Se llevó a cabo una búsqueda en PubMed durante el periodo del 2010-2015, se eligieron 439 artículos, los cuales fueron sometidos a dos procesos de filtrado manual, eligiendo por un grupo de investigadores los resúmenes que respondieran nuestra pregunta de investigación. Posteriormente un grupo de oftalmólogos expertos y médicos con experiencia en oftalmología realizaron una segunda revisión. Resultados: Posterior al primer proceso de filtrado se obtuvieron 73 artículos que se sometieron a un segundo proceso de selección donde se obtuvieron 30 artículos. De la selección final de artículos: seis fueron estudios observacionales o ensayos clínicos; los artículos restantes fueron revisiones de la literatura. Los estudios observacionales y ensayos clínicos aleatorizados se evaluaron con la herramienta GRADE siendo la mayoría de evidencia alta. Se hizo una revisión de los treinta artículos seleccionados, por parte de nuestros investigadores, dando como resultado recomendaciones para el diagnóstico y tratamiento de la uveítis para el personal médico no oftalmólogo. Conclusiones: Existen un conjunto de signos y síntomas que pueden hacer sospechar al médico no oftalmólogo el diagnóstico de uveítis. Ante un paciente que presenta dolor ocular asociado a disminución de la agudeza visual, fotofobia, ojo rojo sin secreción conjuntival, miosis pupilar, depósitos retroquératicos y hallazgos al fondo de ojo como vitreitis o coriorretinitis se debe sospechar una uveítis. El manejo precoz de la uveítis anterior no infecciosa puede ser instaurado por el médico no oftalmólogo con corticoides tópicos, sin embargo, en caso de uveítis intermedia y posterior es importante remitir al oftalmólogo cuanto antes. Proponemos un algoritmo para ayudar al diagnóstico de la uveítis y recomendaciones para su manejo inicial.

Abstract Objective: The purpose of this study was to describe the main diagnostic features and the initial management of uveitis, in order to avoid delays in the treatment and the remission to the ophthalmologist. Methods: A systematic review of the literature, which identified the main signs and symptoms and initial treatment for patients with uveitis, was done. A search of the literature published through 2010-2015 was performed using PubMed database. Four hundred and thirty nine eligible articles underwent a selection process in which titles, abstracts and full texts were reviewed, obtaining thirty final articles. Results: Thirty articles were reviewed, six were observational studies and clinical trials; 24 articles were reviews or case reports. The observational studies and clinical trials were rated with the Grading of Recommendations Assessment (GRADE) tool. After the grading tree of the articles were of high level of evidence. Conclusions: In a patient with ocular pain related to decreased visual acuity, photophobia, red eye without secretion, miosis, keratic precipitates, and vitritis or chorioretinitis the healthcare provider should rule out the diagnosis of uveitis. A non-ophthalmologist physician can start the initial management of an anterior uveitis and then refer the patient to the ophthalmologist as soon as possible. If the diagnosis is an infectious anterior uveitis, intermediate uveitis or posterior uveitis the patient should be derived to the ophthalmologist immediately.

Outcomes of phacoemulsification in patients with Fuchs' heterochromic iridocyclitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical outcomes of phacoemulsification in patients with Fuchs' heterochromic iridocyclitis(FHIC). <p>METHODS: In this noncomparative case series,18 eyes of 18 patients clinically diagnosed with FHIC and cataract were studied. All of them received phacoemulsification combined with intraocular lens implantation.Preoperative and postoperative visual acuity, intraocular pressure, corneal endothelial cells density were measured. Intraoperative and postoperative complications were evaluated. <p>RESULTS: The mean follow-up period was 9.8±3.3mo. The only intraoperative complication was peripheral iris bleeding(17%). Compared with preoperative, the best corrected visual acuity improved 6mo postoperatively(0.98±0.85 <i>vs</i> 0.08±0.14, <i>P</i><0.001). There was no significant difference in intraocular pressure between preoperative and postoperative(15.11±2.63mmHg <i>vs</i> 14.94±2.49mmHg, <i>P</i>>0.05).The mean endothelial cells counting loss rate postoperatively was 10%±6%. Fibrin formation in the anterior chamber occurred in 2 eyes postoperatively. During follow-up, 1 eye developed anterior capsule contraction, and 4 eyes developed posterior capsule opacification. <p>CONCLUSION: Phacoemulsification is a safe procedure with good visual outcomes in patients with FHIC and cataract.

