ABSTRACT
AIM: To evaluate the course of clinical picture of intraocular lymphoma, possibilities of examination of this disease and the association with general symptoms of the non-Hodgkin lymphoma (NHL) in patients with manifestations of uveitis. PATIENTS AND METHODS: A retrospective study in 14 patients followed in the period of 1996-2001 in the Center for Diagnostics and Therapy of Uveitis, Ocular Clinic of General Faculty Hospital and 1st Medical Faculty, Charles University in Prague. RESULTS: The group included 7 women and 7 men at the average age of 57.3 years (18-82) with clinical picture of uveitis. The time period from the first symptoms to the diagnosis of NHL was 5-38 months (mean, 14.6 month). In two patients the diagnosis of systemic NHL preceded ocular symptoms, in four other patients the diagnosis of systemic or central nervous system NHL (CNS NHL) was established during ocular manifestations of uveitis. Intraocular lymphoma was the only first manifestation of CNS NHL in six patients for the period of 9-34 months (mean, 15.2). Two patients have been so far affected by primary intraocular lymphoma (PIL) for 8 and 14 months respectively, and presently do not display any signs of systemic or CNS NHL. Clinical signs of intraocular inflammation of both eyes were encountered in 71.4% of patients. Vitritis (85.7%) and tumor infiltration of retina (65.3%) were the most frequent manifestations of NHL. Intraocular NHL was diagnosed on the basis of cytological examination of samples of intraocular fluids in 8 patients (57.1%). In four patients radiotherapy was applied onto 5 eyes and in 5 patients radiotherapy of CNS was used. Nine patients were treated with chemotherapy. 50% of patients died until the end of 2001, the survival from the establishment of diagnosis was 20.6 months on the average. CONCLUSIONS: Intraocular lymphoma should be considered as the eye and life-threatening disease. Cytological examination of intraocular fluids in patients with uveitis who do not respond to the therapy with steroids in the usual way may give more precision and shorten the establishment of diagnosis in this masquerade syndrome. Early diagnosis and therapy may improve the prognosis of NHL.
Subject(s)
Eye Neoplasms/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Uveitis/diagnosis , Uveitis/etiologyABSTRACT
A retrospective study evaluates the importance of pars plana vitrectomy (PPV) in four patients with ocular form of toxocarosis. The results of laboratory determination of the titres of antibodies against Toxocara canis (the ELISA method) in samples of vitreous body were compared with those in the serum of the patient. The individual cases exemplify the problems in interpretation of laboratory findings and document the authors' experience in considering the diagnosis of ocular toxocarosis in individual cases. The authors' experience indicates that PPV is of diagnostic as well as of therapeutic significance.
Subject(s)
Eye Infections, Parasitic/diagnosis , Toxocara canis , Toxocariasis/diagnosis , Vitrectomy , Animals , Child , Eye Infections, Parasitic/surgery , Female , Humans , Larva Migrans/diagnosis , Middle Aged , Toxocariasis/surgeryABSTRACT
PURPOSE: To report clinical findings, diagnostic and treatment possibilities of patients with endogenous fungal endophthalmitis (EFE). METHODS: Retrospective study of 13 patients (19 eyes) with EFE diagnosed and treated in the Dept. of Ophthalmology, 1st Medical Faculty, Charles University in Prague. A detailed personal medical history was taken in all patients. Standard ophthalmic examinations were performed in all cases. RESULTS: All of our patients had one or more of known risk factors for ocular fungal infections. There were intravenous drug users, immunosuppressed patients, postoperative patients receiving broad-spectrum antibiotics in our investigated group. The mean age of the patients was 39 years (from 19 to 68 years), the interval between the first ocular symptoms and correct diagnosis was up to 7 months (mean 2.1 months). Pars plana vitrectomy (PPV) was performed in 15 eyes and Amphotericin B was instilled into vitreous cavity at the end of the procedure. Amphotericin B was injected into vitreous without PPV in two eyes. All patients were treated with systemic antifungal agents. Only Candida albicans was the cause of EFE in 10 patients. Microscopic examination and culture were positive in 9 patients, 1 patient had positive serum antibodies against Candida albicans in significant titres. Final visual acuity improved in 47% of the eyes, stabilized in 36% of the eyes, and decreased in 17% of the eyes. CONCLUSION: Endogenous fungal endophthalmitis was seen as an opportunistic disease in all patients. Candida albicans was the only evidenced cause of fungal endophthalmitis. If prompt antifungal treatment after clinical suspicion of EFE begins, successful visual outcome is possible.
Subject(s)
Endophthalmitis/surgery , Eye Infections, Fungal/surgery , Vitrectomy , Adult , Aged , Antifungal Agents/therapeutic use , Endophthalmitis/drug therapy , Eye Infections, Fungal/drug therapy , Female , Humans , Male , Middle Aged , Opportunistic Infections/drug therapy , Opportunistic Infections/surgery , Retrospective StudiesABSTRACT
OBJECTIVE: To evaluate the importance of diagnostic-therapeutic pars plana vitrectomy in patients with clinical manifestations of endogenous uveitis. PATIENTS AND METHODS: The diagnostic-therapeutic pars plana vitrectomy (DT PPV) has been performed at the Eye Clinic of General Faculty Hospital and 1st Medical Faculty on Prague on 62 eyes in 49 patients at the mean age of 45 years. The DT PPV was indicated in patients with uveitis of unusual clinical picture or poorly reacting to treatment, suspected infection or tumor etiology. In the beginning of PPV, 0.5 to 1.5 ml of undiluted vitreous body was samples and subsequently examined by microbiology, immunology and molecular genetic methods. PPV was performed on both eyes in 10 patients, on one eye twice in each of three patients. The authors evaluated 62 samples of vitreous body on the whole. The patients were observed for up to 96 months. RESULTS: Laboratory examination of the samples of vitreous body from 22 eyes (35.4%) supported our notion on infection etiology of intraocular inflammation, manifestations of intraocular tumor were in 12 eyes (19.3%), vascular or vitreoretinal pathology was present in 6 eyes (9.6%). Nonspecific inflammatory changes were detected in 22 eyes (35.4%). Drugs were administered into the vitreous body in 16 eyes. In the observation period the authors detected marked late complications in connection with DD PPV in 18 eyes (29%). Visual acuity improved by two or more lines of the Snellen optotypes in 43 eyes (69.3%), remained unchanged in 11 (17.7%) eyes. The vision deteriorated in 8 eyes (12.9%). CONCLUSION: Based on this experience the authors are of the opinion that DT PPV is indicated in patients with uveitis for giving more precision to the diagnosis of intraocular inflammation or a masking syndrome. DT PPV also represents a therapeutic procedure to cure complications connected with a severe form of inflammation and makes it possible to save central visual acuity.
