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Posterior lens capsule neovascularization treated with anti-VEGF complicated by phacogenic uveitis. Am J Ophthalmol Case Rep 2020; 20:100943. [PMID: 33204896 PMCID: PMC7652777 DOI: 10.1016/j.ajoc.2020.100943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/31/2020] [Accepted: 09/20/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose To report a case of neovascularization of posterior capsule (NVPC) successfully treated with intravitreal ranibizumab (Lucentis) and neodymium:YAG (Nd:YAG) capsulotomy, followed by phacogenic uveitis. Observations We report a systemically otherwise healthy 81-year-old male presenting with unilateral NVPC and iris (NVI) occurring five years after a central retinal vein occlusion. A single intravitreal injection of ranibizumab led to complete regression of NVPC and NVI within three weeks after which a Nd:YAG capsulotomy was performed. Two weeks later, the patient returned with a severe inflammatory reaction diagnosed as phacogenic uveitis and treated with surgical capsular bag/intraocular lens complex removal and peripheral pan-retinal photocoagulation. One-year follow-up demonstrated no recurrence of NVPC. Visual acuity remained at baseline of light perception. Conclusions We acknowledge that intravitreal anti-vascular endothelial growth factor treatment with Nd:YAG capsulotomy for NVPC is a rational option, but raise awareness to the rare possibility of phacogenic uveitis.
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El Hamichi S, Aguilar RJ, Kon Graversen V, Gold AS, Berrocal AM, Murray TG. Lens-Induced Uveitis Triggered by Intravitreal Injection 40 Years after Primary Congenital Cataract Surgery with Aphakia. Case Rep Ophthalmol 2020; 11:293-298. [PMID: 32774295 PMCID: PMC7383197 DOI: 10.1159/000508390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022] Open
Abstract
We report a case of a 42-year-old male with a history of bilateral congenital cataract surgery performed at 2 years of age. The patient was left with aphakia, secondary glaucoma, and a history of diabetic macular edema in the setting of diabetes mellitus type 1. The right eye became prephthisical from his congenital surgical repair, and his left eye presented with an acute pseudo-endophthalmitis developing after the seventh intravitreal injection to treat the macular edema. The eye then presented with decrease in vision, periocular injection, and a diffuse inflammatory reaction focused around the anterior residual lens capsule. The patient underwent surgical removal of the residual capsule and primary vitrectomy repair of the eye, achieving a significant improvement in visual symptoms and recovery of visual and anatomic function.
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Affiliation(s)
- Sophia El Hamichi
- Miami Ocular Oncology and Retina, Miami, Florida, USA.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - Aaron S Gold
- Miami Ocular Oncology and Retina, Miami, Florida, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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Nche EN, Amer R. Lens-induced uveitis: an update. Graefes Arch Clin Exp Ophthalmol 2020; 258:1359-1365. [PMID: 31907641 PMCID: PMC7223998 DOI: 10.1007/s00417-019-04598-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022] Open
Abstract
Ocular inflammation resulting from a lens pathology is rare in the absence of a cataract or lens trauma because of the lens' immune privilege. The lens can be a source of ocular inflammation when the capsule is broken or when lens proteins leak out through an intact capsule. These uveitides are termed lens-induced uveitis (LIU) and are often associated with advanced cataracts. Cataracts are part of the normal aging process, and in today's world, cataract surgery is a safe and affordable means of vision restoration in the developed world. In patients with neglected cataracts and in the developing world where cataract surgery rates are lower, LIU rates are higher together with the associated complications. In this literature review, we intend to equip the armamentarium of the practicing ophthalmologist with an updated knowledge on the demographic features, clinical characteristics, treatment options, and outcomes of LIU. This is to highlight the need for timely management of cataracts before the development of advanced cataracts and LIU.
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Affiliation(s)
- Eleanor Ngwe Nche
- Department of Ophthalmology, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel.
