Heparin surface-modified intraocular lenses in patients with inactive uveitis or diabetes.

OBJECTIVE: This study aimed to determine whether heparin surface-modified (HSM) intraocular lenses (IOLs) with a hydrophilic surface would reduce cell adherence and other postoperative changes compared with the conventional polymethylmethacrylate (PMMA) IOLs in patients with either diabetes mellitus or inactive uveitis. DESIGN: The study design was a randomized, double-masked, clinical trial. PARTICIPANTS: Twenty-five patients with bilateral cataracts, 14 with inactive anterior uveitis and 11 with diabetes, with an age range of 11 to 81 years (mean, 52.8 years) participated. INTERVENTION: Bilateral cataract extraction with posterior chamber IOL implantation was measured, each patient receiving an HSM lens in one eye and a PMMA lens in the other. Pharmacia one-piece HSM and PMMA IOLs were used. Postoperative ocular changes were evaluated at regular intervals for 24 months in patients with inactive uveitis and for 6 months in patients with diabetes. Patients and physicians alike were unaware of which eye contained which lens until postoperative results were compiled. Records were kept by a study coordinator. MAIN OUTCOME MEASURES: Comparisons of posterior synechiae, IOL cellular deposits, and posterior capsular fibrosis between PMMA and HSM IOLs were measured. RESULTS: Using the chi-square test, no statistically significant difference was found between the HSM and PMMA IOLs in the number of cellular deposits found on the anterior IOL surface, the number of adhesions between the iris and IOL, or the incidence of capsular opacification. CONCLUSION: The HSM and PMMA IOLs showed similar postoperative results in patients with inactive uveitis or diabetes mellitus.

Vogt-Koyanagi-Harada syndrome in children compared to adults.

PURPOSE: To study the course and visual outcome of Vogt-Koyanagi-Harada (VKH) syndrome in children. METHODS: The medical records of 97 consecutive patients with VKH syndrome were reviewed. Patients had been seen at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. The records were divided into two groups: those in whom the onset of the disease occurred at the age of 14 years or younger (pediatric group) and those in whom the disease manifested after the age of 14 years (adult group). RESULTS: Eight (61%) of the 13 children required cataract surgery compared to 14(17%) of 84 adult patients. Despite medical and surgical therapy, eight (61%) of the pediatric group had a final visual acuity of 20/200 or worse compared with 22 (26%) of the 84 adult patients (p=0.0103). CONCLUSION: The course of early-onset VKH (before the age of 14 years) appears to be aggressive. The ocular complications are more severe in children than in adults, leading to rapid deterioration in vision. Despite therapy, the final visual outcome of VKH in children is poor.

Demyelination of retinal myelinated nerve fibers in Behcet's disease.

A 39 year-old Behcet's patient had demyelination of retinal myelinated nerve fibers after recurrent papillitis and vitritis. Oral Prednisolone, cyclosporine, and later periocular corticosteroids and oral colchicine were used but demyelination continued over a 5 year-period. A pseudobulbar palsy with urinary incontinence and pyramidal tract signs developed and azathioprine and corticosteroids were used. Demyelination of retinal nerve fibers stopped and while treatment was underway, the central nervous system (CNS) signs were stable. While the ocular pathology of Behcet's can mirror the CNS signs, indeed optic nerve ischemic demyelination may signal the potential for CNS involvement; azathioprine with prednisone may be more effective in the long-term for optic nerve and CNS involvement than cyclosporine with prednisone.

Temporal crescent syndrome with magnetic resonance correlation.

BACKGROUND: A young woman with a history of controlled hypertension noted a suddenly decreased peripheral temporal field in the left eye. This occurred after moderate peripartum hypertension. METHOD: A monocular peripheral temporal crescentic defect could be plotted on Goldmann visual fields despite a normal dilated peripheral retinal examination and normal disc appearance. RESULT: A dilated parieto-occipital sulcus could be seen on computed tomography, and magnetic resonance imaging showed changes consistent with atrophy and gliosis in the cuneus, precuneus, and anterior calcarine cortex surrounding the parieto-occipital sulcus. CONCLUSION: By magnetic resonance imaging, this can be seen to comprise less than 10% of the visual cortex, as suggested by the Horton and Hoyt revised Holmes map. The temporal crescent syndrome is a rare monocular retrochiasmatic visual field defect that can be correlated to a lesion along the parieto-occipital sulcus.

