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Pépin F, Namkung S, Koh L, Sims JL, Niederer RL. Etiology of hypopyon in patients presenting acutely to the emergency eye department and characteristics of hypopyon uveitis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00136-4. [PMID: 38815955 DOI: 10.1016/j.jcjo.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/20/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To examine the etiology of undifferentiated hypopyon presenting acutely and to better characterize hypopyon uveitis. METHODS Patients with hypopyon were retrospectively identified from presentations to the emergency eye department between January 2015 and 2022 and also from a uveitis database of 3,925 patients seen between January 2008 and January 2022. A total of 426 episodes of hypopyon occurred in 375 eyes in 359 patients, and medical records were reviewed for each patient. RESULTS In all, 222 hypopyon episodes were due to uveitis, and 204 were due to nonuveitic causes. The most common cause of hypopyon was HLA-B27-associated uveitis in 146 patients (34.3%). The next most common causes were infectious keratitis in 125 patients (29.3%) and endophthalmitis in 63 patients (14.8%). Compared with those presenting with nonuveitic hypopyon, patients with uveitis tended to present younger (p < 0.001), were more likely to be male (p < 0.0001), had better initial and final visual acuities (p < 0.001), and had lower intraocular pressures (p = 0.030). CONCLUSION About half of the cases of hypopyon were secondary to uveitis, most of them being associated with HLA-B27 conditions with a good prognosis, and the other half were secondary to infectious keratitis and endophthalmitis with a poor prognosis.
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Affiliation(s)
- François Pépin
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec, QC.
| | - Soobin Namkung
- Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland-Auckland City Hospital, Auckland, New Zealand
| | - Lilian Koh
- Department of Ophthalmology, Woodlands Health, National Healthcare Group Eye Institute, Singapore
| | - Joanne L Sims
- Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland-Auckland City Hospital, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Te Whatu Ora Te Toka Tumai Auckland-Auckland City Hospital, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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2
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Maya Naranjo MI, Vallejo López S, Mesa Mesa S, Ortiz Pérez M, López Posada M, Gaviria Bravo ML, González Alviar ME. Intravitreal methotrexate in type B lymphoblastic leukemia-Case Report. Front Oncol 2023; 13:1237204. [PMID: 37700830 PMCID: PMC10493324 DOI: 10.3389/fonc.2023.1237204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023] Open
Abstract
Leukemia is a common neoplasia that, in its progress, can have ocular involvement due to direct infiltration or secondary to hematological alterations typical of the disease. These findings are consistent with an involvement of the central nervous system and are thus related to the prognosis. Despite the existing systemic therapies, there needs to be more literature that shows the treatment in the ocular involvement of this disease. A case report of a child with ocular involvement due to treatment-refractory acute lymphoblastic leukemia, successfully managed with intravitreal methotrexate, is presented.
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Affiliation(s)
| | | | - Sara Mesa Mesa
- Department of Ophthalmology, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Mónica Ortiz Pérez
- Department of Ophthalmology, Universidad Pontificia Bolivariana, Medellín, Colombia
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3
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Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Sechrist SJ, Zhang YS, Brodie FL. Bilateral Hypopyon in a Young Woman. JAMA Ophthalmol 2023; 141:598-599. [PMID: 37079313 DOI: 10.1001/jamaophthalmol.2023.0939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
A 28-year-old woman presented to the emergency department with a 5-day history of bilateral blurry vision, eye redness, discharge, photophobia, and pain. There were more than 20 cells per high-power field of 1 mm × 1 mm beam, with fibrin bilaterally and 2.5-mm hypopyon in the right eye and 2.7-mm hypopyon in the left eye. What would you do next?
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Affiliation(s)
| | | | - Frank L Brodie
- Department of Ophthalmology, University of California, San Francisco
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Corbitt K, Nowatzky J. Inflammatory eye disease for rheumatologists. Curr Opin Rheumatol 2023; 35:201-212. [PMID: 36943695 PMCID: PMC10461883 DOI: 10.1097/bor.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review provides a framework for understanding inflammatory eye disease diagnosis, differential diagnosis, and management for rheumatologists. Uveitis, scleritis, episcleritis, peripheral ulcerative keratitis, and orbital inflammation are all discussed. The goal is to facilitate the development of approaches to inflammatory eye diseases that will help rheumatologists co-manage these patients with eye care providers specializing in ocular inflammation. RECENT FINDINGS In recent years, studies have aimed to advance biologic treatments and define standard-of-care therapy. Inflammatory eye diseases are highly heterogeneous and often rare, which poses significant challenges to their research and the interpretation of existing data. To date, glucocorticoids, mycophenolate, methotrexate, and TNF inhibitors remain the mainstay of treatment options for many of these diseases. SUMMARY Patients with inflammatory eye diseases require multidisciplinary care for best outcomes, frequently including rheumatologists. Understanding the differentials, diagnostics, and treatment are essential to preserving vision in these patients. The diverse nature of the disease processes within this field requires focusing on specific disease phenotypes and endotypes in research and clinical practice.
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Affiliation(s)
- Kelly Corbitt
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
| | - Johannes Nowatzky
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology, NYU Langone Behçet’s Disease Program, NYU Ocular Rheumatology Program
- New York University Grossman School of Medicine, Department of Pathology
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Altman MT, Staubach Z, Dunlap J, Zaki A, Skalet AH, Leonard J, Lin P. PSEUDOPANUVEITIS AS A HARBINGER FOR SYSTEMIC LEUKEMIA RECURRENCE. Retin Cases Brief Rep 2023; 17:117-119. [PMID: 34081042 PMCID: PMC10421638 DOI: 10.1097/icb.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a patient with a history of pre-B-cell acute lymphoblastic leukemia in remission, who developed recurrent alternating intraocular leukemia manifesting with pseudohypopyon, uveal mass, and serous retinal detachment. In multiple instances, this constellation of ocular findings preceded systemic leukemia recurrence. METHOD Case report. RESULTS A 29-year-old man with a history of pre-B-cell acute lymphoblastic leukemia, in remission after a hematopoietic stem cell transplant, presented with pseudohypopyon, uveal lesions, and serous retinal detachment of the right eye. Comprehensive workup for infectious and inflammatory etiologies was unremarkable, and a bone marrow biopsy revealed systemic recurrence of leukemia. One year later, while again in remission, the patient developed a pseudohypopyon, uveal mass, and serous retinal detachment of the other eye. Repeat bone marrow biopsy showed impending leukemia relapse, which occurred 1 month later. Orbital radiation resulted in complete ocular resolution. CONCLUSION The constellation of pseudohypopyon, serous retinal detachment, and uveal mass (pseudopanuveitis) should be recognized as a harbinger for systemic pre-B ALL recurrence.