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Abstract
INTRODUCTION Phaco-antigenic glaucoma occurs in less than 1% of cataract surgeries. Managing this rare complication is challenging, especially when there are few documented cases reported. We describe the challenges of managing a case of bilateral phaco-antigenic glaucoma following uncomplicated cataract surgery requiring viscocanalostomy. CASE DESCRIPTION An 82-year-old atopic lady presented with a 2-day history of painful injected right eye. She was 4 days post left and 8 days post right uncomplicated cataract surgery. On examination, the anterior chambers were deep with no hypopyon. Intraocular pressure was raised at 38 mmHg in the right eye and 24 mmHg in the left eye initially. However, intraocular pressure remained uncontrolled despite maximum medical treatment; she attended A + E six times within 11 days with intraocular pressures of up to 48 mmHg in the right eye and 46 mmHg in the left eye. A vitreous biopsy was reported negative for infective organisms. Eventually, bilateral viscocanalostomies were performed and vision improved to 0.24 logMAR in both eyes with intraocular pressures of 8 mmHg in the right eye and 10 mmHg in the left eye. CONCLUSION We present a rare presentation of phaco-antigenic glaucoma following an uncomplicated cataract surgical procedure with good results following timely intervention.
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Zhang W, Proia AD, Sharma S, Fleischman D. Iris melanin pigment as a masquerade of Gram-positive cocci after penetrating ocular trauma. Digit J Ophthalmol 2019; 24:27-30. [PMID: 30800011 DOI: 10.5693/djo.02.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a case of penetrating eye injury that resulted in a post-injury day 1 hypopyon, leading to concern for endophthalmitis and phacoanaphylaxis. A Gram stain prepared by the clinical microbiology laboratory was interpreted as Gram-positive cocci (GPC). However, when cultures returned negative, further investigation with microbiology and pathology found that what was thought to be GPC was actually iris melanin pigment. Although endophthalmitis following ocular trauma remains an important diagnosis to consider, this microbiologic masquerade of iris melanin pigment as GPC should be considered in cases where Gram stain is positive yet cultures return negative.
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Affiliation(s)
- Wenlan Zhang
- Duke University Eye Center, Durham, North Carolina
| | - Alan D Proia
- Duke University Eye Center, Durham, North Carolina.,Department of Pathology, Duke University, Durham, North Carolina
| | - Sumit Sharma
- Cleveland Clinic, Cole Eye Institute, Cleveland, Ohio
| | - David Fleischman
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
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Wang LC, Kim JW, Rao NA. Coexisting Phacoanaphylaxis and Choroidal Melanoma: An Unusual Intraocular Inflammation. Ocul Immunol Inflamm 2017; 26:1278-1282. [PMID: 28960124 DOI: 10.1080/09273948.2017.1347693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To describe an unusual case of panuveitis in coexisting choroidal melanoma and phacoanaphylaxis. METHODS Clinical records of the patient with intraocular melanoma and pathologic findings of the affected eye were reviewed. Composition of inflammatory infiltrates involving the tumor and lens was evaluated immunohistochemically. RESULTS Histologically, tumor showed a choroidal mixed cell type malignant melanoma with infiltration of inflammatory cells. The globe also showed typical features of phacoanaphylaxis, characterized by disruptions of the lens capsule with zonal granulomatous inflammation. The inflammatory infiltration revealed the predominant presence of both cytotoxic T cells and histiocytes in phacoanaphylaxis and intra-tumoral inflammation. CONCLUSIONS The current clinico-pathologic case report suggests that a long standing intraocular melanoma can present with phacoanaphylaxis. The immunophenotype of the inflammatory infiltrates at both sites, lens and the tumor, is similar, cytotoxic T cells and histiocytes, favoring a common immune inflammatory process directed at the tumor and the lens.
