Retinal detachment with atopic dermatitis similar to traumatic retinal detachment

Association Between Atopic Dermatitis and Aging: Clinical Observations and Underlying Mechanisms

As one of the most prevalent chronic inflammatory skin diseases, atopic dermatitis (AD) increasingly affects the aging population. Amid the ongoing global aging trend, it's essential to recognize the intricate relationship between AD and aging. This paper reviews existing knowledge, summarizing clinical observations of associations between AD and aging-related diseases in various systems, including endocrine, cardiovascular, and neurological. Additionally, it discusses major theories explaining the correlation, encompassing skin-mucosal barriers, systemic inflammation and stress, genes, signal transduction, and environmental and behavioral factors. The association between AD and aging holds significant importance, both in population and basic perspectives. While further research is warranted, this paper aims to inspire deeper exploration of inflammation/allergy-aging dynamics and the timely management of elderly patients with AD.

Contemporary Patterns and Underlying Causes of Vitrectomy in Pediatric and Adolescent Patients: A Nationwide, Population-Based Analysis

PURPOSE

We determined the incidence, etiology, and longitudinal trends of vitreoretinal diseases necessitating pars plana vitrectomy (PPV) in the pediatric and adolescent population.

DESIGN

Nationwide, population-based cohort study.

METHODS

This study utilized data extracted from the Korean National Health Claims database spanning from 2009 to 2020. All pediatric and adolescent patients (under 20 years of age) who underwent PPV across the Korean population were included. The cumulative incidence of PPV was estimated from 2009 to 2020, with 2009 to 2011 as the washout period. The annual trends of PPV incidence, the proportion of each etiology, and comorbidity were estimated based on sex and specific age groups.

RESULTS

In total, 1913 patients, including 83 infants, 746 pediatric patients, and 1084 adolescents, were newly identified as having undergone PPV surgery. The cumulative incidence of PPV surgery per 100,000 individuals was 21.42 (95% CI, 21.41-21.43). The rate of PPV was 2.4 times higher for males than females, and the rate of trauma as a comorbidity was also higher for males than females (13.1% vs 4.8%). Among males aged 5 years and older, the incidence of PPV nearly halved from 2011 to 2020. Among the primary etiologies, ROP had the highest rate (72%) in infants (under 1 year), while RD was most common (63%) in individuals aged 5 to 19 years. Myopia was present in 30.3% of patients, and atopic dermatitis was present in 31.8% of all patients.

CONCLUSION

The primary etiologies underlying the need for PPV in the pediatric and adolescent populations vary by sex and age group. The incidence of PPV continues to decline in the adolescent population. Therefore, tailored patient education and age-specific etiological examination are recommended.

Iris Retraction Without Hypotony

PURPOSE

All published cases of iris retraction syndrome have been associated with low intraocular pressure. We report here a case clinically indistinguishable from iris retraction syndrome except for the absence of hypotony, which has not been previously described in the literature.

OBSERVATIONS

A 35-year-old woman with a history of atopic dermatitis developed a rapidly progressive anterior subcapsular cataract and acute uveitis. During follow-up, the presence of bilateral iris retraction was noted, while ocular pressure was either normal or elevated, and the position did not normalize with pupillary dilation. The clinical course was complicated by retinal detachment and posterior cyclitic membrane, which was managed with pars plana vitrectomy, lensectomy, and dissection of cyclitic membrane. The case was further complicated by ocular hypertension attributed to steroid response and formation of an epiretinal membrane. Following micropulse cyclophotocoagulation, placement of an Ahmed tube shunt, epiretinal membrane peel, and placement of secondary intraocular lens, our patient eventually had a good visual outcome.

CONCLUSIONS AND IMPORTANCE

Hypotony is generally recognized as a key physiological step in the development of iris retraction syndrome. Our case demonstrates that posterior bowing of the iris can occur in the absence of hypotony, and suggests that an alternative mechanism involving posterior cyclitic membrane may be responsible.

Surgical Outcomes of Epiblepharon Related to Atopic Dermatitis

Purpose: Patients with atopic dermatitis often have difficulty managing their condition after epiblepharon repair surgery due to edema and itching at the operation site. We examined surgical outcomes in relation to atopic dermatitis.Methods: A retrospective review of medical records was performed on epiblepharon patients and eyelids (patients = 1,829; eyelids = 4,694) that were followed after surgical correction between 2005 and 2016. Patients were classified into those with atopic dermatitis (the atopic dermatitis group) and a control group. Success rates and recurrence rates were compared and analyzed.Results: The mean patient age was 5.82 ± 2.87 years. Of the 200 eyelids with atopic dermatitis, 12 eyelids (6.0%) had undercorrection, as did 108 (2.4%) of the 4,494 eyelids of the control group. Of the 188 eyelids with atopic dermatitis, 13 (6.9%) underwent reoperation due to recurrence, as did 57 (1.3%) of the 4,386 eyelids of the control group. A statistically significant difference between two groups was confirmed in comparing failure rates and recurrence rates (p = 0.002, p < 0.001).Conclusions: The failure rates of surgery and recurrence rates of epiblepharon symptoms were significantly higher in patients with atopic dermatitis. It can be assumed that the suture fixed to the tarsal plate was untied or loosened due to edema and itching of the operation site due to atopic dermatitis. In consideration of this, more effective treatment methods, such as solid suturing, are needed in clinical practice for atopic dermatitis patients.

