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BMJ Case Reports Apr 2015Intermediate uveitis is a subset of intraocular inflammation where vitritis is the most consistent sign, with or without snowball opacities or snow banks over the pars...
Intermediate uveitis is a subset of intraocular inflammation where vitritis is the most consistent sign, with or without snowball opacities or snow banks over the pars plana. Some patients will have an associated underlying systemic disease such as sarcoidosis, multiple sclerosis, ocular tuberculosis, inflammatory bowel disease, possibly Behçet's disease and intraocular lymphoma, whereas some will be classified as pars planitis in case of the lack of an identifiable systemic disease association. Our patient, a 47-year-old woman, developed intermediate uveitis after cataract surgery in her right eye, was misdiagnosed as pars planitis, and received steroid monotherapy for 8 months. Her inflammation only fully resolved after vitrectomy with removal of the intraocular lens (IOL) and capsular bag. Oral fluconazole and intravitreal amphotericin B injection had failed to resolve her inflammation when Candida albicans was identified as the cause of her persistent intermediate uveitis.
Topics: Administration, Oral; Amphotericin B; Candida albicans; Cataract Extraction; Diagnostic Errors; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Intravitreal Injections; Middle Aged; Pars Planitis; Postoperative Complications; Steroids; Treatment Outcome; Uveitis, Intermediate; Vitrectomy
PubMed: 25870216
DOI: 10.1136/bcr-2014-208847 -
Middle East African Journal of... 2017To study the patterns of intermediate uveitis in the pediatric age group in a referral eye care center in South India.
PURPOSE
To study the patterns of intermediate uveitis in the pediatric age group in a referral eye care center in South India.
METHODS
This is a study of twenty consecutive patients under 16 years of age with intermediate uveitis, conducted at a tertiary referral center. Numerous variables were assessed, including age and gender distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features, their complications, therapeutic strategies with their outcomes, remission, final visual acuity (VA), and characteristics associated with poor visual outcome.
RESULTS
Bilateral involvement was observed in 80% of the patients. Remission was observed in five out of 7 patients (78%) with completed follow-up of 5 years. Final VA improved by at least two lines in 11 patients, remained stable in 6 patients, and worsened in 3 patients. The etiological diagnosis showed one patient with Bechet's disease, one with juvenile idiopathic arthritis, 1 with human leukocyte antigen B27 associated uveitis, 9 with laboratory proven tuberculosis, and 3 with sarcoidosis and 5 where it was idiopathic. The mean follow-up was 4.8 years (range 3-8 years). Cataract was the most frequent complication observed (40%). Glaucoma, choroidal neovascularization, and amblyopia accounted for worsening of vision in three patients.
CONCLUSION
Median time of development of complications is about 3 years based on our study. Intermediate uveitis of childhood might exhibit a self-limiting course after several years. Visual recovery is good in the majority, and visual loss is limited despite the high rate of ocular complications.
Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Incidence; India; Male; Prognosis; Referral and Consultation; Retrospective Studies; Tertiary Care Centers; Time Factors; Uveitis, Intermediate; Visual Acuity
PubMed: 28936054
DOI: 10.4103/meajo.MEAJO_264_15 -
Therapeutics and Clinical Risk... 2015We report a rare case of rhegmatogenous retinal detachment due to a full-thickness macular hole in a young patient with pars planitis. This study was an interventional...
We report a rare case of rhegmatogenous retinal detachment due to a full-thickness macular hole in a young patient with pars planitis. This study was an interventional case report. A 38-year-old Asian man presented with acute reduction of vision in his left eye. His past ocular history revealed a precedent of two intravitreal steroid injections in his left eye, and fundoscopy revealed a total bullous retinal detachment along with 360° snowbanking at the pars plana. Precise preoperative visualization of the posterior pole was impossible due to a dense nuclear cataract. During surgery, an unexpected full-thickness macular hole with no associated epiretinal membrane was observed, which resulted in the retinal detachment. This case of chronic pars planitis complicated with a full-thickness macular hole resulting in retinal detachment was successfully treated with vitrectomy, internal limiting membrane peeling, and perfluoropropane tamponade. Visual acuity improved from hand movements to 6/36 Snellen at 12 months postsurgery. This case report illustrates the rare but possible association between pars planitis with macular hole formation and subsequent retinal detachment, underlying the beneficiary outcome of vitrectomy surgery both diagnostically and therapeutically.
PubMed: 25565856
DOI: 10.2147/TCRM.S70711 -
Journal Francais D'ophtalmologie Jun 2024Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case...
INTRODUCTION
Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case of a child with toxocariasis associated with serous retinal detachment.