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Affiliation(s)
- Lei-Chi Wang
- a Department of Ophthalmology and Pathology, USC Roski Eye Institute , Keck School of Medicine of the University of Southern California , Los Angeles , California , USA.,b Department of Pathology and Laboratory Medicine , Taipei Veterans General Hospital , Taipei , Taiwan.,c School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Jonathan W Kim
- a Department of Ophthalmology and Pathology, USC Roski Eye Institute , Keck School of Medicine of the University of Southern California , Los Angeles , California , USA
| | - Narsing A Rao
- a Department of Ophthalmology and Pathology, USC Roski Eye Institute , Keck School of Medicine of the University of Southern California , Los Angeles , California , USA
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7
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Guffey Johnson J, Margo CE. Intraocular inflammatory mass associated with lens-induced uveitis. Surv Ophthalmol 2017; 62:541-545. [PMID: 28069494 DOI: 10.1016/j.survophthal.2016.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 01/30/2023]
Abstract
Intraocular inflammatory tumefactions large enough to simulate neoplasms are uncommon. We report a patient with a large intraocular inflammatory mass composed of cells with features of histiocytes and myofibroblasts that was associated with lens-induced uveitis. The spindle cell mass appears to have arisen as an exaggerated response to exposed lens fibers. Although information from immunohistochemistry and cytogenetics has advanced the classification of inflammatory tumefactions, this case highlights the challenges in establishing the nature of these lesions.
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Affiliation(s)
- Jean Guffey Johnson
- Department of Pathology, James A. Haley Veterans Affairs Hospital, Tampa, Florida, USA
| | - Curtis E Margo
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA; Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
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8
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Rajesh B, Hussain R, Gopalakrishnan M, Giridhar A. Phacoantigenic Reaction Masquerading as Postoperative Endophthalmitis in a Silicone Oil-filled Eye. Middle East Afr J Ophthalmol 2016; 23:318-320. [PMID: 27994397 PMCID: PMC5141627 DOI: 10.4103/0974-9233.194088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 72-year-old phakic male with immature cataract underwent vitrectomy with silicone oil injection in his left eye for rhegmatogenous retinal detachment. The surgery was uneventful except for lens touch during vitrectomy. Two weeks postoperatively, he presented with circumcorneal congestion, hypopyon, and absent fundal glow suggestive of postoperative endophthalmitis. The patient was managed conservatively as he refused further intervention. Five weeks later, ocular inflammation subsided following posterior dislocation of the cataractous lens, thus revealing the error in our initial diagnosis. Following surgical intervention, the inflammation gradually settled. However, the eye progressed to the prephthisical stage. Phacoantigenic reaction following lens touch during vitreoretinal surgery is very rare. Hence, surgeons should maintain a high index of suspicion in similar case, and prompt intervention is warranted to prevent further complications.
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Affiliation(s)
- Bindu Rajesh
- Department of Vitreoretina, Giridhar Eye Institute, Kochi, Kerala, India
| | - Rameez Hussain
- Department of Vitreoretina, Giridhar Eye Institute, Kochi, Kerala, India
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9
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Margo CE, Harman LE. Autoimmune disease: Conceptual history and contributions of ocular immunology. Surv Ophthalmol 2016; 61:680-8. [PMID: 27131478 DOI: 10.1016/j.survophthal.2016.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/13/2016] [Accepted: 04/21/2016] [Indexed: 12/30/2022]
Abstract
Medical historians identify the mid-20th century as the time when the scientific and medical communities acknowledged the existence of autoimmune disease. Several conditions including sympathetic ophthalmia and endophthalmitis phacoanaphylactica, however, were proposed as autoimmune disorders much earlier. During the first half of the century, autoimmune disease was viewed as biologically implausible. Paul Ehrlich coined the term horror autotoxicus to emphasize that autoimmunity would contradict nature's aversion to self-injury. The discoveries of allergy and anaphylaxis were the first clues that the immune system was capable of self-harm. A major obstacle to comprehending the pathogenesis of autoimmunity was how the immune system distinguishes foreign from self, a process eventually understood in the context of immune tolerance. Investigators of sympathetic ophthalmia and endophthalmitis phacoanaphylactica were positioned to invalidate horror autotoxicus but lacked sufficiently convincing experimental and clinical evidence to accomplish the task. Seminal studies of chronic thyroiditis and a series of clinical laboratory breakthroughs led to the general acceptance of autoimmune disease in the 1950s. The travails encountered by ophthalmic investigators offer insights into the how medical ideas take shape. We review the contributions of ocular immunology to the conceptual development of autoimmune disease and explore the reasons why the concept caught on slowly.
