Pigmentation on anterior chamber angle in eyes of patients with atopic dermatitis.

PURPOSE: To evaluate pigmentation on the anterior chamber angle in patients with atopic dermatitis. METHODS: This study includes 61 patients suffering from atopic dermatitis who visited our hospital between 1991 and 1995. Gonioscopy, cycloscopy, and fundus examinations with a scleral depressor were performed on every patient during the initial visit, and were repeated every 6 months. Pigmentation on the anterior chamber angle was classified according to Scheie. RESULTS: The pigmentation on the anterior chamber angle at the initial visit was evaluated as grade 0 (15 eyes), grade 1 (81 eyes), grade 2 (21 eyes), and grade 3 (5 eyes). Retinal detachment was found in 9 eyes of the 26 eyes with grade 2 or 3 pigmentation, but in only one of the 96 eyes with grade 0 or 1. The pigmentation on the anterior chamber angle correlated significantly with the incidence of retinal detachment (P < .0001). Causative breaks were found in the peripheral retina or ciliary epithelium in all eyes. CONCLUSIONS: Moderate to dense pigmentation on the anterior chamber angle in patients with atopic dermatitis seems to be a sign of breaks in the retina or ciliary epithelium, and the fundus of these patients should be examined carefully for signs of retinal detachment.

[Comparison of retinal breaks between patients with atopic dermatitis and mentally retarded patients with self-inflicted ocular injury].

We compared the distribution of retinal breaks in retinal detachment between patients with atopic dermatitis (AD) and mentally retarded patients who had self-inflicted ocular injury (MR). The cases of AD were 16 eyes in 14 patients (six males and eight females, ranging in age from 15 to 52 years, mean 24.5) and the cases of MR were 6 eyes in 5 patients (5 males, ranging in age from 14 to 25 years, mean 20.2). There was no corneoscleral laceration in either group. In the patients with AD, 14 (87.5%) of 16 eyes had retinal breaks at the vitreous base, and 21 (87.5%) of 24 retinal breaks in 16 eyes were at the vitreous base. In the patients with MR, five (83.3%) of 6 eyes had retinal breaks at the vitreous base and 6(66.7%) of 9 retinal breaks in 6 eyes were at the vitreous base. In both groups, ciliary epithelial breaks and peripheral retinal tears were frequently observed, suggesting that retinal detachment in AD has a pathophysiology similar to traumatic retinal detachment with repeated ocular contusion (self-inflicted injury).

Non-rubeotic angle-closure glaucoma associated with ciliary medulloepithelioma.

Non-rubeotic angle-closure glaucoma associated with ciliary medulloepithelioma was reported in a 3-year-old boy. On the first visit, a free-floating white mass was observed in the anterior chamber of his right eye. The mass disappeared spontaneously after 5 months of observation. One year later, angle-closure glaucoma with peripheral anterior synechia occurred in the same eye and intraocular pressure rose to 55 mmHg. After glaucoma surgery, the white mass appeared again in the anterior chamber of his right eye. By cycloscopy, numerous small grayish-white masses could be seen on the ciliary body and in the posterior chamber. Histopathological examination of one mass confirmed medulloepithelioma and the eye was enucleated. Disseminated tumor cells in the anterior chamber had caused the cornea and the peripheral iris to adhere to each other, resulting in the formation of peripheral anterior synechia.

[Corticosteroid-induced glaucoma following treatment of the periorbital region].

In this paper we report on three patients with open-angle glaucoma following use of corticosteroid ointment in the periorbital region. Case 1 used fluocinolone acetonide 0.025% for vitiligo vulgaris in the left periorbital region for 2 years. The intraocular pressure (IOP) was 35 mmHg in the left eye. Case 2 used methylprednisolone 0.5% for atopic dermatitis for 14 years. The IOP was 21 mmHg in the right eye and 50 mmHg in the left. Case 3 used betamethasone valerate 0.12% for atopic dermatitis for 2 years. The IOP was 68 mmHg in the right eye and 21 mmHg in the left. The left eye of case 2 and the right eye of case 3 showed glaucomatous optic disc atrophy and visual field defect, and trabeculectomy was performed. Because of the risk of glaucoma, it is strongly recommended that dermatologists advise patients to consult with ophthalmologists regarding application of corticosteroids to the periorbital region.

[Pigmentation on the anterior chamber angle in retinal detachment associated with atopic dermatitis].

We reported pigmentation on the anterior chamber angle in twenty-two patients suffering from atopic dermatitis. Dense pigmentation on the anterior chamber angle was observed in all eight eyes with retinal detachment and was evident before clinical recognition of detached retina. Minimal or slight pigmentation was also evident in eyes without retinal detachment. Increased pigmentation on the anterior chamber angle is a characteristic and predictive sign of retinal detachment associated with atopic dermatitis. This pigment appeared to migrate from latent breaks because of inflammation of the peripheral retina and ciliary body.

[Incidence of cataract and retinal detachment associated with atopic dermatitis].

The incidence of cataract and retinal detachment associated with atopic dermatitis is reported. The subjects suffered from moderate or severe atopic dermatitis. Seventy-five patients (32 male and 43 female, age: 7-46, mean 19.7 years) had their initial examination at the Department of Ophthalmology, Sapporo Medical University Hospital, from 1981 to 1990. Cataract was found in 13 (6 male and 7 female) out of the 75 patients (17.3%). All cases except one already had cataract at the initial visit. The average age was 21.2 years. Nine had bilateral cataracts and four had unilateral. Type of cataract in 22 eyes was anterior subcapsular cataract (n = 3), posterior subcapsular cataract (n = 8), anterior and posterior cataract (n = 9), and mature cataract (n = 2). Retinal detachment was associated in six (8.0%) out of the 75 patients. Four were male and two were female. The average age was 21.6 years (range 18-29). Three cases were bilateral and 3 unilateral. Five of nine eyes with retinal detachment had no history of intraocular surgery. Four of the nine had a history of cataract extraction (3 eyes) and trabeculectomy (1 eye). Tears were observed in 5 out of 9 eyes (small tears in the peripheral retina (n = 1), oral dialysis (n = 3), and breaks at the pars plicata (n = 1). Tears could not be observed in four eyes (44%). Detachment of the pars plana was found in seven eyes. Retinal detachment was always associated with cataract.

Epidemiology of glaucoma in Japan--a nationwide glaucoma survey.

A population-based, collaborative glaucoma survey was conducted in seven regions throughout Japan, during the years of 1988 and 1989. The total number of subjects examined was 8,126 out of 16,078 residents aged 40 years or older, representing a participation rate of 50.54%. There were no significant differences in background factors between participants and randomly sampled nonparticipants. A mainstay of the screening consisted of tonometry and fundus photography with nonmydriatic camera, followed by automatic perimetry as a recall examination. Overall prevalences obtained were primary open-angle glaucoma (POAG) 0.58%, low-tension glaucoma (LTG) 2.04%, primary angle closure glaucoma (PACG) 0.34%, other types of glaucomas 0.60%, and ocular hypertension (OH) 1.37% at the time of screening. The very high prevalence of LTG and extremely low prevalence of OH in the Japanese might reflect a racial peculiarity in the age-specific trend of the intraocular pressure. The prevalence of PACG was found much higher in Japanese than in Caucasians, with a predilection for women. Racial peculiarities as revealed in this study were discussed, with particular reference to the refractive status in the Japanese that showed progressive decrease in myopia with age.