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Affiliation(s)
| | - Zane Staubach
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Jennifer Dunlap
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Amr Zaki
- Casey Eye Institute, Oregon Health & Science University
| | - Alison H. Skalet
- Casey Eye Institute, Oregon Health & Science University
- Department of Radiation Medicine, Oregon Health & Science University
- Department of Dermatology, Oregon Health & Science University
| | - Jessica Leonard
- Department of Hematology and Medical Oncology, Oregon Health & Science University
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University
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7
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Pastore S, Tumminelli C, Burlo F, Tommasini A. Uncommon presentation of eye involvement in juvenile psoriatic arthritis relapse. BMJ Case Rep 2022. [DOI: 10.1136/bcr-2022-252252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Thulasidas M, Patyal S. Acute Unilateral Hypopyon Uveitis and Secondary Glaucoma in an Adult With Relapsing Acute Lymphoblastic Leukemia. Cureus 2022; 14:e24968. [PMID: 35698696 PMCID: PMC9188782 DOI: 10.7759/cureus.24968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/05/2022] Open
Abstract
Anterior segment infiltration in acute lymphoblastic leukemia (ALL) presenting as hypopyon uveitis in an adult is rare. We report this case as an uncommon presentation in a patient in remission after chemotherapy for ALL. In addition to the hypopyon, the patient presented with congested eye caused by secondary raised intraocular pressure. There is a need to maintain a high index of clinical suspicion in uveitis cases, as early diagnosis of ocular malignancy can save vision. Atypical unilateral hypopyon, even in adults, can be an indication of relapsing ALL.
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9
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Gutteridge IF. 'Can you touch your toes?' spondyloarthropathies and acute anterior uveitis for primary eyecare practitioners. Clin Exp Optom 2021; 105:143-148. [PMID: 34538202 DOI: 10.1080/08164622.2021.1971933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The rheumatological diseases known as spondyloarthropathies (SpAs) are reviewed with respect to the current classifications of SpAs and from the perspective of ophthalmic practitioners. The focus is on the most common spondyloarthropathy, ankylosing spondylitis (AS), and the key symptoms, such as inflammatory back pain. The association with HLA-B27 and acute anterior uveitis (AAU) and the major clinical considerations for primary eye care practitioners are reviewed. An atypical case study illustrates difficulties in the detection and diagnosis of ankylosing spondylitis.
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Affiliation(s)
- Ian F Gutteridge
- Department of Optometry and Vision Sciences, The University of Melbourne Parkville, Parkville, Australia
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10
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Scoville NM, Feng S, Taylor MR, Herlihy E, Wilkes JJ, Chisholm KM, Tarczy-Hornoch K. Bilateral Pseudo-hypopyon as Presenting Symptom of Acute Monocytic Leukemia in an 8-Month-Old Infant. J Pediatr Ophthalmol Strabismus 2021; 58:e30-e33. [PMID: 34592122 DOI: 10.3928/01913913-20210708-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A previously healthy 8-month-old female infant presenting with lethargy and bilateral eye redness and cloudiness had bilateral hypopyon uveitis, which persisted despite topical steroids. Cytology of the anterior chamber and cerebrospinal fluid and flow cytometry of cerebrospinal fluid revealed malignant cells consistent with acute monocytic leukemia. Bone marrow aspirates and biopsies showed no evidence of disease. She was treated with systemic and intrathecal chemotherapy, with subsequent remission and resolution of pseudo-hypopyon. Anterior chamber involvement is a rare presentation of acute myeloid leukemia and may indicate concurrent central nervous system involvement. This has important therapeutic implications, because additional treatment modalities such as intrathecal chemotherapy, local chemotherapy, and ocular radiation may be required to overcome the "pharmacologic sanctuary" created by the blood-ocular barrier. [J Pediatr Ophthalmol Strabismus. 2021;58(5):e30-e33.].
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Ksiaa I, Abroug N, Mahmoud A, Ben Amor H, Attia S, Khochtali S, Khairallah M. Hypopyon: Is-it Infective or Noninfective? Ocul Immunol Inflamm 2021; 29:817-829. [PMID: 34255602 DOI: 10.1080/09273948.2021.1922708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypopyon usually corresponds to the sedimentation of white blood cells, and it signifies severe intraocular inflammation. This key clinical sign may occur in association with a wide variety of infectious, inflammatory, and neoplastic conditions that may be sight- and, occasionally, life-threatening. A careful history and thorough clinical examination are the cornerstones for orienting the differential diagnosis, identifying the causative agent, and initiating prompt and appropriate treatment. This review outlines the clinical characteristics and management of hypopyon in relation with the underlying causative infectious or noninfectious ocular or systemic diseases.
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Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Taher Sfar University Hospital of Mahdia, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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12
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Hiyama T, Harada Y, Kiuchi Y. Unilateral Hypopyon in an Elderly Man With Dementia. JAMA Ophthalmol 2021; 139:575-576. [PMID: 33630030 DOI: 10.1001/jamaophthalmol.2020.4633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tomona Hiyama
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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13
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Chatziralli IP, Keryttopoulos P, Papazisis L, Moschos MM. Hypopyon in the context of tuberculous uveitis. Clin Exp Optom 2021; 95:241-3. [DOI: 10.1111/j.1444-0938.2011.00680.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Irini P Chatziralli
- 1st Department of Ophthalmology, University of Athens, Athens, Greece
- Departments of Ophthalmology
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14
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Gonzalez Collazo MP, Rebollo Rodriguez NP, Santiago-Vazquez M, Crespo-Ramos SM, Marcos-Martinez MJ, Villegas VM, Oliver AL. Bilateral hypopyon in syphilitic uveitis. Am J Ophthalmol Case Rep 2021; 21:101007. [PMID: 33437894 PMCID: PMC7788489 DOI: 10.1016/j.ajoc.2020.101007] [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: 05/29/2020] [Revised: 10/25/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report an atypical bilateral hypopyon presentation of syphilitic uveitis. OBSERVATIONS A 38-year-old male presented with a 2-day history of bilateral progressive visual loss, conjunctival hyperemia, and photophobia. Initial ophthalmologic examination revealed bilateral hypopyon and vitritis that limited the examination of the posterior segment. The physical exam revealed cervical lymphadenopathy, glossal leukoplakia, erythematous maculae on the hard palate, erythematous macular lesions on both palms, onychodystrophy, onycholysis, and psoriasiform plaques on both plantar surfaces, testicular tenderness, and hypopigmented patches on the scrotal and perianal skin. A therapeutic and diagnostic vitrectomy was performed on the right eye, and the intraoperative findings were consistent with severe vitritis and pre-retinal precipitates. The cytopathologic analysis of the right vitreous revealed a mixed inflammatory process composed of lymphocytes, histiocytes, and neutrophils in a proteinaceous background. Laboratory testing revealed positive serum RPR, CSF FTA-Abs and VDRL, and HIV serology. Treatment with a 2-week course of intravenous penicillin G 4 million units every 4 hours and topical corticosteroids resulted in complete resolution of the uveitis. CONCLUSIONS AND IMPORTANCE Bilateral hypopyon uveitis may be a rare presentation of syphilitic uveitis. As with most forms of uveitis, syphilis should be considered in the differential diagnosis of patients presenting with bilateral hypopyon.