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Affiliation(s)
- Curtis E Margo
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA; Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
| | - Lynn E Harman
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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10
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Kim JH, Yoo WS, Kong MG, Han YS, Chung IY, Seo SW, Yoo JM, Kim SJ. A Case of Phacoanaphylactic Uveitis Presenting as Endophthalmitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.9.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Hye Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Woong Sun Yoo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Min Gui Kong
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Seong Wook Seo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Ji Myong Yoo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Seong Jae Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
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11
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Erickson B, Rachitskaya A, Shane T. A 48-year-old woman with redness, photophobia, and eye discomfort. Digit J Ophthalmol 2013; 19:42-5. [PMID: 24109250 DOI: 10.5693/djo.03.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Safneck JR. Endophthalmitis: A review of recent trends. Saudi J Ophthalmol 2012; 26:181-9. [PMID: 23960990 PMCID: PMC3729827 DOI: 10.1016/j.sjopt.2012.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 02/28/2012] [Indexed: 11/19/2022] Open
Abstract
Endophthalmitis is a feared complication of trauma, surgical procedures and septicemia. Although uncommon, its potential for significant visual loss is well recognized. Especially over the past decade, complicated surgeries and medical techniques have increased and seriously ill patients are being sustained in ever increasing numbers. New pathogens are being recognized and known ones reclassified thanks to advances in molecular analysis. Continuously evolving PCR methodologies also add a new dimension to the diagnosis of infectious endophthalmitis. As well, medical literature is now truly international, encompassing studies from around the world that expand our understanding of ocular infectious disease. This report reviews some of these changes as they relate to endophthalmitis and particularly to the spectrum of organisms involved.
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Affiliation(s)
- Janice R. Safneck
- Departments of Pathology and Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Diagnostic Western blot for lens-specific proteins in aqueous fluid after traumatic lens-induced uveitis. Jpn J Ophthalmol 2009; 53:436-9. [PMID: 19763765 DOI: 10.1007/s10384-009-0671-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 01/15/2009] [Indexed: 10/20/2022]
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14
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Papaconstantinou D, Georgalas I, Kourtis N, Krassas A, Diagourtas A, Koutsandrea C, Georgopoulos G. Lens-induced glaucoma in the elderly. Clin Interv Aging 2009; 4:331-6. [PMID: 19696897 PMCID: PMC2722872 DOI: 10.2147/cia.s6485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lens-induced glaucoma comprises a number of different glaucomatous processes occurring in the elderly that share in common the role of the crystalline lens in the mechanism of increase in intraocular pressure. We will review the anatomic predisposing factors, their physiology, signs and symptoms, and therapeutic approach. We will consider two studies and discuss the visual results and risk factors associated with these pathologic conditions.