An adult worm in the eye.

We report a case of ocular loiasis in a 9 yrs old girl. Very few case reports of ocular loiasis have published from India to date. Loa loa is a subcutaneous filarial parasite of man and known to be transmitted to humans by Chrysops flies. Patient presented with visual disturbances due to worm in her eye. A live adult worm was extracted and identity was confirmed by gross and microscopic examination to be Loa loa. Patient was treated with albendazole, gentamicin and steroids.

Bilateral acute depigmentation of the iris: a case report / Despigmentação aguda bilateral da íris: um relato de caso

ABSTRACT Bilateral acute depigmentation of the iris (BADI) is a new clinical entity of unknown etiology and is characterized by bilateral, symmetrical, and simultaneous depigmentation of the iris with focal or diffuse stromal atrophy; this condition generally has a good prognosis. We present a case of a 26-year-old woman who noted a spontaneous change in the iris color in both eyes in the last 2 months. The ophthalmological findings were atrophy of the iris stroma and pigmentation of the trabecular meshwork, without affecting the pigmented epithelium of the iris. Her intraocular pressure was normal and the visual acuity was 20/20 in both eyes.

RESUMO A despigmentação aguda bilateral da íris (DABI) é uma nova entidade clínica caracterizada pela despigmentação bilateral, simétrica e simultânea da íris, com atrofia focal ou difusa do seu estroma, geralmente com bom prognóstico. Apresentamos o caso de uma mulher de 26 anos de idade que procurou atendimento médico em nosso serviço com queixa de mudança espontânea na cor da íris de ambos os olhos nos últimos dois meses. Os achados oftalmológicos observados durante o exame clínico foram atrofia do estroma da íris e pigmentação da malha trabecular, sem afetar o epitélio pigmentado da íris. A pressão intraocular era normal e acuidade visual de 20/20 em ambos os olhos.

Activation of serum complement in Posner-Schlossman syndrome patients / 中华实验眼科杂志

Background Activation of serum complement system is involved in the pathological process of uveitis and open angle glaucoma.Pathogenesis and pathological characteristics of Posner-Schlossman syndrome (PSS) are similar to uveitis and open angle glaucoma.However,etiology of PSS remains unelucidated.The activation complement in PSS patients' serum is rarely reported.Objective The aim of this study was to investigate the activation of serum complement in PSS patients for PSS pathogenesis.Methods A prospective case-controlled study was designed.The peripheral blood simples of 79 PSS patients were collected from Shenzhen Eye Hospital during December 2013 to December 2015,and the peripheral blood simples were obtained from 83 unrelated healthy blood donors as healthy control group.Immuno-scatter turbidmetry was adopted to detect the common activated components in complement pathway in each group including complement C3 (a vital intersection molecule in the three pathways),C4 (the vital molecule both the complement classical and lectin pathways),split products C3a,soluble membrane attack complex (sC5b-9),C 1q (complement classical pathway),L-ficolin (complement lectin pathway),complement factor Bb (complement alternative pathway),IgG,IgA and IgM.The correlation between serum C3a content and sC5b-9 content in PSS group was analyzed.The serum contents of fabric binding protein 2 (FCN2) (a marker of serum classical pathway),factor Bb (a marker of complement alternative pathway),C3a (the common activation products of three complement activation pathways),and sC5b-9 were assayed by ELISA.This research protocal was approved by Shenzhen Eye Hospital and written informed consent was obtained from each PSS patient prior to any medical examination.Results Compared with normal control group,the serum levels of C3,C4,C3a,sC5b-9,C1q,FCN2,IgG,IgA and IgM were significantly higher in PSS group (Z =-4.743,-2.913,-1.985,-2.620,-2.062,-2.500,-7.010,-6.327,-3.652,all at P ＜ 0.05).The serum complement factor Bb level was 13.87 (9.24,32.00) μg/ml in PSS group,which was significantly lower than 20.51 (12.90,33.50) μg/ml in normal control group (Z =-2.515,P =0.012).Serum C3a content was positively correlated with the serum sC5b-9 content in PSS group (rs =0.832,P＜0.001).Conclusions The serum complement system is activated in PSS patients.Complement alternative pathway,classical pathway and lectin pathway might all be involved in the activative process of complement system.