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Affiliation(s)
- Monica P. Gonzalez Collazo
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
| | - Nicole P. Rebollo Rodriguez
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
| | - Marely Santiago-Vazquez
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Dermatology, San Juan, PR, USA
| | - Susanne M. Crespo-Ramos
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Pathology and Laboratory Medicine, San Juan, PR, USA
- Puerto Rico Medical Services Administration Pathology Laboratory, San Juan, PR, USA
| | - Maria J. Marcos-Martinez
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Pathology and Laboratory Medicine, San Juan, PR, USA
- Puerto Rico Medical Services Administration Pathology Laboratory, San Juan, PR, USA
| | - Víctor M. Villegas
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
| | - Armando L. Oliver
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
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15
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Bajwa A, Maleki A, Payal AR, Fandiño A, Padrón MIM, Walsh M, Foster CS. Efficacy and Safety of Infliximab in HLA-B27-associated Ocular Inflammation Refractory or Intolerant to Conventional Immunomodulatory Therapy. J Ophthalmic Vis Res 2020; 15:459-469. [PMID: 33133436 PMCID: PMC7591838 DOI: 10.18502/jovr.v15i4.7786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/10/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose To determine the efficacy and safety of infliximab therapy in patients with HLA B-27-associated ocular inflammation resistant or intolerant to conventional immunomodulatory therapy. Methods This was a retrospective observational case series. All cases were uveitic patients with positive HLA-B27, confirmed through HLA testing, resistant or intolerant to conventional immunomodulatory therapy. The primary outcome of the study was to identify the efficacy of infliximab determined by the control of inflammation, duration of remission, and the ability to reduce conventional immunomodulatory therapy. The secondary outcome was an improvement of two or more lines of best-corrected visual acuity (BCVA) on the Snellen visual acuity chart. Results Twenty-four patients (38 eyes) were included in the study. All patients were followed for 24 months. Twenty-one (87.5%) patients completed 24 months of follow-up. Sixteen (66.7%) patients had active uveitis at the beginning of therapy. One patient out of these active patients had active inflammation at the end of follow-up period. Thirteen (87.5%) out of sixteen active patients were in steroid-free remission. The mean duration of treatment to induce remission was 16.5 months (range 6–24 months). Corticosteroid was stopped in 19 (90.5%) patients by the end of the study. At the end of the study, in patients who achieved remission, 14 (58.3%) patients were in remission on infliximab therapy and 6 (25%) patients were in remission off infliximab therapy. Of the 38 eyes, 8 (21.05%) showed improvement in BCVA (three eyes had successful cataract extraction with intraocular lens implantation during infliximab therapy with no subsequent inflammation), while 26 eyes (68.4%) had stable BCVA over the 24-month study period. The side effects included allergic reaction, fatigue, cellulitis, headache, restlessness, elevation of liver enzymes, and anemia. Two patients (n = 24, 8.3%) experienced severe adverse effects and the treatment was stopped prematurely in these two patients. Conclusion Infliximab might induce and maintain the steroid-free remission in HLA-B27-associated ocular inflammation in patients resistant or intolerant to conventional immunomodulatory therapy.
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Affiliation(s)
- Asima Bajwa
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts.,Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts.,Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Abhishek R Payal
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts.,University of Pennsylvania, Scheie Eye Institute, Philadelphia, Pennsylvania
| | - Adriana Fandiño
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts.,Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - María Inés Menéndez Padrón
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts.,Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Marisa Walsh
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts.,Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - C Stephen Foster
- Harvard Medical School, Boston, Massachusetts.,Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
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16
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Zhou HP, Tanaka R, Kaburaki T. Multidisciplinary Diagnostic Approach in Intraocular Lymphoma Featuring Pseudo-hypopyon: Case Series and Literature Review. Ocul Immunol Inflamm 2020; 29:490-495. [PMID: 32965144 DOI: 10.1080/09273948.2020.1815796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Diagnosis of intraocular lymphoma (IOL) is usually achieved by histopathological analysis. However, it may lead to inconclusive results due to the scarcity of malignant cells obtained by biopsy, hence leading to delayed diagnosis. We report two cases of IOL with pseudo-hypopyon, a rare feature of IOL, as their initial ocular feature, diagnosed using a multidisciplinary diagnostic approach. Common clinical features of IOL with pseudo-hypopyon were also investigated. METHODS Retrospective case series and literature review. RESULTS Two cases of IOL, a 78-year-old female and a 59-year-old male, whom had been diagnosed with systemic B-cell lymphoma developed pseudo-hypopyon and visual impairment during the course of their chemotherapy. Diagnosis of IOL was achieved from anterior chamber aspiration samples with supplementary diagnostic tools including flow cytometric immunophenotyping, interleukin and IgH gene rearrangement analysis in addition to the conventional histopathological analysis. Generally, pseudo-hypopyon was more commonly seen in secondary IOL and may associate with hyphema and high intraocular pressure. CONCLUSION Pseudo-hypopyon is a rare feature of IOL, more commonly seen in secondary IOL, which can be accompanied by hyphema and high intraocular pressure. Supplementary diagnostic tools such as flow cytometric immunophenotyping, interleukin analysis, and immunogloblin H gene rearrangement analysis are useful for supporting the diagnosis of IOL with pseudo-hypopyon.