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15
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Murase KH, Goto H, Kezuka T, Yamauchi Y, Usui M. A case of lens-induced uveitis following metastatic endophthalmitis. Jpn J Ophthalmol 2007; 51:304-6. [PMID: 17660994 DOI: 10.1007/s10384-007-0446-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
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16
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Mohammadpour M, Jafarinasab MR, Javadi MA. Outcomes of acute postoperative inflammation after cataract surgery. Eur J Ophthalmol 2007; 17:20-8. [PMID: 17294379 DOI: 10.1177/112067210701700104] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine characteristics and final visual and surgical outcomes of patients who experienced early onset postoperative inflammation after cataract surgery and their early and late complications. METHODS This is a prospective case series of 126 patients out of 1500 cases who underwent cataract surgery and experienced early onset postoperative inflammation during the first 2 weeks after cataract surgery. All the patients received complete ocular examinations at onset of signs and symptoms of inflammation. A total of 110 patients with follow-up examinations between 3 and 30 months after recovery of early onset postoperative inflammation (mean follow-up 11.6 months) were enrolled in the next part of the study to evaluate the final visual and surgical outcomes. Background systemic and ocular diseases, type of surgery, type of intraocular lenses and viscoelastic agent, early and late complications, and final best-corrected visual acuity were studied. RESULTS Among 1500 patients, 126 cases (8.4%) had early onset postoperative inflammation, 64 cases (50.7%) were male, and 62 cases (49.3%) were female. Early complications were posterior synechia in 9 cases (7.1%), pupillary block in 2 cases (1.5%), and acute rise of intraocular pressure in 6 cases (4.7%). Late complications consisted of posterior capsular opacity in 38 cases (34.5%) and cystoid macular edema in 4 cases (3.2%). Peak of signs and symptoms of inflammation was during 2 weeks after surgery and all patients responded well to topical steroids. Final best-corrected visual acuity (BCVA) was 20/30 and better in 76 cases (69%), between 20/40 and 20/80 in 24 cases (22%), and less than 20/80 in 10 cases (9%). All cases with BCVA less than 20/80 had ocular diseases like choroidal neovascularization scar or age-related macular degeneration, advanced glaucoma, or corneal opacity. CONCLUSIONS Early onset postoperative inflammation causes pain, decreased vision, and patient anxiety in the acute phase but neither decreases final visual acuity nor has any significant or permanent ocular sequels.
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Affiliation(s)
- M Mohammadpour
- Ophthalmic Research Center, Labbafi Nejad Medical Center, Tehran, Iran.
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17
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Gelderman MP, Charukamnoetkanok P, Brady JP, Hung L, Zigler JS, Wawrousek EF, Vistica BP, Fortin E, Chan CC, Gery I. A novel inflammatory eye disease induced by lymphocytes from knockout mice sensitized against the deleted ocular antigen. Clin Exp Immunol 2003; 133:177-81. [PMID: 12869022 PMCID: PMC1808771 DOI: 10.1046/j.1365-2249.2003.02218.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lens-associated uveitis (LAU), a severe inflammatory eye disease, is thought to be mediated by autoimmunity against lens crystallins. Previously described animal models for this disease are antibody-mediated, since no cellular response to self crystallins could be induced in experimental animals. Here, we describe a new model for LAU, in which lymphocytes from knockout mice deficient in alphaB-crystallin are sensitized against the deleted protein and induce severe ocular inflammation when adoptively transferred into wild type recipients. Similar to LAU, the experimental disease developed only following rupture of the lens capsule, produced in this study by capsulotomy; no disease was detected in recipient eyes with no capsulotomy, or in those treated with cautery, or in eyes affected by systemic treatment with sodium iodate, lipopolysaccharide or X-irradiation. The ocular changes in affected eyes included heavy cellular infiltration and proteinaceous exudate in both the anterior and posterior segments of the eye, that reached their peak on day 4 following cell transfer and subsided quite rapidly thereafter.
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Affiliation(s)
- M P Gelderman
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1857, USA
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18
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Abstract
has been described in humans and many animal species. Traumatic rupture of the lens capsule may result in vision-threatening intraocular inflammation that is poorly responsive to medical management. Phthisis bulbi, persistent uveitis or glaucoma often occurs in these eyes. Surgical removal of the lens material is generally indicated shortly after the injury in an effort to preserve vision. Leaking of lens proteins through an intact lens capsule may result in a lympho-plasmacytic anterior uveitis. This is most commonly associated with the presence of a hypermature cataract. The presence of lens-induced uveitis prior to cataract surgery significantly reduces the success rate of cataract surgery. Small amounts of circulating lens proteins maintain a normal T-cell tolerance for lens proteins. Lens-induced uveitis develops when a breakdown occurs of this normal T-cell tolerance. Immune complexes play an important role in the tissue damage associated with the ensuing inflammation. Other factors associated with the tissue damage include hydroxyl radicals, nitroxide radicals, and hydrogen peroxide and arachidonic acid metabolites. Treatment consists of topical and systemic anti-inflammatory medications, mydriatic agents, and glaucoma medications when indicated. Experimental pharmacological agents include dual cyclooxygenase/lipoxygenase inhibitors, interleukin-1 blockers, antioxidants and hydroxyl radical scavengers.