Clinical effect and safety of atropine gel combined with anisodamine eye drops on the treatment of iridocyclitis / 中国生化药物杂志

Objective To investigate the clinical effect and safety of atropine gel combined with anisodamine eye drops on the treatment of iridocyclitis.Methods A total of 174 cases with iridocyclitis in Zhejiang Hospital from May 2013 to July 2015 in this study were selected and divided into the control group and research group with 87 cases in each group.The patients in the control group were treated with tropicamide mydriatic,the patients in the research group were treated with atropine gel combined with anisodamine eye drops mydriatic.Serum levels of inflammatory factors, serum immunoglobulin and complement levels were observed and recorded before and after treatment,the clinical efficacy and incidence of adverse reactions were compared.Results The effective rate in the control group(85.06%) was lower than the research group(94.26%),the difference was statistically significant(P<0.05);compared with the control group,serum levels of TNF-α,IFN-γ,IL-23,CRP were lower in the research group after treatment, serum levels of IgG,IgE were lower,and serum levels of IgA,C3 were higher after treatment,the difference was statistically significant(P<0.05);there was no significant difference in the incidence of adverse reactions between the two groups.Conclusion The clinical effect of atropine gel combined with anisodamine eye drops in the treatment of iridocyclitis was exactly , can effectively reduce the inflammatory response,improve the immune status,and high security.

Bilateral acute iris transillumination (BAIT) initially misdiagnosed as acute iridocyclitis / Transiluminação de íris aguda bilateral (BAIT) inicialmente diagnosticada como iridociclite aguda

Bilateral acute iris transillumination (BAIT) is a relatively new clinical entity characterized by bilateral acute loss of iris pigment epithelium, iris transillumination, pigment dispersion in the anterior chamber, and sphincter paralysis. We report the case of a 30-year-old male who was initially diagnosed with acute iridocyclitis in a different clinic and treated with topical and systemic corticosteroids. He was referred to our clinic to seek another opinion because his symptoms did not improve. An ocular examination revealed bilateral pigment dispersion into the anterior chamber, diffuse iris transillumination, pigment dusting on the anterior lens capsule, atonic and distorted pupils, and increased intraocular pressure, suggesting a diagnosis of BAIT rather than iridocyclitis. Clinicians should be aware of the differential diagnosis of syndromes associated with pigment dispersion from iridocyclitis to avoid aggressive anti-inflammatory therapy and detailed investigation for uveitis.

A transiluminação de íris aguda bilateral (do inglês, bilateral acute iris transillumination, BAIT) é uma entidade clínica relativamente nova, caracterizada pela perda aguda bilateral do epitélio pigmentado da íris, transiluminação iriana, dispersão de pigmentos na câmara anterior, e paralisia do esfíncter pupilar. Nós relatamos o caso de um homem de 30 anos que foi diagnosticado com iridociclite aguda e tratado com corticosteroides tópicos e sistêmicos. Ele foi encaminhado ao nosso serviço para outra opinião, porque seus sintomas não melhoram com a terapia. Um exame oftalmológico revelou dispersão bilateral de pigmentos para a câmara anterior, transiluminação difusa de íris, pigmento difusa na cápsula anterior do cristalino, pupilas atônicas e distorcidas, e um aumento da pressão intraocular, o que sugere um diagnóstico de BAIT em vez de iridociclite. Os médicos devem estar cientes do diagnóstico diferencial das síndromes associadas à dispersão de pigmento com a iridociclite para evitar a terapia antiinflamatória agressiva e investigação detalhada para uveíte.