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Affiliation(s)
- Han Peng Zhou
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Japan.,Department of Ophthalmology, Jichi Medical University Saitama Medical Center, Saitama-shi, Japan
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17
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Bentata R, Chan H, Coste V, Delyfer MN, Ducassou S, Léger F, Korobelnik JF. [Pseudo-hypopyon secondary to a meningeal recurrence of acute lymphoblastic leukemia: Case report]. J Fr Ophtalmol 2020; 43:e259-e261. [PMID: 32800420 DOI: 10.1016/j.jfo.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Affiliation(s)
- R Bentata
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France.
| | - H Chan
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - V Coste
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - M-N Delyfer
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - S Ducassou
- Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France; Service d'onco-hématologie pédiatrique, CHU Pellegrin, Bordeaux, France
| | - F Léger
- Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France; Service d'anatomopathologie, CHU Pellegrin, Bordeaux, France
| | - J-F Korobelnik
- Service d'ophtalmologie, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
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18
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Jakati S, Patel A, Pathengay A, Kaliki S. Coincidental retinal dysplasia in patients presenting with pseudohypopyon: a series of two cases. BMJ Case Rep 2020; 13:13/4/e233922. [PMID: 32300034 DOI: 10.1136/bcr-2019-233922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical diagnosis is always challenging in cases with atypical presentation. Herein, we present two cases which masqueraded as ocular infection/inflammation on presentation, were clinically suspicious for retinoblastoma, and histopathology revealed the diagnosis of retinal dysplasia. Case 1 had left corneal perforation with anterior chamber exudates on presentation. On ultrasound B-scan, ill-defined mass was noted, raising a suspicion of malignancy. MRI showed dilated ventricles with midline shift. Vitreous cytology was inconclusive. Enucleation was performed as malignancy could not be ruled out. Histopathology revealed detached retina with dysplastic rosettes in addition to inflammation and multinucleate giant cell reaction. Case 2 presented with right eye anterior chamber pseudohypopyon. Fundus examination revealed diffuse vitreous haze and a suspicious mass in the retinal periphery raising suspicion for retinoblastoma. Histopathology revealed the diagnosis of retinal dysplasia.
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Affiliation(s)
- Saumya Jakati
- LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anamika Patel
- Vitreoretina and Uveitis Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | | | - Swathi Kaliki
- Ocular Oncology, LV Prasad Eye Institute, Hyderabad, Telangana, India
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19
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Hiraoka M, Ohguro H, Ikeda H, Furuya D, Takahashi S. Intraocular infiltration of Philadelphia chromosome-positive acute lymphoblastic leukemia diagnosed by polymerase chain reaction from the aqueous humor: A case report. Medicine (Baltimore) 2020; 99:e18872. [PMID: 31977890 PMCID: PMC7004763 DOI: 10.1097/md.0000000000018872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intraocular manifestation of hematopoietic tumors is rare and often difficult to distinguish from inflammation. We report a patient with acute lymphoblastic leukemia (ALL) who developed intraocular infiltration during the remission period. PATIENT CONCERNS A 40-year-old man presented with hypopyon in his right eye. Three months later, extensive subretinal infiltration and the elevation of intraocular pressure were observed. Fourteen months prior to this, he had been diagnosed with Philadelphia chromosome-positive ALL, and had received chemotherapy and bone marrow transplantation that resulted in complete remission. DIAGNOSIS The breakpoint cluster region-Ableson (BCR/ABL) chimera was detected by polymerase chain reaction (PCR) analysis in the patient's aqueous humor. Additionally, a high expression of WT1 (Wilms tumor gene) mRNA in the aqueous humor was discovered. A bone marrow examination yielded a high expression of BCR/ABL fusion gene, and it was determined the patient had experienced a relapse of ALL. INTERVENTIONS The dasatinib was administered orally to the patient. OUTCOMES The intraocular infiltration disappeared, and intraocular pressure was normalized. LESSONS Intraocular infiltration in leukemia patients may be an indication of relapse regardless of systemic conditions. Analyzing mRNA expression of BCR/ABL and WT1 of ocular fluid in patients with hypopyon is beneficial in diagnosing topical relapses in leukemia.
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Affiliation(s)
| | | | | | - Daisuke Furuya
- Department of Clinical Engineering, Faculty of Health Sciences, Hokkaido University of Science
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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20
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Touhami S, Audo I, Terrada C, Gaudric A, LeHoang P, Touitou V, Bodaghi B. Neoplasia and intraocular inflammation: From masquerade syndromes to immunotherapy-induced uveitis. Prog Retin Eye Res 2019; 72:100761. [DOI: 10.1016/j.preteyeres.2019.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 12/18/2022]
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21
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Hiyama T, Harada Y, Doi T, Kiuchi Y. Early administration of adalimumab for paediatric uveitis due to Behçet's disease. Pediatr Rheumatol Online J 2019; 17:29. [PMID: 31182107 PMCID: PMC6558698 DOI: 10.1186/s12969-019-0333-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Behçet's disease is a chronic inflammatory multisystem disorder that is characterised by oral and/or genital ulcerations as well as intraocular inflammation. Recurrent retinal vasoocclusive episodes and macular involvement may lead to severe loss of visual acuity. Patients may eventually become resistant to systemic corticosteroid and develop side effects; therefore, other immunosuppressive therapies are needed. Biologic agents are promising for the treatment of Behçet's disease-associated uveitis. Here, we report two cases of paediatric uveitis due to Behçet's disease that were successfully treated by early administration of adalimumab. CASE PRESENTATION Patient 1 was an 11-year-old girl who presented with right conjunctival injection and photophobia. Patient 2 was a 14-year-old girl who presented with blurry vision in the left eye. Both patients were treated with topical treatment and prednisolone for uveitis; however, relapses occurred during the tapering of prednisolone. The patients were diagnosed with Behçet's disease, and adalimumab therapy was initiated. In both cases, the inflammation was well-controlled by adalimumab administration without local or systemic corticosteroid. CONCLUSIONS Adalimumab is effective for treating children with Behçet's disease-associated uveitis. Control of ocular inflammation was achieved without local and systemic corticosteroid, thus preventing further complications.
