[Observation on surgical results of complicated cataract in patients with uveitis].

OBJECTIVE: To evaluate the efficacy of surgical intervention of complicated cataract in patients with uveitis. METHODS: Fifty-one patients (69 eyes) with complicated cataract secondary to uveitis who had cataract surgery in Peking Union Medical College Hospital between January 2000 and August 2006 were retrospectively analyzed. Surgical procedures, visual outcome, postoperative recurrence of uveitis and complications were investigated. RESULTS: Phacoemulsification was performed on 64 eyes (92.8%), while extracapsular cataract extraction (ECCE) was performed on the remaining 5 eyes (7.2%). Posterior chamber intraocular lens (IOL) was implanted in 61 eyes (88.4%), while the remaining 8 eyes (11.6%) remained aphakic, 6 of those were in patients who were blind in the other eye. At the final follow-up, 38 eyes (55.0%) had a best corrected visual acuity of 0.5 or better, an improvement that was highly significant (Z = 8.26, P < 0.001). Postoperative recurrence of anterior uveitis occurred in 19 (27.5%) eyes, however, 18 of them were pseudophakic, among which 5 eyes had 3 or more episodes of recurrence. Neodymium: YAG (Nd: YAG) laser posterior capsulotomy was performed in 24 (34.8%) eyes, however, 23 of them were pseudophakic, among which 7 eyes underwent at least two separate capsulotomies. CONCLUSIONS: Surgical intervention of complicated cataract in patients with uveitis is effective and safe. In comparison with the pseudophakia group, less postoperative complications are found in patients without IOL implantation. Accordingly, it seems feasible that cataract extraction without IOL implantation is the procedure of choice for treating uveitis patients who are blind in the other eye.

[Treatment of thyroid-associated ophthalmopathy: comparative study between prednisone and COP therapy].

OBJECTIVE: To evaluate the efficacy of two therapies, high-dose prednisone and COP in the treatment of patients with active thyroid-associated ophthalmopathy (TAO). METHODS: According to severity and compliance, the patients admitted in Peking Union Medical College Hospital from August 2000 to July 2003 were divided into two groups. Thirteen patients with active TAO were treated with high-dose prednisone. The initial dosage was 1.5-2.0 mg.kg(-1).d(-1) (maximal dosage 200 mg), tapering gradually, and shifting to alternate-day treatment. Fourteen patients in the COP group were treated with cyclophosphamide (CTX), oncovin (VCR) and prednisone. This therapy was modified from CHOP in the treatment of patients with non-Hodgkin's lymphoma: CTX 600 mg/m(2), VCR 1.1 mg/m(2) were administrated by intravenous infusion every 2-4 weeks, prednisone was given orally at 1 mg.kg(-1).d(-1) for seven days after each infusion. The duration of treatment for both groups was approximately 10 months. The parameters including clinical activity score (CAS), thickness of extra-ocular muscle as well as 24 h urinary GAG were used to evaluate the efficacy of treatment in both groups. RESULTS: There was no significant difference in age and sex between two groups. However the patients in the COP group were more severe than that in prednisone group (P < 0.05). CAS in the patients treated with prednisone before and after treatment were 4.4 +/- 1.8, 1.6 +/- 1.1 respectively, that in patients treated with COP were 6.5 +/- 1.6, 1.9 +/- 1.3 respectively. All these changes were highly significant (P < 0.01). The thickness of extra-ocular muscles in the patients treated with prednisone decreased from (6.5 +/- 1.5) mm to (5.8 +/- 1.1) mm, that in patients treated with COP decreased from (6.8 +/- 1.7) mm to (5.3 +/- 1.1) mm. Both changes were highly significant (P < 0.01). Comparative study of the changes in the thickness of extra-ocular muscle by percentage between two groups demonstrated that the muscle thickness in patients treated with COP was decreased by (23.7 +/- 4.3)%, that in patients treated with prednisone was by (13.3 +/- 4.6)%. The difference between the two groups was highly significant (P < 0.01). The 24 h urinary GAG level in patients treated by prednisone decreased from (33.6 +/- 6.6) mg/24 h before treatment to (16.7 +/- 2.5) mg/24 h after treatment. Those in COP group were (40.6 +/- 10.1) mg/24 h and (15.7 +/- 5.1) mg/24 h respectively. The difference was significant (P < 0.01) in each group. There were no serious complications during treatment. CONCLUSIONS: Both the prednisone and COP therapy are effective in the treatment of patients with active TAO. The preliminary results indicate that COP is more effective than prednisone, it suggests that COP might be feasible for treating patients with progressive and severe TAO.

[Cytomegalovirus retinitis associated with Acquired immunodeficiency syndrome].

OBJECTIVE: To investigate the fundus characteristics, systemic features and therapeutic outcomes of cytomegalovirus (CMV) retinitis associated with acquired immunodeficiency syndrome (AIDS). METHODS: Fundus features, visual acuity, fundus fluorescence angiography (FFA) and CD4(+)T-lymphocyte counts of 15 eyes (8 patients) of CMV retinitis associated with AIDS were analyzed. The time of average follow-up was 16 months. Intravitreal injection of ganciclovir (400 microg) was performed in 4 eyes (2 patients). RESULTS: In the initial examination, visual acuity of the patients was as following: < or = 0.2, 10 eyes (66.7%); no light perception (NLP) (2 eyes); light perception (LP) (2 eyes); 0.04-0.2, 6 eyes; > or = 1.0, 3 eyes (20.0%) and 0.8 or 0.9 each for 1 eye (13.3%). The fundus manifestation includes: the retinal vasculitis; dense, full-thickness, yellow-white lesions along vascular distribution, and hemorrhage on the retinal surface; granular with irregular border featured as "cheese and ketchup retinitis" was revealed in 12 eyes; the vitreous was clear or light opaque. Late stage of the retinopathy was demonstrated in 2 eyes characterized as grayish atrophic retina, vessel-sclerotic and attenuated, retinal pigment epithelium (RPE) atrophy, prominent choroid vasculature, and optic nerve atrophy. Retinal detachment was found in 1 eye. CD4(+)T-lymphocytes counts in peripheral blood were between 0 approximately 36/mm(3), average (15.0 +/- 12.9) mm(3). Visual acuity improved, fundus lesions disappeared observably and hemorrhage was absorbed in the 4 eyes after intravitreal injection of ganciclovir. CONCLUSIONS: CMV retinitis is the severest and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis of undefined cause, the antibody of serum anti-human immunodeficiency virus (HIV) should be screened. Routing eye examination should be performed if the serological test of HIV is positive.