Inspection of the lens to determine the age of corticosteroid induced cataracts.

Since the lens grows layer upon layer one can estimate the age of a posterior subcapsular cataract by its thickness and distance from the posterior capsule. An artist's depiction of several examples are given. It is helpful for the ophthalmologist to draw in pencil the appearance of the PSC as seen with a +10D lens in the ophthalmoscope.

Chorioretinal scars in Fuchs' heterochromic iridocyclitis.

To determine the incidence of chorioretinal lesions in patients with Fuchs' heterochromic iridocyclitis, we reviewed the records of all patients with this disease seen at the Indiana University Uveitis Service, Indianapolis, since 1963. For comparison the records of age- and sex-matched patients with HLA-B27-positive iritis were also reviewed. The incidence of chorioretinal lesions in one or both eyes of patients with Fuchs' heterochromic iridocyclitis was significantly higher than in the patients with HLA-B27-positive iritis or than expected in the general population. Among the types of lesions manifested, the most notable increase was in toxoplasmosislike lesions. However, two of the five patients with these lesions had negative indirect hemagglutination assays for toxoplasmosis, down to undiluted serum. The reason for the high incidence of chorioretinal lesions in patients with Fuchs' heterochromic iridocyclitis is unclear and may be related to immunologic changes in these patients.

The macula in ocular toxoplasmosis.

Of 60 attacks of ocular toxoplasmosis, in 37 (62%) no apparent macular problems were demonstrated on inspection, in seven (12%) active retinitis was evident within 5 degrees of the umbo, and in seven (12%) some evidence was shown of mild macular edema; severe edema, such as cystoid macular edema, was uncommon.

The tuberculin skin test in the diagnosis of tuberculous uveitis.

Of 18 patients (seven men and 11 women, ranging in age from 15 to 63 years) with presumed tuberculous uveitis seen between 1970 and 1982, 11 had intermediate-strength tuberculin skin test responses of less than 10 mm of induration. Similarly, nine had intermediate-strength responses of less than 5 mm of induration. Thus, any response of erythema or induration may be significant in the diagnosis of tuberculous uveitis and evidence enough for further testing with an isoniazid therapeutic trial.

Serum immunoglobulins and uveitis.

Sixty-two percent of 975 uveitis patients had a statistically significant elevation in the levels of one or more of three serum immunoglobulins. The percentage of cases of above-normal values was greatest for IgM (43.8%), followed by IgA (34.0%), and then by IgG (11.9%). There was no statistically significant difference in immunoglobulin values obtained for one diagnosis as compared with all others, except for men with HLA-B27. They had a higher percent of elevated IgM values than men with all other diagnoses. Testing for immunoglobulins is of little or no value in the etiologic diagnosis of a single case of uveitis, but may be of value in research studies to better understand its pathogenesis.

The role of the isoniazid therapeutic test in tuberculous uveitis.

Of 38 cases of uveitis examined from 1970 to 1980 in which a tuberculous cause was considered, we classified 18 as presumed tuberculous on the basis of a positive response to isoniazid. We compared these patients to a control group who had a positive skin test but a negative response to the isoniazid therapeutic test. We found a family history of tuberculosis in seven of the 18 (P less than .05) and a more common (18 of 36 eyes) incidence of iridocyclitis (P less than .05) than of other types of uveitis. A uveitis patient who has a positive tuberculin skin test of any size or strength should undergo the isoniazid therapeutic test to ensure that a possible diagnosis of tuberculous uveitis is not missed. Tuberculosis should be suspected in both granulomatous and non granulomatous uveal lesions, especially in cases of chronic iridocyclitis.

Thyroid dysfunction and uveitis.

In 544 patients with uveitis, those with presumptive diagnoses of toxoplasmosis, tuberculosis, sarcoidosis, toxocariasis, and "unknown" had significant hypothyroidism (defined as a thyroxine level below 5.3 microgram/dL). Those with diagnoses of histoplasmosis, syphilis, rheumatoid arthritis, Fuchs'heterochromic iridocyclitis, serpiginious choroiditis, or HLA B27 did not have such low levels. No diagnostic entities showed significant hyperthyroidism (defined as a thyroxine level of 12.0 microgram/dL or more). All results were based on thyroxine levels; further studies should employ more modern techniques.

A review (1970-1980) of 28 presumptive cases of syphilitic uveitis.

We classified 1.1% of our uveitis cases from 1970 to 1980 as presumably caused by syphilis. We did not initially suspect syphilis in most of these 28 patients. None of the women and only half of the men had reactive VDRL tests. If the fluorescent-treponemal-antibody absorption test had not been used, three-fourths of these would have gone undiagnosed.

Bacterial and protozoal uveitis.

Tuberculosis and syphilis are often missed by ophthalmologists. The remedy is to perform complete PPD and FTA-ABS testing in all cases of uveitis in which the diagnosis is not apparent. Ocular toxoplasmosis should never be treated with corticosteroids alone but should be covered by at least one antitoxoplasmic agent. From none to four systemic medications may be used depending on the position and severity of the retino-choroiditis. There are currently two schools of thought in the diagnosis of ocular toxoplasmosis. It is suggested that each school should combine their minimal diagnostic criteria as a start in developing common diagnostic measures.

Linear streaks of the equator in the presumed ocular histoplasmosis syndrome.

A fourth sign of the presumed ocular histoplasmosis syndrome (POHS), peripheral streak lesions, is added to the common triad of disseminated punched-out atrophic spots, peripapillary atrophy, and macular disciform lesions. The streaks are of variable length, width, and pigmentation. They are almost invariably in the equatorial region and oriented parallel to the ora serrata. Streak lesions were found in 5.0% of patients with the POHS.

Bilateral acute retinal necrosis.

A 20-year-old woman lost all useful vision over a 2 1/2-month period as a result of a necrotizing and occlusive vasculitis of the retina. Treatment with prednisone, immunosuppressants, and aspirin was unsuccessful. No systemic manifestations of the disease were found and no cause was discovered. Kodachromes and fluorescein angiograms showed the progression in one eye from normal to near total retinal necrosis. The process began with a mild venous dilation and peripheral arteritis that progressed into an obliterative vasculitis with abrupt vessel dilation, hemorrhages, and retinal swelling. This was followed by necrosis and sloughing of the retina into the vitreous. Vitreous contraction and necrotic retina produced unrepairable retinal detachments.

Eye histoplasmosis.

Mainly in the endemic area, eye histo strikes healthy adults in their 30's and 40's. They note distortion and blurring of central vision of 1 eye. Such patients can tell when they are having this muculopathy before the ophthalmologist is able to detect any damage. Later a hemorrhagic maculopathy may develop. The diagnosis of eye histo is made by the characteristic eye picture. To bring you up to data about this common but little known entity, we will use a question and answer format.