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Affiliation(s)
- Tomona Hiyama
- 0000 0000 8711 3200grid.257022.0Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takehiko Doi
- 0000 0000 8711 3200grid.257022.0Department of Paediatrics, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Yoshiaki Kiuchi
- 0000 0000 8711 3200grid.257022.0Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
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22
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Bostancı S, Akay BN, Vural S, Ertop P, Heper AO. Hypopyon sign in dermatoscopy of cutaneous angiosarcoma. Australas J Dermatol 2019; 60:e366-e368. [PMID: 30982952 DOI: 10.1111/ajd.13053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Seher Bostancı
- Dermatology Department, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Bengü Nisa Akay
- Dermatology Department, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Seçil Vural
- Dermatology Department, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Pelin Ertop
- Dermatology Department, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aylin Okcu Heper
- Pathology Department, Faculty of Medicine, Ankara University, Ankara, Turkey
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23
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İnanç M, Şimşek M, Çakar Özdal MP. Etiological and Clinical Characteristics of HLA-B27-associated Uveitis in a Tertiary Referral Center. Turk J Ophthalmol 2019; 49:10-14. [PMID: 30829019 PMCID: PMC6416480 DOI: 10.4274/tjo.galenos.2018.53896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/27/2018] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the demographic, etiologic, and clinical features of HLA-B27-associated uveitis. Materials and Methods The clinical records of 91 patients diagnosed with HLA-B27-associated uveitis at the Ulucanlar Eye Training and Research Hospital between the years of 2005 and 2016 were reviewed. Each patient’s presenting complaints, best-corrected visual acuities in first and last visits, biomicroscopic and fundoscopic examination findings, frequency and seasonal distribution of attacks, and demographic data such as age and sex were noted. Therapeutic approaches, duration of follow-up, and complications were analyzed. Results A total of 91 patients (179 eyes) aged 19-82 years (mean age 46.52±13.06 years) were included. Forty-three patients (47.3%) were female and 48 (52.7%) were male. Bilateral involvement was observed in 44 (48.4%) and unilateral involvement was observed in 47 (51.6%) patients. The most frequent complaint was redness (67%), followed by decreased and/or blurred vision (50.5%). The mean follow-up time was 38.2 months (range, 1-245 months). Anterior uveitis was most common anatomical subtype, seen in 86 (94.5%) of the patients. Mean number of attacks was 1.93±1.45 per patient-year and a significantly higher number of uveitis attacks (47%) occurred in winter. Twenty-four patients (26.3%) were diagnosed with ankylosing spondylitis. Fibrinous uveitis was detected in 36 patients (39.5%). Posterior synechia developed in 41 (22.9%) and hypopyon developed in 7 (3.9%) eyes. The most common complications were cataract (n=12, 6.7%) and ocular hypertension (n=15, 8.3%). Conclusion Ninety-one (6.3%) of the 1422 patients followed in our uvea clinic were diagnosed with HLA-B27-associated uveitis. HLA-B27-associated uveitis is characterized by acute, recurring sudden-onset iridocyclitis with a moderate to severe amount of fibrin and cells in the anterior chamber, and is easily treatable. Visual prognosis is good despite the complications.
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Affiliation(s)
- Merve İnanç
- Erciş State Hospital, Ophthalmology Clinic, Van, Turkey
| | - Mert Şimşek
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
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24
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Abstract
Anterior uveitis is the most common form of uveitis. There are several known and many possible etiologies for anterior uveitis. After examining the posterior segment and ruling out masquerade syndromes, the main step of etiologic diagnosis is clinical characterization. It is essential to establish unilateral versus bilateral involvement and presence or absence of granulomatous features. Subsequently, a work-up may be obtained which then helps to confirm diagnostic hypotheses based on the detailed history and clinical examination. The priority is to rule out an infection, although less frequent, before starting steroid therapy, adapted to the severity of the clinical picture. Finally, biologics have greatly changed the management and prevention of some forms of anterior uveitis, in particular uveitis associated with HLA-B27 and juvenile idiopathic arthritis-associated anterior uveitis.
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Affiliation(s)
- J Gueudry
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen Cedex, France.
| | - M Muraine
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen Cedex, France
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25
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Yoon HG, Jeong J, Kim JY. Presumptive Diagnosis of Recurrent Herpes-induced Anterior Uveitis with Acute Hypopyon. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Han Gyul Yoon
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jinho Jeong
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jin Young Kim
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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26
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Gueudry J, Muraine M. Anterior uveitis. J Fr Ophtalmol 2017; 41:e11-e21. [PMID: 29290458 DOI: 10.1016/j.jfo.2017.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/07/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Abstract
Anterior Uveitis is the most common form of uveitis. There are several known and many possible etiologies for anterior uveitis. After examining the posterior segment and ruling out masquerade syndromes, the main step of etiologic diagnosis is clinical characterization. It is essential to establish the presence or absence of unilateral versus bilateral and granulomatous features. Subsequently, a directed work-up may be obtained which then helps to confirm diagnostic hypotheses based on the detailed history and clinical examination. The priority is to rule out an infection. Treatments are adapted according to etiology and disease severity. Finally, biologics have greatly changed the management and prevention of some forms of anterior uveitis, in particular uveitis associated with HLA-B27 and juvenile idiopathic arthritis-associated anterior uveitis.
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Affiliation(s)
- J Gueudry
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - M Muraine
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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27
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Tyagi M, Govindhari V, Pappuru RR, Ambiya V. Bilateral Hypopyon Uveitis in Chronic Myeloid Leukemia. Ocul Oncol Pathol 2017; 4:12-15. [PMID: 29344492 DOI: 10.1159/000475718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background A leukemic hypopyon is considered an early sign of central nervous system involvement or systemic relapse. A differential diagnosis of masquerade syndromes should be considered in cases of hypopyon uveitis that are atypical or unresponsive to treatment. We report a case of a 45-year-old man who presented with bilateral hypopyon uveitis and was subsequently diagnosed as having chronic myeloid leukemia. Method Retrospective case review. Results A 45-year-old diabetic male presented with diminished vision in both eyes for 10 days. Ophthalmic evaluation revealed rubeosis iridis, hypopyon, and signs of proliferative diabetic retinopathy with panretinal laser photocoagulation scars. He subsequently presented 1 week later with a bloodstained hypopyon in his right eye and a persistent hypopyon in his left eye. A peripheral blood smear and subsequent bone marrow trephine biopsy confirmed the diagnosis of chronic myeloid leukemia in blast crisis and he was referred to an oncologist for further management. Conclusion A recalcitrant or atypical hypopyon uveitis can be an indicator of a blast crisis or a central nervous system involvement or sign of a relapse in cases of leukemia. The presence of unusual bloodstained hypopyon helped in identifying the presence of chronic myeloid leukemia and aided in a prompt oncology consultation.
