[Cytomegalovirus retinitis in HIV negative patients - retrospective study]. / Cytomegalovirová retinitida u HIV negativních pacientu - retrospektivní studie.

AIM: To evaluate own experience with the diagnosis and treatment of cytomegalovirus (CMV) retinitis in HIV negative patients with immunodeficiency. METHODS: Retrospective study and case reports. RESULTS: In the Centre for diagnosis and treatment of Uveitis 1869 patients with uveitis we have examined from June 2003 to June 2012. CMV retinitis was diagnosed in 7 patients (1 woman and 6 men) according to the typical clinical findings and history of immunodeficiency. In 2 atypical findings was the diagnosis confirmed by determination of DNA pathogen in vitreous sample (a patient with non-Hodgkin lymphoma) or by positive serology (CMV in leukocytes - indolent form of CMV retinitis in a patient with systemic lupus erythematosus). In 8 cases we found fulminant form, in 1 case indolent form of CMV retinitis. The average age of patients was 39,1 years (18-51 years old), ratio of men to women 6 : 3. In 6 of 9 cases we noticed bilateral retinitis. The average period of observation in our study was 15,8 months (1-48 months). Five of our patients underwent bone marrow transplantation, 2 patients were treated with systemic immunosuppressive drugs (colitis ulcerosa, systemic lupus erythematosus) and 2 patients had chemotherapy for lymphoma. The initiation or modification of treatment (gancyklovir p.o./i.v., foscarnet i.v.) was consulted and coordinated with others specialists. After initiation of treatment we followed-up 7 patients. In 4 eyes of 3 patients (31 %) the improvement of visual acuity was documented, in 5 eyes of 5 patients (38 %) the visual acuity was stabilized. The worsening of vision in 4 eyes of 3 patients (31 %) was caused by complications without any connection to virostatic therapy. All of our patients, who underwent bone marrow transplantation, died within 12 months since the diagnosis of CMV retinitis was determined. CONCLUSION: The diagnosis of CMV retinitis only in 9 cases (0,48% of all uveitic patients) confirms the rare occurrence of this retinitis. The important tool to the diagnosis of CMV retinitis is the history of immunodeficiency. In an atypical findings, the analysis of intraocular fluids or serological tests could help to the final diagnosis. The occurrence of CMV retinitis signify a very unfavourable prognosis for patients who underwent bone marrow transplantation and these patients died within 12 months since CMV retinitis has been diagnosed. The management of the therapy requires close interdisciplinary cooperation.

[Eye and inflammatory bowel diseases]. / Oko a idiopatické strevní zánety.

AIM: To point out the wide range of ocular features of inflammatory bowel diseases (IBD), focusing on uveitis. METHODS: A retrospective study. RESULTS: In the Centre for diagnosis and therapy of uveitis of our Ophthalmology Department, we have in years 2003-2010 followed in total 18 patients with intraocular inflammation associated with IBD: anterior uveitis (14), vasculitis (1), panuveitis (1), infectious uveitis as a secondary complication of systemic immunosuppressive therapy (2). The most often diagnosis was mild to moderate recurrent acute anterior uveitis. We have noticed more severe course of uveitis in patients with the HLA B27 positivity. Part of this paper consists of an overview of other ocular manifestations of IBD and current available therapeutical strategies. CONCLUSION: Ocular manifestations of IBD can be a valuable signal of the activity of the primary disease. The knowledge of the ocular manifestations of these systemic diseases and of possible complications is required for successful interdisciplinary care of patients with IBD. While local treatment is fully in hands of an ophthalmologist, the form and extent of the systemic treatment is necessary to coordinate with gastroenterologists.

[Malignant masquerade syndromes]. / Maligní maskující syndromy.

PURPOSE: To evaluate our experience with the diagnosis and treatment of malignant masquerade syndromes. METHODS: A retrospective study of 46 patients treated for malignant masquerade syndromes at our Department for Diagnosis and Treatment of Uveitis, 1st Faculty of Medicine in Prague, between 1995 and 2008, was performed. RESULTS: Eighty-nine patients with masquerade syndromes (7.2%) from all 1233 patients with uveitis were included. Malignant masquerade syndromes were recognized in 46 patients (22 females and 24 males, mean age 55 years). The most frequent cause of malignant masquerade syndromes was intraocular non-Hodgkin lymphoma (26 patients). The primary diagnosis was idiopathic uveitis in many cases. The most valuable diagnostic procedure was analysis of intraocular fluids. CONCLUSION: Diagnosis of masquerade syndromes should be considered in all patients with idiopathic corticosteroid-resistant chronic uveitis. Timely diagnosis and treatment may in case of malignant masquerade syndromes improve prognosis and sometimes gain control over this potentially lethal disease.