Cataract extraction in Behçet's disease.

AIMS/BACKGROUND: To assess the outcome and complications of cataract extraction in patients with Behçet's disease. METHODS: Thirty-six Behçet's disease patients underwent cataract surgery without intraocular lens implantation. Twenty-six patients had phacoemulsification or extracapsular cataract extraction, and ten patients had pars plana lensectomy/vitrectomy. The follow-up period ranged from 24 to 84 months (mean, 38 months). RESULTS: There was no statistically significant difference in the follow-up period of patients who underwent phacoemulsification, extracapsular cataract extraction, or pars plana lensectomy/vitrectomy. Sixteen (62%) of 26 patients who had extracapsular cataract extraction or phacoemulsification had a visual acuity of 20/200 or better compared with none of the 10 patients who had pars plana lensectomy/vitrectomy. Three (30%) of ten eyes which underwent pars plana lensectomy/vitrectomy eventuated in phthisis bulbi while none of the eyes that underwent extracapsular cataract extraction or phacoemulsification developed phthisis bulbi. CONCLUSION: Extracapsular cataract extraction or phacoemulsification had a better visual outcome and fewer postoperative complications than pars plana lensectomy/vitrectomy in patients with Behçet's disease.

Fibrinolysis in pseudotumor cerebri.

Pseudotumor cerebri is a syndrome associated with diverse putative etiological factors that include chemicals such as vitamin A, tetracycline and estrogens or venous circulatory disturbances like sagittal or transverse sinus thrombosis. Diseases predisposing to thrombosis, such as polycythemia vera and essential thrombocythemia, were reported to cause sinus thrombosis and pseudotumor cerebri. This is a pilot study to investigate the possible role of hemostatic factors in the pathogenesis of pseudotumor cerebri. We studied nine patients with severe, recurrent, or refractory pseudotumor cerebri causing visual impairment and found abnormal euglobulin clot lysis time (prestress in all of them and post stress in seven). Digital subtraction angiography was suggestive of recanalized sinus thrombosis in only three patients. We conclude that abnormalities in the fibrinolytic system are present in a subset of patients with severe pseudotumor cerebri, which calls for further studies on venous circulatory pathogenesis of pseudotumor cerebri and the possible role of anticoagulants in such cases.

Cyclosporine effects on optic nerve and retinal vasculitis in Behçet's disease.

In a prospective, open clinical trial, we studied long-term effects of cyclosporine (CsA) on the optic nerve and retinal vasculitis in 14 Behçet's disease patients. Patients were treated with CsA and corticosteroids for a mean period of 42 months, with a range of 36 to 52 months. They received an initial CsA dosage of 7 mg/kg/day for three days, followed by 5 mg/kg/day, and prednisone 1 mg/kg/day for three to five days, tapered to 0.4 mg/kg/day. CsA was tapered when clinical response was noted. Improvement occurred in visual acuity and visual field defects secondary to papillitis, optic neuritis, macular neuroretinitis, and retinal phlebitis, but not with retinal arteritis. Despite a 12/14 (85%) exacerbation rate, no permanent liver or renal lab tests abnormalities were noted. Intermittent, low-dose CsA therapy may be considered in treatment of acute retinal and optic nerve vasculitis assisted with Behçet's disease.

Charcot-Marie-Tooth disease mimicking ocular myasthenia gravis.

The purpose of this report is to alert the ophthalmologist and neurologist to the fact that intermittent ocular symptoms may herald the onset of chronic progressive external ophthalmoplegia and therefore resemble the weakness produced by myasthenia gravis. In addition, chronic progressive external ophthalmoplegia may complicate the course of Charcot-Marie-Tooth disease.

Further evidence of a possible association between house dogs and multiple sclerosis.

The present study was undertaken because of the recent report of an association between familial multiple sclerosis (MS) and prior ownership of a small pet. Forty-five patients with sporadic MS were retrospectively compared with 45 closely matched controls and were found to have owned a significantly greater number of indoor dogs prior to the onset of MS. Importantly, the MS patients had also had more exposure to neurologically ill dogs in the five years before the onset of symptoms. These new data further support the hypothesis that house dogs may serve as an animal vector in MS.