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Affiliation(s)
- Mudit Tyagi
- Kanuri Santhamma Center for Vitreo-Retina Services, L.V. Prasad Eye Institute, Hyderabad, India
| | - Vishal Govindhari
- Kanuri Santhamma Center for Vitreo-Retina Services, L.V. Prasad Eye Institute, Hyderabad, India
| | - Rajeev R Pappuru
- Kanuri Santhamma Center for Vitreo-Retina Services, L.V. Prasad Eye Institute, Hyderabad, India
| | - Vikas Ambiya
- Army College of Medical Sciences, New Delhi, India
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28
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Chersich MF, Takkinen J, Charlier C, Leclercq A, Adams PE, Godbole G, Altmeyer U, Friesema IHM, Labbé Sandelin L, Jenkin L, Fontana L, Aldigeri R, Venter F, Luchters SMF, Lecuit M, Cimino L. Diagnosis and Treatment of Listeria monocytogenes Endophthalmitis: A Systematic Review. Ocul Immunol Inflamm 2017; 26:508-517. [PMID: 28145786 DOI: 10.1080/09273948.2016.1276788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Describe patient characteristics, treatment, and vision outcomes of Listeria monocytogenes endophthalmitis, an exceedingly rare form of listeriosis. METHODS L. monocytogenes endophthalmitis cases in human adults, located through Medline (32) and from disease surveillance centers (11). L. monocytogenes conjunctivitis and keratitis were excluded. RESULTS Most cases occurred in 2000-2015 (22/43), and almost all in Europe or North America (40/43). Patients were a median 61 years, 57% male (24/42) and half were immunosuppressed. Median days from entering care to diagnosis was 8 (IQR = 5-17). Only four were exogenous infections. L. monocytogenes was identified in 31/35 of anterior eye fluid samples (89%). Antibiotic regimens varied markedly (mostly ≥3 drugs). At diagnosis, most were blind in the affected eye (85%, 28/33), only a third regained normal vision (12/36). Older patients had poorer outcomes. CONCLUSIONS Cases increased over time. Diagnostic delays were common and visual impairment often refractory to treatment, especially in older adults. The condition's rarity and variation in treatment makes it difficult to identify optimum therapy.
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Affiliation(s)
- Matthew F Chersich
- a Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Johanna Takkinen
- b European Centre for Disease Prevention and Control , Solna , Sweden
| | - Caroline Charlier
- c Institut Pasteur, Inserm U1117, National Reference Center and WHO Collaborating Center Listeria , Biology of Infection Unit , Paris , France.,d Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine , Assistance Publique-Hôpitaux de Paris , Paris , France
| | - Alexandre Leclercq
- c Institut Pasteur, Inserm U1117, National Reference Center and WHO Collaborating Center Listeria , Biology of Infection Unit , Paris , France
| | - Paul E Adams
- e Department of Paediatrics, Division of Paediatric Cardiology , Chris Hani Baragwanath Academic Hospital , Soweto , South Africa.,f School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Gauri Godbole
- g Reference Microbiology, National Infection Service, Public Health England, UK
| | | | - Ingrid H M Friesema
- i Epidemiology and Surveillance of Infectious Diseases , Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - Lisa Labbé Sandelin
- j Department of Communicable Diseases and Infection Control , Kalmar County Hospital , Kalmar, Sweden
| | - Lorna Jenkin
- k Department of Microbiology , Target Laboratory , Johannesburg , South Africa
| | - Luigi Fontana
- l Department of Opthalmology , Arcispedale S. M. Nuova IRCCS, Reggio Emilia , Italy
| | - Raffaella Aldigeri
- m Department of Clinical and Experimental Medicine , University of Parma , Parma, Italy
| | - Francois Venter
- a Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Stanley M F Luchters
- n Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia.,o Centre for International Health, Burnet Institute , Melbourne , Australia
| | - Marc Lecuit
- c Institut Pasteur, Inserm U1117, National Reference Center and WHO Collaborating Center Listeria , Biology of Infection Unit , Paris , France.,d Paris Descartes University, Sorbonne Paris Cité, Necker-Pasteur Infectiology Centre, Necker-Enfants Malades University Hospital, Institut Imagine , Assistance Publique-Hôpitaux de Paris , Paris , France
| | - Luca Cimino
- p Immunology Eye Unit, Department of Ophthalmology , Arcispedale S. M. Nuova IRCCS, Reggio Emilia , Italy
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29
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Bypareddy R, Takkar B, Azad SV, Chawla R. Anterior chamber exudation in chronic myeloid leukaemia. BMJ Case Rep 2016; 2016:bcr-2016-217173. [PMID: 27895079 DOI: 10.1136/bcr-2016-217173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Anterior chamber leukaemic hypopyon is a rare occurrence in chronic myeloid leukaemia. We discuss two cases marked by rapid exudation inside the anterior chamber, which were subsequently diagnosed as chronic myeloid leukaemia. The hypopyon in both the cases resolved on induction of chemotherapy.
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Affiliation(s)
- Ravi Bypareddy
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shorya Vardhan Azad
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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30
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Bazvand F, Zarei M, Ebrahimiadib N, Karkhaneh R, Davoudi S, Soleimanzadeh M, Sharifian E, Roohipoor R, Modjtahedi BS. Ocular Manifestations, Conventional Fundus Fluorescein Angiographic Findings, and Relationship Between Angiographic Findings and Visual Acuity in Behçet's Disease. Semin Ophthalmol 2016; 32:764-771. [PMID: 27715380 DOI: 10.1080/08820538.2016.1178310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Evaluating the ocular manifestation and fundus fluorescein angiography (FA) findings of patients with Behçet's disease as well as the relationship between visual acuity and angiographic findings. METHODS Retrospective chart review of patients with Behçet's disease seen at the Farabi Eye Hospital. RESULTS Forty-six patients (92 eyes) with mean age of 33.41 ± 10.67 were included. The most frequent presenting symptom and sign were reduced vision (76%) and uveitis (87%), respectively. Panuveitis was the most frequent type of uveitis (76%). Among patients with FA, vasculitis was the most common finding (87%) and it was significantly more severe among patients with visual acuity less than 20/200. Macular leakage (P = 0.001), arterial narrowing (P = 0.000), and posterior retinal vasculitis (P = 0.002) on FA were all associated with worsening final visual acuity. CONCLUSION The most common ocular findings in Behçet's disease were panuveitis and vasculitis. Location of vasculitis, arterial narrowing, and macular leakage on initial FA may predict visual prognosis.
