ABSTRACT
Allergic diseases are prominent, possibly life threatening, and a cause of worldwide concern. Evidence-based education of doctors in the specialty of allergology is a prerequisite for correct diagnosis and treatment of patients with allergic diseases. Recently, the specialty of allergology has been abolished in Denmark, without any upgrading of the education of doctors in related specialties. As a consequence, one could fear that allergy expertise will be disappearing. We propose collaboration among experts from related specialties with joint mediation of knowledge through a centre of allergology, common educational programs for doctors in training and physician specialists, and collaboration in regional centres of allergology.
Subject(s)
Allergy and Immunology , Allergy and Immunology/education , Allergy and Immunology/organization & administration , Allergy and Immunology/standards , Clinical Competence , Denmark , Education, Medical, Graduate , Evidence-Based Medicine , Humans , Hypersensitivity/diagnosis , Hypersensitivity/therapy , Medicine/organization & administration , SpecializationABSTRACT
PURPOSE: To describe a rare case of Churg-Strauss syndrome presenting with severe visual loss due to a combined central retinal vein and artery occlusion. METHODS: A 42-year old man with a medical history of asthma and blood hypereosinophilia developed a sudden loss of vision in his right eye. We describe the clinical features and evolution of the case after treatment. RESULTS: A combined occlusion of the central retinal artery and central retinal vein was diagnosed by the funduscopic appearance of retinal whitening, macular cherry-red spot, papilloedema, retinal haemorrhages in all four quadrants and dilated and tortuous veins. The diagnosis was confirmed by a fluorescein angiogram showing absence of retinal filling and normal choroidal filling. Churg-Strauss syndrome was diagnosed based on the necessary presence of four of six criteria for the disease proposed by the American College of Rheumatology. Corticosteroid therapy was initiated. However, during the following year when tapering off the daily dosage, the patient experienced two relapses, with pulmonary symptoms and hypereosinophilia, and the corticosteroid dosage had to be augmented. The patient presented with neovascular glaucoma 7 weeks after the vascular occlusion and experienced no visual improvement. CONCLUSION: Combined central retinal artery and vein occlusion can occur in Churg-Strauss syndrome. We suggest that regional vasculitis may be the pathological mechanism underlying the vascular occlusions observed in our case. The condition carries a very poor prognosis for vision, due to the resulting retinal ischaemia, and a poor general prognosis due to the late stage of the systemic disease. Corticosteroids should be instigated promptly in order to prevent further systemic or ocular vasculitis.
Subject(s)
Churg-Strauss Syndrome/complications , Retinal Artery Occlusion/etiology , Retinal Vein Occlusion/etiology , Adult , Churg-Strauss Syndrome/diagnosis , Churg-Strauss Syndrome/drug therapy , Fluorescein Angiography , Glaucoma, Neovascular/diagnosis , Glaucoma, Neovascular/etiology , Glucocorticoids/therapeutic use , Humans , Laser Coagulation , Male , Papilledema/diagnosis , Recurrence , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/drug therapy , Retinal Hemorrhage/diagnosis , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/drug therapyABSTRACT
PURPOSE: To investigate the integrity of the blood-aqueous barrier (BAB) and the blood-retinal barrier (BRB) in diabetic patients with clinically significant macular edema (CSME). METHODS: The rate constant (Kd(F)) of the BAB and the permeability of the blood-retinal barrier for non-protein bound fluorescein were determined simultaneously by fluorometry. Results were analysed pairwise in diabetic patients (n = 25) with CSME in one eye and without CSME in the other eye. RESULTS: Kd(F) for the eyes with CSME was significantly increased compared to eyes without CSME (444. 10(-6) min( -1) and 387. 10(-6) min(-1) respectively, p = 0.01). The passive permeability of the BRB was also significantly increased in CSME (5.7 nm/sec and 3.5 nm/sec respectively, p = 0.009, n = 19). CONCLUSIONS: Both the rate constant of the BAB and the BRB permeability were significantly increased in CSME indicating that eye-specific factors are common for both barriers in diabetic patients with CSME.
Subject(s)
Blood-Aqueous Barrier/metabolism , Blood-Retinal Barrier/metabolism , Contrast Media/pharmacokinetics , Diabetic Retinopathy/metabolism , Edema/metabolism , Fluorescein/pharmacokinetics , Macula Lutea , Adult , Aged , Capillary Permeability , Diabetic Retinopathy/physiopathology , Edema/physiopathology , Humans , Middle Aged , Visual AcuitySubject(s)
Anti-Allergic Agents/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Conjunctivitis, Allergic/drug therapy , Dibenzoxepins/administration & dosage , Histamine H1 Antagonists/administration & dosage , Anti-Allergic Agents/pharmacokinetics , Anti-Inflammatory Agents, Non-Steroidal/pharmacokinetics , Dibenzoxepins/pharmacokinetics , Histamine H1 Antagonists/pharmacokinetics , Humans , Olopatadine Hydrochloride , Ophthalmic Solutions , TabletsABSTRACT
Two patients with mono-symptomatic unilateral loss of vision are presented. Both developed a bilateral loss of vision over a period of 2-3 weeks. No clinical suspicion of TA was raised on the basis of symptoms or signs, but a careful history and repeated blood tests might have given the correct diagnosis.