OBSERVATION
A 8-year-old child with no previous history of toxocariasis was referred for a 1-year decline in visual acuity, unimproved by optical correction, with vitreous condensation on examination, without central or peripheral granulomas, and serous retinal detachment on OCT. The diagnosis was made after extensive questioning, with evidence of contact with dogs and positive serology. Medical treatment combining corticosteroid therapy and antiparasitic therapy was initiated, and the clinical picture improved.
DISCUSSION
Ocular toxocariasis is a rare infection, unilateral in 90% of cases. Its clinical manifestation in children is pars planitis, posterior uveitis with a posterior pole chorioretinal focus associated with vitreoretinal traction and/or peripheral granuloma. In our case, the patient presented with vitreous condensation only, with OCT serous retinal detachment and no peripheral or central granulomas. Positive plasma serology or ocular samples confirmed the diagnosis.
CONCLUSION
Ocular toxocariasis should not be ruled out in the absence of a typical clinical picture, and seropositivity enables confirmation of the diagnosis when clinical suspicion arises.
Topics: Humans; Toxocariasis; Child; Eye Infections, Parasitic; Retinal Detachment; Male; Dogs; Animals
PubMed: 38713931
DOI: 10.1016/j.jfo.2024.104191 -
Graefe's Archive For Clinical and... Sep 2019To describe the characteristics of de novo uveitis in patients ≥ 60 years old. (Comparative Study)
Comparative Study
PURPOSE
To describe the characteristics of de novo uveitis in patients ≥ 60 years old.
METHODS
Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared.
RESULTS
A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group.
CONCLUSION
In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.
Topics: Age Factors; Aged; Animals; Behcet Syndrome; Eye Neoplasms; Female; Fluorescein Angiography; France; Fundus Oculi; Humans; Incidence; Male; Middle Aged; Ophthalmoscopy; Retrospective Studies; Sarcoidosis; Tertiary Care Centers; Tomography, Optical Coherence; Uveitis
PubMed: 31312906
DOI: 10.1007/s00417-019-04411-1 -
Medical Science Monitor : International... Dec 2019BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye....
Comparison of Methods of Endotamponade Used During 23-Gauge Pars Plana Vitrectomy and the Risk of Raised Intraocular Pressure During 24-Month Follow-Up: A Retrospective Study of 196 Patients.
BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye. Complications following PPV include raised intraocular pressure (IOP). This retrospective study aimed to compare methods of endotamponade used during 23-gauge PPV and the risk of raised IOP during 24-month follow-up at a single center. MATERIAL AND METHODS The study included 196 patients (age, 15-86 years; mean, 63.5 years) (196 eyeballs). There were 93 patients (47.45%) with a preoperative history of type 2 diabetes mellitus and 14 patients (7.14%) with a history of myopia. IOP was measured with Goldmann applanation tonometry at one-, three-, six-, 12-, and 24-month follow-up. The outcome was compared following endotamponade with silicone oil, sulfur hexafluoride (SF6), and balanced salt solution (BSS). RESULTS Mean IOP at one-month follow-up was 17.2 mmHg (±3.61 mmHg; range, 9-45 mmHg), and at 24-month follow-up was 17.3 mmHg (±3.23 mmHg; range, 7-30 mmHg). IOP following PPV was significantly associated with the indication for PPV (P=0.023), and the type of endotamponade used (P=0.049). In patients with silicone oil endotamponade, the risk of IOP at 24 months was increased by 2.3 times compared with SF6 or BSS endotamponade. Patients with SF6 endotamponade had a risk of IOP that was 3.3 times lower than for silicone oil tamponade or BSS tamponade. CONCLUSIONS Silicone oil endotamponade in PPV was associated with an increased risk of IOP at 24-month follow-up.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Endotamponade; Female; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Pars Planitis; Poland; Prospective Studies; Retinal Detachment; Retinal Diseases; Retrospective Studies; Risk Factors; Silicone Oils; Tonometry, Ocular; Vitrectomy; Vitreous Body
PubMed: 31811816
DOI: 10.12659/MSM.918114 -
Retina (Philadelphia, Pa.) Aug 2023To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal.
A New Technique of Pars Plana Vitrectomy With Microinterventional Nucleus Disassembly to Reduce the Energy of Fragmatome Lensectomy for Posteriorly Dislocated Crystalline Lens Removal.
PURPOSE
To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal.
METHODS
A microinterventional microfilament loop device was introduced through the sclerotomy created for the fragmatome to cleave the lens into smaller, manageable pieces.
RESULTS
Five cases were performed with this technique with improved visual acuity and no complications.