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Affiliation(s)
- A. Van Der Woerdt
- Department of Medicine, Bobst Hospital of the Animal Medical Center, 510 East 62nd Street, New York, NY
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Tran VT, Mermoud A, Herbort CP. Appraisal and management of ocular hypotony and glaucoma associated with uveitis. Int Ophthalmol Clin 2000; 40:175-203. [PMID: 10791265 DOI: 10.1097/00004397-200004000-00014] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- V T Tran
- Hôpital Jules Gonin, University of Lausanne, Switzerland
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20
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Hochman M, Sugino IK, Lesko C, Friedman AH, Zarbin MA. Diagnosis of Phacoanaphylactic Endophthalmitis by Fine Needle Aspiration Biopsy. Ophthalmic Surg Lasers Imaging Retina 1999. [DOI: 10.3928/1542-8877-19990201-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Endophthalmitis is an inflammatory reaction of intraocular fluids or tissues. Infectious endophthalmitis is one of the most serious complications of ophthalmic surgery. Occasionally, infectious endophthalmitis is the presenting feature of an underlying systemic infection. Successful management of infectious endophthalmitis depends on timely diagnosis and institution of appropriate therapy. Recognition of the different clinical settings in which endophthalmitis occurs and awareness of the highly variable presentation it may have facilitate timely diagnosis. Biopsy of intraocular fluid/tissue is the only method that permits reliable diagnosis and treatment. The different presenting clinical settings, a rational approach to diagnosis (i.e., when, what, and how to biopsy), and the treatment of infectious endophthalmitis are reviewed.
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Affiliation(s)
- M S Kresloff
- Department of Ophthalmology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103-2499, USA
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22
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Besen G, Freeman WR. Intraoperative Recognition of Retinal Vasculitis in a Patient With Early Lens-Induced Uveitis. Ophthalmic Surg Lasers Imaging Retina 1997. [DOI: 10.3928/1542-8877-19970101-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Abstract
Phacoanaphylactic endophthalmitis is a rare disease that develops infrequently after lens injury. The recent popularity of extracapsular cataract extraction with intraocular lens implants and the recently described possible association of low-grade infections have stimulated renewed interest in phacoanaphylactic endophthalmitis. It was formerly believed that this disease was due to the rejection of a lens protein that had been sequestered prior to lens injury. Recent observations indicate that this concept is incorrect and that phacoanaphylactic endophthalmitis represents altered tolerance to lens proteins. Clinical and histopathologic features as well as controversies in clinical management are discussed. Recent evidence concerning mechanisms of pathogenesis is reviewed [corrected].
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Affiliation(s)
- G E Marak
- Georgetown University, Washington, D.C
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24
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Abstract
The crystalline lens is implicated as a causative element in producing several forms of glaucoma. Etiologically they represent a diversity in the presentation of the glaucomatous process. These conditions include glaucoma related to: lens dislocation (ectopia lentis), lens swelling (intumescent cataract), classical pupillary block, aqueous misdirection--ciliary block, phacoanaphylaxis, lens particle, and phacolytic glaucoma. The management of elevated intraocular pressure often requires altering the intraocular relationship of anatomic structures surrounding the lens or lens removal. We will review the entities that produce these lens-induced glaucomatous conditions and suggest a rational approach to their diagnosis and treatment.
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Affiliation(s)
- J P Ellant
- Department of Ophthalmology, Lenox Hill Hospital, New York
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