Clinical observation of dexamethasone phonophoresis in the treatment of acute iridocyclitis / 中国基层医药

Objective To investigate the clinical efficacy of drug phonophoresis therapy in the treatment of acute iridocyclitis.Methods According to randomized block design,104 patients with acute iridocyclitis were divided into the control group of 52 cases (72 eyes)with 1％ atropine mydriasis,oral prednisone tablets and subconjunctival injection of dexamethasone treatment,76 eyes of 52 cases in the treatment group with 1％ atropine mydriasis,oral prednisone tablets and dexamethasone phonophoresis intraocular treatment.Results Compared with the control group,the cure rates of treatment group and control group were 84.2％ and 58.5％ respectively,there was significantly significant difference between the two groups(x2 =12.598,P =0.000),oral hormone time from the beginning to the first reduction[treatment group and control group were (5.12 ± 1.00) d and (7.32 ± 0.97) d respectively (t =-13.495,P =0.000)] and oral hormone total time [treatment group and control group were (27.82 ± 4.84) d and (35.49 ± 4.74) d respectively (t =-9.720,P =0.000)] were significantly shortened,complications decreased significantly[conjunctival edema rate (x2 =9.657,P =0.002),subconjunctival hemorrhage rate (x2 =6.601,P =0.010),conjunctival scarring rate (x2 =4.340,P =0.037),pain rate (x2 =63.419,P =0.000) and oculocardiac reflectivity rate (x2 =33.293,P =0.000)] and patient satisfaction improved significantly (treatment group and control group were 94.7％ and 69.4％ respectively) (x2 =16.333;P =0.000).Conclusion Dexamethasone phonophoresis therapy has better clinical efficacy and higher cure rate,and it is non-invasive,safe and reliable,less complications and high satisfaction in the treatment of acute iridocyclitis.

Corneal Endothelial Cell Loss after Tube Shunt Surgery in Fuch's Heterochromic Iridocyclitis

PURPOSE: To report a case of corneal failure after implantation of the Ahmed glaucoma valve occurring in a patient diagnosed with Fuchs' heterochromic iridocyclitis. CASE SUMMARY: A 53-year-old male who complained of ocular pain and suddenly decreased visual acuity in his right eye visited our clinic. His visual acuity was 0.15 and intraocular pressure (IOP) was 55 mm Hg. The slit-lamp examination revealed edematous cornea, fine round or stellate keratic precipitates connected with fine filaments on the endothelium and depigmentation of the iris. The corneal endothelial cell density was 2,958 cells/mm2. There was no specific finding in his left eye. The IOP did not improve with medical treatment, therefore, an Ahmed glaucoma valve was implanted in his right eye. At every follow-up exam the tube was well positioned and the IOP was maintained between 8 and 13 mm Hg. Eight months postoperatively, the patient complained of decreased visual acuity and the cell density was decreased to 1,408 cells/mm2. Posterior subcapsular cataract opacity was observed as well as progression of depigmentation and distortion of the iris. Seventeen months after the surgery, the cell density was 700 cells/mm2. On follow-up examination, his visual acuity was decreased to FC10 cm with the cataract progressing, therefore cataract surgery was performed. One month postoperatively, his vision improved to 0.1. However, the visual acuity deteriorated due to progression of the corneal edema and penetrating keratoplasty was performed. CONCLUSIONS: Aggravation of the corneal complication after Ahmed glaucoma valve implantation should be considered in patients with Fuchs' heterochromic iridocyclitis-induced glaucoma.

Hypertensive iridocyclitis associated with delayed onset biopsy proven Cytomegalovirus retinitis.

We describe a case of primary hypertensive iridocyclitis with biopsy-proven Cytomegaloviral retinitis. It is an observational case report of a 69-year-old diabetic gentleman on azathioprine for Crohn’s disease who presented with recurrent episodes of hypertensive iridocyclitis. On the 4th a􀄴 endance in 5 months, a granular white lesion was noted in the temporal periphery of the mid-peripheral fundus and a chorioretinal and vitreous biopsy performed. Vitreous PCR was positive for Cytomegalovirus (CMV). Hematoxylin and eosin staining revealed cytomegaliclike inclusions within necrotic neural retina. Transmission electron microscopy revealed herpes family virus particles and immunohistochemistry demonstrated CMV protein. This case provides further evidence implicating CMV infection in the etiology of hypertensive iridocyclitis. With hindsight, the cumulative eff ect of diabetes and azathioprine on the immune surveillance system proved sufficient to render the patient susceptible to CMV retinitis.

Implantation of iris-claw Artisan intraocular lens for aphakia in Fuchs’ heterochromic iridocyclitis.