CONCLUSION
The use of microinterventional nucleus disassembly during pars plana vitrectomy for retained lens material is a novel approach with potential advantages including decreased operating time and reduced complications secondary to excessive production of ultrasound energy.
Topics: Humans; Pars Planitis; Vitrectomy; Lens, Crystalline; Postoperative Complications; Cataract Extraction
PubMed: 33315829
DOI: 10.1097/IAE.0000000000003048 -
European Journal of Ophthalmology Mar 2024To report a rare case of a 65 year old patient with a single caterpillar hair with localised lenticular opacity around it and no active inflammation.
PURPOSE
To report a rare case of a 65 year old patient with a single caterpillar hair with localised lenticular opacity around it and no active inflammation.
OBSERVATIONS
A single quiescent caterpillar hair embedded in the anterior lens capsule causing localised cataract around it. There was no other sign of ocular toxicosis and the patient was unaware of the presence of this intraocular foreign body.
CONCLUSIONS
Caterpillar hair (also known as setae) are a common cause of ophthalmia nodosa. These setae can penetrate intraocularly with ease to cause various forms of ocular toxicosis ranging from conjunctivitis, keratitis, pars planitis, chorioretinitis to even severe vitritis warranting enucleation. As per our knowledge and experience, no case of caterpillar hair without inflammation has been reported till date. We hereby report a rare case of a 65 year old patient with a single caterpillar hair embedded in the anterior lens capsule causing localised cataract around it without any active inflammation. In our opinion, if the eye is quiescent, the patient should be kept on close and long term follow-up and active intervention can be undertaken at the first instance of inflammation or if cataract progresses.
Topics: Animals; Humans; Aged; Lepidoptera; Eye Foreign Bodies; Cataract; Hair; Inflammation
PubMed: 37649334
DOI: 10.1177/11206721231199274 -
BMC Ophthalmology May 2016The aim of this work is to refine understanding of anatomical and functional alterations in eyes with Intermediate Uveitis (IU), their natural history in mild cases not...
BACKGROUND
The aim of this work is to refine understanding of anatomical and functional alterations in eyes with Intermediate Uveitis (IU), their natural history in mild cases not necessitating treatment and their response to treatment in severely affected eyes with macular edema.
METHODS
61 consecutive patients with IU presenting over a 6-year period were prospectively recruited into the study. Two subgroups of patients with IU were identified on the basis of the need or not for systemic cortico-steroid treatment. A group of healthy volunteers was identified for determining normal average central foveal thickness (CFT) values. Statistical comparisons were sought between patient sub-groups and with the group of normal volunteers for CFT and Best Corrected Visual Acuity (BCVA) at baseline and after 6 months. In a post hoc analysis, a cut-off value of CFT for systemic treatment initiation in IU was statistically identified and its sensitivity and specificity determined.
RESULTS
A statistically significant difference in mean CFT at baseline was observed between patients under systemic treatment and untreated patients (p = 0.0005) as well as between untreated patients and healthy volunteers. (p < 0.001) After six months difference in CFT between the two patients subgroups was no longer significant (p = 0.699). BCVA was worse for patients under systemic treatment. No statistically significant difference could be identified between the subgroup of untreated patients and the group of healthy volunteers either at baseline or after 6 months. Correlation between LogMAR visual acuity and central retinal thickness at baseline was strong (r = 0.7436, p < 0.0001, Pearson's correlation coefficient). The cut-off value of CFT for initiating systemic treatment was determined at 215.5 μm in a post hoc analysis (sensitivity 62.5 %, specificity 96.4 %).
CONCLUSIONS
Subclinical retinal thickening of mildly inflamed eyes with IU can occur though bearing no functional clinical significance and spontaneously resolving within 6 months. A cut-off CFT value for treatment of macular edema in IU, in the presence of other relevant morphological features on Optical Coherence Tomography, seems to emerge from post hoc analysis of collected data demonstrating strong specificity and moderate sensitivity.
Topics: Adrenal Cortex Hormones; Adult; Case-Control Studies; Cross-Sectional Studies; Female; Fluorescein Angiography; Fovea Centralis; Humans; Macular Edema; Male; Middle Aged; Prospective Studies; Tomography, Optical Coherence; Uveitis, Intermediate; Visual Acuity; Young Adult
PubMed: 27188332
DOI: 10.1186/s12886-016-0230-4 -
Archivos de La Sociedad Espanola de... Jun 2018
Topics: Adult; Erythema; Humans; Male; Pars Planitis; Tattooing; Tuberculin; Tuberculin Test; Tuberculosis, Ocular
PubMed: 29137823
DOI: 10.1016/j.oftal.2017.09.004