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Affiliation(s)
- Fatemeh Bazvand
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Zarei
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Nazanin Ebrahimiadib
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Reza Karkhaneh
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Samaneh Davoudi
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Mahyar Soleimanzadeh
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Elaheh Sharifian
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Ramak Roohipoor
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Bobeck S Modjtahedi
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
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Gender Differences in Behçet's Disease Associated Uveitis. J Ophthalmol 2014; 2014:820710. [PMID: 24864195 PMCID: PMC4017716 DOI: 10.1155/2014/820710] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease is a systemic vasculitis of unknown etiology, characterized by oral and genital ulceration, skin lesions, and uveitis as well as vascular, central nervous system, and gastrointestinal system involvement. It is prevalent in the Middle East, Mediterranean, and Eastern Asia. The aim of this review is to evaluate the gender differences in clinical manifestations of Behçet's disease, treatment responses, mortality, and morbidity. Behçet's disease has been reported to be more prevalent in males from certain geographic regions and particular ethnic groups; however, recent reports indicate more even gender distribution across the world. There are gender differences in clinical manifestations and severity of the disease. Ocular manifestations, vascular involvement, and neurologic symptoms are more frequently reported in male patients whereas oral and genital ulcers, skin lesions, and arthritis occur more frequently in female patients. The disease can have a more severe course in males, and overall mortality rate is significantly higher among young male patients.
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Espósito E, Maccio PJ, Monti R, Cervi L, Serra HM, Urrets-Zavalía JA. Alternaria keratitis and hypopyon after clear-cornea phacoemulsification. J Cataract Refract Surg 2014; 40:331-4. [DOI: 10.1016/j.jcrs.2013.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 07/25/2013] [Accepted: 07/26/2013] [Indexed: 10/25/2022]
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LaMattina KC, Becker NM. Bilateral Hypopyon Uveitis Secondary to Mycosis Fungoides with Sezary Syndrome. Ocul Immunol Inflamm 2013; 22:246-7. [DOI: 10.3109/09273948.2013.841488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE To report clinical experience with the use of voriconazole for management of cases with fungal keratitis and to evaluate the factors affecting treatment outcomes. METHODS Retrospective database review of all cases with fungal keratitis that were treated with topical voriconazole at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, between January 2003 and July 2010, was undertaken. Main parameters evaluated were clinical and microbiological profile of the cases, treatment, and final outcomes. RESULTS A total of 26 cases were treated with voriconazole eye drops during the study period. In addition, voriconazole was used in the form of oral tablets (n = 16, 61.5%), intracorneal injection (n = 7, 26.9%), and intracameral injection (n = 2, 7.7%). Overall, 50% (n = 13) of cases responded to medical treatment. Further definitive surgical intervention in the form of penetrating keratoplasty was required in 11 cases (42.3%). Two cases (7.7%) underwent enucleation for severe nonresolving keratitis. Nonresponders were more likely to have peripheral infiltrates (38.5% vs. 7.7%, P = 0.16) and hypopyon (61.5% vs. 23%, P = 0.11) as compared with responders. There was no significant variation in the microbiological results between responders and nonresponders. CONCLUSIONS Voriconazole was successful in the management of 50% cases of fungal keratitis in our study. Cases with peripheral infiltrates and hypopyon are less likely to respond to medical treatment.
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Abstract
The diagnosis of Behçet disease is clinical and based on the presence of characteristic ocular and systemic inflammatory manifestations. Patients may present with anterior, posterior, or panuveitis in one or both eyes. The differential diagnosis includes a variety of infectious and noninfectious causes of acute nongranulomatous anterior uveitis, intermediate uveitis, occlusive retinal vasculitis, focal or multifocal retinitis, and necrotizing retinitis. A course characterized by sudden onset with improvement followed by recurrence of inflammatory signs is most typical for Behçet uveitis.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
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Abstract
Purpose. Leukemic hypopyon uveitis in acute myeloid leukemia (AML) is a very rare condition. We report this case of an unusual finding in a 2½-year-old boy in second remission after chemotherapy for relapsed AML. Methods. A young patient with an AML FAB M5 in second remission developed pain, photophobia, and conjunctival injections in the right eye. Recent bone marrow aspiration showed no blast increase and recent peripheral blood sampling presented no evidence of relapse. Results. The patient showed a viscous hypopyon and a myotic pupil in the right eye that was refractory to corticosteroids. Anterior chamber aspiration revealed atypical blasts similar to the leukemic cells that were found in the bone marrow aspirate at the time of systemic relapse. Conclusions. Timely anterior chamber aspiration and subsequent cytology is useful in differentiating leukemic hypopyon from true intraocular inflammation in AML patients. This is the first report about a leukemic hypopyon uveitis in AML without systemic findings of malignant cells in a child.
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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Hegde SP, Ursekar AT, Chitale AA. Relapsing acute myeloid leukemia presenting as hypopyon uveitis. Indian J Ophthalmol 2011; 59:391-3. [PMID: 21836350 PMCID: PMC3159326 DOI: 10.4103/0301-4738.83621] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Anterior segment infiltration in acute myeloid leukemia (AML) presenting as hypopyon uveitis is very rare. We report this case as an uncommon presentation in a patient on remission after bone marrow transplant for AML. In addition to the hypopyon, the patient presented with “red eye” caused by ocular surface disease due to concurrent graft-versus-host disease and glaucoma. The classical manifestations of masquerade syndrome due to AML were altered by concurrent pathologies. Media opacities further confounded the differential diagnosis. We highlight the investigations used to arrive at a definitive diagnosis. In uveitis, there is a need to maintain a high index of clinical suspicion, as early diagnosis in ocular malignancy can save sight and life.
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Affiliation(s)
- Sapna P Hegde
- Department of Ophthalmology, Jaslok Hospital and Research Centre, Dr. G. Deshmukh Marg, Mumbai 400 026, India
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Gencoglan G, Inanir I, Ermertcan AT. Hypopyon-like features: new dermoscopic criteria in the differential diagnosis of cutaneous lymphangioma circumscriptum and haemangiomas? J Eur Acad Dermatol Venereol 2011; 26:1023-5. [PMID: 21645121 DOI: 10.1111/j.1468-3083.2011.04136.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lymphangiomas are congenital malformations of the lymphatic system characterized by clusters of translucent vesicles. Dermoscopically, yellow and bluish lacunea according to the lymphatic or haematic content were described previously, but it is difficult to distinguish them from haemangioma. OBSERVATIONS In nine patients with cutaneous lymphangioma circumscriptum (CLC), hypopyon-like features were observed. None of the 10 patients with haemangioma had this finding. CONCLUSION Hypopyon-like features can be a useful dermoscopic pattern in differentiating CLC from haemangioma.