Implantation of iris-claw Artisan intraocular lens (IOL) is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs’ heterochromic iridocyclitis (FHI) due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.

Síndrome de Waardenburg tipo I: relato de caso / Waardenburg syndrome type I: case report

A síndrome de Waardenburg tipo I é uma desordem auditivo-pigmentária que inclui, entre outros, perda auditiva neurossensorial congênita não progressiva, telecanto, distúrbios pigmentares de íris, cabelo e pele. Indivíduos afetados podem ter maior risco de: defeitos no tubo neural, fendas labial e palatina, anormalidades nos membros e doença de Hirschsprung. O diagnóstico é clínico, sendo necessários dois critérios maiores ou um maior e dois menores. PAX3 é o único gene conhecido associado à síndrome, sendo, entretanto, mais usado no aconselhamento genético. Quanto ao diagnóstico diferencial, podemos citar: outras causas de perda auditiva neurossensorial congênita não progressiva, outros tipo de síndrome de Waardenburg, piebaldismo, albinismo, vitiligo e síndrome de Teitz. Neste trabalho, apresenta-se um paciente masculino de 11 anos com diagnóstico de síndrome de Waardenburg tipo I. Ressalta-se a importância do oftalmologista no auxílio do diagnóstico deste raro quadro sistêmico, uma vez que inclui algumas alterações oftalmológicas. O diagnóstico precoce da síndrome permite estimulação adequada para a perda auditiva, assim como medidas preventivas em caso de gestantes afetadas no aconselhamento genético.

Waardenburg syndrome (WS) type I is a non-progressive auditory-pigmentary disorder comprising congenital sensorineural hearing loss and pigmentary disturbances of the iris, hair, and skin, along with dystopia canthorum (lateral displacement of the inner canthi). Affected individuals may have higher risk of: neural tube defects, cleft lip and palate, limb abnormalities, and Hirschsprung disease. The diagnosis is clinical and should be considered if the individual has two major or one major plus two minor criteria. PAX3 is the only known gene associated to the syndrome. Nevertheless, its use is mostly for genetic counseling. Regarding different diagnosis, we may list: other causes of non-progressive auditory-pigmentary disorder comprising congenital sensorineural hearing loss, other types of Waardenburg syndrome, piebaldism, albinism, vitiligo and Teitz syndrome. This paper presents a case of an eleven year old boy with deafness and ophthalmologic alterations, based on his files and exams. It reinforced the importance of the ophthalmologist contributing for the diagnosis of this rare systemic disease, as it includes some ophthalmologic alterations. We remind that the early diagnosis allows adequate stimulation for the hearing loss, as well as preventive measures in case of pregnant women affected by genetic counseling.

Chikungunya virus iridocyclitis in Fuchs’ heterochromic iridocyclitis.

We are reporting a case of bilateral Fuchs’ heterochromic iridocyclitis with chikungunya virus infection in the left eye. A 20-year-old female was presented with a past history of fever suggestive of chikungunya with bilateral Fuchs’ heterochromic iridocyclitis and complicated cataract. She had a tripod dendritic pattern of keratic precipitates by confocal microscopy in the left eye with a stippled pattern of keratic precipitates in both eyes. The real-time polymerase chain reaction (RT-PCR) assay in the aqueous humor detected 98 copies/ml of chikungunya virus RNA. The patient underwent clear corneal phacoemulsification with in-the-bag intraocular lens implantation in the left eye with a good visual outcome. This is the first report where the presence of chikungunya virus RNA has been associated with a case of bilateral Fuchs’ heterochromic iridocyclitis.

Current approach in diagnosis and management of anterior uveitis.

Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.

Comparative study of periocular injection and subconjunctival injection in treatment of iridocyclitis / 中国实用护理杂志

Objective To discuss different effect of periocular injection and subconjunctival injection in treatment of iridocyclitis. Methods Eighty people with iridocyclitis were divided into group A and group B according to their admission order. Group A adopted periocular injection and group B was given subconjunctival injection. The incidence of complication was compared between the two groups. Results Significant difference existed in complications and related factors between two groups after treatment, periocular injection proved to be superior to subconjunctival injection. Conclusions Periocular injection is a desirable treatment method for iridocyclitis. It is easy to operate, safe, rapid and with less pain, so it is worthy of clinical application.