[Current therapeutic approach in non-infectious uveitis]. / Soucasné prístupy k lécbe neinfekcních uveitid.

The aim of this paper is to summarize current therapeutic approach in non-infectious uveitis. It focuses on different immunosuppressive/immunomodulatory treatment modalities and address' its adverse effects.

[Benign masquerade syndromes in differential diagnosis of uveitis]. / Benigní maskující syndromy v diferenciální diagnostice uveitid.

PURPOSE: To present our experience with the diagnosis of benign masquerade syndromes, to evaluate the prevalence, clinical features and diagnostic tests. METHODS: A retrospective study of 42 patients treated for benign uveitis masquerade syndromes at our Department for DIAGNOSIS AND TREATMENT OF UVEITIS: 1st Faculty of Medicine in Prague, between 1996 and 2006, was performed. RESULTS: Seventy-nine patients with masquerade syndromes (7.1%) from all 1112 patients with uveitis were included. Malign masquerade syndromes were recognized in 37 patients (19 females and 18 males, mean age 55 years) and benign masquerade syndromes in 42 patients (23 females and 19 males, mean age 33.7 years). The most frequent cause of benign masquerade syndromes was a group of vascular anomalies (22 patients). The primary diagnosis was infectious or idiopathic uveitis in many cases.The most valuable diagnostic procedures were fluorescein angiography and analysis of intraocular fluids. CONCLUSION: Diagnosis of masquerade syndromes should be considered in all patients with idiopathic corticosteroid-resistant chronic uveitis. Timely diagnosis and treatment may improve the prognosis of masquerade syndromes.

[Sympathetic ophthalmia]. / Sympatická oftalmie.

PURPOSE: To evaluate the efficacy of treatment on prevention of disease development and protection of visual outcomes in patients suffering from sympathetic ophthalmia. METHODS: Retrospective case. RESULTS: Four patients with sympathetic ophthalmia were treated in our department from 1999 to 2004. All patients were men with the mean age 27.5 years (15-49 years). In two patients, there was a history of penetrating eye injury prior to the onset of sympathetic ophthalmia, in other two patients sympathetic ophthalmia occurred after eye surgery (pars plana vitrectomy), with no previous ocular trauma. Two patients were treated with monotherapy of corticosteroids; other two patients were commenced on combined immunosuppression. In all these cases, the therapy was effective. CONCLUSION: Sympathetic ophthalmia is a rare, sight-threatening eye disease. Among the triggering factors dominates penetrating eye injury, however, there is currently an increase in the number of cases with sympathetic ophthalmia following eye surgery, mainly pars plana vitrectomy. Early introduction of immunosuppressive treatment can get the disease under control, prevent the development of intraocular inflammation and improve visual outcomes.

The effect of urocanic acid on graft rejection in an experimental model of orthotopic corneal transplantation in rabbits.

BACKGROUND: Urocanic acid (UCA) is a natural component of the stratum corneum of the skin. It has been described as a photoreceptor for ultraviolet B radiation. UCA is present in the skin as a trans-isomer and undergoes UVB irradiation-dependent isomerization from trans-to cis-isomer. An immunosuppressive effect of irradiated UCA, i.e. a mixture of cis- and trans-isomers, has been demonstrated both in vivo and in vitro. The aim of this study was to evaluate an immunosuppressive effect of irradiated UCA on graft rejection in an experimental model of orthotopic corneal transplantation. METHOD: A commercially available UCA was dissolved in salt solution and irradiated by XeCl excimer laser beam in order to obtain a mixture of cis- and trans-isomers. The immunosuppressive effect of irradiated UCA, compared to controls, unirradiated UCA and salt solution, was evaluated in a high-risk orthotopic corneal transplantation model; the agents were administered subconjunctivally to rabbits. RESULTS: The rejection reaction was observed in all animals. The mean graft survival time in rabbits administered salt solution or unirradiated UCA was 20 days and 22 days, respectively. The irradiated solution of UCA significantly (P < 0.01, Mantel-Cox test) prolonged mean graft survival time to 29 days. CONCLUSION: Subconjunctival administration of irradiated UCA prolonged the graft survival time in comparison with unirradiated UCA or salt solution in recipients in a rabbit transplantation model. Although further studies are necessary, UCA seems to be an effective immunosuppressive drug after corneal transplantation.