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Affiliation(s)
- G Gencoglan
- Department of Dermatology, Medical Faculty of Celal Bayar University, Manisa, Turkey.
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Sanghvi C, Mercieca K, Jones NP. Very Severe HLA B27-associated Panuveitis Mimicking Endophthalmitis: A Case Series. Ocul Immunol Inflamm 2010; 18:139-41. [DOI: 10.3109/09273940903560236] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bilateral Pseudohypopyon as a Presenting Feature of Recurrent Diffuse Large B-Cell Lymphoma. J Neuroophthalmol 2010; 30:67-9. [DOI: 10.1097/wno.0b013e3181ce2c98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sudharshan S, Kumari A, Biswas J. Bilateral Hypopyon as the Presenting Feature of Chronic Myeloid Leukemia. Ocul Immunol Inflamm 2009; 16:244-6. [DOI: 10.1080/09273940802411437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Anjana Kumari
- Medical and Vision Research Foundation, Sankara Nethralaya, Chennai
| | - Jyotirmay Biswas
- Medical and Vision Research Foundation, Sankara Nethralaya, Chennai
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Lim TH, Han JI. A Case of Hypopyon Uveitis Associated With Relapsing Polychondritis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.3.486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Hoon Lim
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Seoul, Korea
| | - Jung Il Han
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Seoul, Korea
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Pathanapitoon K, Suksomboon S, Kunavisarut P, Ausayakhun S, Wattananikorn S, Leetrakool N, Rothova A. HLA-B27-associated acute anterior uveitis in the University Referral Centre in North Thailand: clinical presentation and visual prognosis. Br J Ophthalmol 2006; 90:1448-50. [PMID: 16899524 PMCID: PMC1857526 DOI: 10.1136/bjo.2006.099788] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2006] [Indexed: 01/20/2023]
Abstract
BACKGROUND Acute anterior uveitis (AAU) is the most frequent type of uveitis encountered in the west. Although human leucocyte antigen (HLA)-B27-associated ankylosing spondylitis was reported in South East Asia, it is not known whether HLA-B27-associated ocular disease is prevalent in Thailand. METHODS A prospective study of 100 unrelated blood donors and 121 consecutive patients with AAU was carried out. All people underwent HLA-B27 typing and full ocular examination. Radiological examination of the sacroiliac joints was conducted in patients with low back pain or arthralgias. RESULTS The prevalence of HLA-B27 was 10% among the blood donors in contrast with 44% in the AAU group (p<0.001). The clinical characteristics of HLA-B27-associated AAU were similar to those published throughout the world (unilaterality in 74%, hypopyon in 31%, recurrent AAU in 64%). However, the increased intraocular pressure (IOP) was more common in the HLA-B-27-negative group (p = 0.03) than in their HLA-B27-positive counterparts. At least 15% of the HLA B27-positive group had radiological signs of ankylosing spondylitis. CONCLUSION The prevalence of HLA-B27 in the population without uveitis in Thailand is about 10% and clinical characteristics of HLA-B27-positive AAU are similar to those reported in the west. In contrast with earlier reports, HLA-B27-negative AAU in Thailand was associated with increased IOP and should be further studied.
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Affiliation(s)
- K Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Chiang Mai 50200, Thailand.
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Okhravi N. Comment on 'Clinical features and outcomes of HLA B27 positive and HLA B27 negative acute anterior uveitis in a Turkish patient population'. Ocul Immunol Inflamm 2006; 14:137-8. [PMID: 16766396 DOI: 10.1080/09273940600794216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Acute anterior uveitis is the most common form of uveitis. HLA-B27-associated acute anterior uveitis is a distinct clinical entity that has wide-ranging medical significance due to its ocular, systemic, immunologic, and genetic features. The association between HLA-B27 and the spectrum of HLA-B27-associated inflammatory diseases remains one of the strongest HLA-disease associations known to date. This review examines acute anterior uveitis with particular focus on HLA-B27-associated acute anterior uveitis, including the epidemiology, immunopathology, association with HLA-B27 and its subtypes, clinical features, complications, prognosis, and potential new therapies such as anti-TNFalpha therapy and oral HLA-B27-peptide tolerance. There have been substantial recent advances in both clinical and basic scientific research in this field, including studies of the various animal models of acute anterior uveitis and the HLA-B27 transgenic animals, and these are summarized in this review. To the ophthalmologist, HLA-B27-associated acute anterior uveitis is an important clinical entity that is common, afflicts relatively young patients in their most productive years, and is associated with significant ocular morbidity due to its typically recurrent attacks of inflammation and its potentially vision-threatening ocular complications. Furthermore, to the ophthalmologist and the internist, HLA-B27-associated acute anterior uveitis is also of systemic importance due to its significant association with extraocular inflammatory diseases.
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Affiliation(s)
- John H Chang
- Laboratory of Ocular Immunology, Inflammatory Diseases Research Unit, School of Medical Sciences, University of New South Wales, Sydney; Department of Ophthalmology, St. Vincent's Hospital, Sydney
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50
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Yi DH, Rashid S, Cibas ES, Arrigg PG, Dana MR. Acute unilateral leukemic hypopyon in an adult with relapsing acute lymphoblastic leukemia. Am J Ophthalmol 2005; 139:719-21. [PMID: 15808176 DOI: 10.1016/j.ajo.2004.09.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2004] [Indexed: 11/23/2022]
Abstract
PURPOSE To report acute unilateral hypopyon uveitis as an initial presenting feature of relapsing acute lymphoblastic leukemia (ALL) in an adult patient. DESIGN Observational case report. METHODS Anterior chamber paracentesis was performed in a 56-year-old male presenting with treatment-resistant unilateral hypopyon while in the remission phase of ALL. RESULTS Examination of the aqueous humor aspirate revealed presence of malignant cells compatible with the previous bone marrow biopsy and subsequent spinal tap results. CONCLUSIONS Atypical hypopyon uveitis can be an indication of relapsing ALL, even in adults. Prompt anterior chamber aspiration is required for the correct diagnosis and subsequent treatment.
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Affiliation(s)
- David H Yi
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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