Bidirectional association between atopic dermatitis, conjunctivitis, and other ocular surface diseases: A systematic review and meta-analysis

BACKGROUND

Conjunctivitis and several other ocular surface diseases (OSDs) have been linked to atopic dermatitis (AD) and its treatment.

OBJECTIVES

To examine the association between AD, conjunctivitis, and other OSDs.

METHODS

A systematic review and meta-analysis was performed. Two authors independently searched EMBASE, PubMed, SCOPUS, and Web of Science and performed title/abstract and full-text review and data abstraction. Pooled random-effects prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated.

RESULTS

The search yielded 5719 nonduplicate articles; 134 were included in the quantitative analysis. AD was associated with conjunctivitis compared to reference individuals (OR, 2.78; 95% CI, 2.33-3.32); the prevalences of conjunctivitis in patients with AD and reference individuals were 31.7% (95% CI, 27.7-35.9) and 13.3% (95% CI, 11.0-15.7), respectively. Keratoconus (OR, 3.71; 95% CI, 1.99-6.94) and ocular herpes simplex (OR, 3.65; 95% CI 2.04-6.51) were also associated with AD.

LIMITATIONS

Disease definitions differed and often relied on self-reports. Few studies provided data concerning AD phenotype or OSDs other than conjunctivitis.

CONCLUSIONS

Conjunctivitis is the most common ocular comorbidity in AD. Signs and symptoms of conjunctivitis and other OSDs in AD may be underreported, making proactive inquiry and examination by physicians treating patients with AD important.

The Association with rhegmatogenous retinal detachment and paediatric atopic dermatitis: a 12-year Nationwide Cohort Study

PURPOSE

Historically, atopic dermatitis (AD) is associated with an increased risk of rhegmatogenous retinal detachment (RRD). However, uncertainty remained regarding the effect of AD itself and comorbidities (e.g., allergic diseases, cataract surgery) on RRD occurrence in a large, population-based paediatric population.

PATIENTS AND METHODS

We analysed the 12-year National Health Insurance Service database (2002-2013) covering the entire Korean population to estimate the association between AD and RRD in people aged under 20 years.

RESULTS

We identified 3142 RRD patients, and matched 18,852 controls (six controls to each RRD patient); therefore, we included 21,994 peoples under aged 20 years in the analyses. AD was more prevalent in the RRD group (329 patients, 10.47%) than the control group (1043 patients, 5.53%; P < 0.001), and so were severe AD (153 patients [4.87%] and 223 patients [1.18%], respectively; P < 0.001). In conditional logistic regression analysis, AD was associated with RRD (OR, 1.61; 95% CI, 1.93-1.87) even after adjusting for allergic conditions, connective tissue disease, uveitis, and cataract surgery. In addition, severity of AD was associated with an increased risk of RRD (OR for non-severe AD and severe AD, 1.26 [95% CI, 1.05-1.51] and 2.88 [95% CI, 2.25-3.68]).

CONCLUSION

This study suggests that AD itself is a risk factor of RRD in children by showing the association between AD and RRD occurrence and the biologic gradient even after adjustment for known confounders including allergic conditions, uveitis, and cataract surgery.

Ocular Co-Morbidities of Atopic Dermatitis. Part II: Ocular Disease Secondary to Treatments

Treatments used for managing atopic dermatitis (AD) may have adverse ocular effects that permanently affect vision. The objective of this review is to raise awareness among dermatologists regarding the potential ocular adverse effects of various AD therapies, including corticosteroids, calcineurin inhibitors, an interleukin-4 receptor α (IL-4Rα) antagonist, and phototherapy. Pertinent potential short- and long-term risks of these therapies include elevations in intraocular pressure from use of topical corticosteroids and conjunctivitis from use of dupilumab. Since some of these adverse effects may not exhibit symptomatology until permanent vision impairment occurs, it is important for dermatologists to understand these risks and proactively ensure their patients are receiving appropriate measures to prevent them.

Ocular Co-Morbidities of Atopic Dermatitis. Part I: Associated Ocular Diseases

Ocular diseases associated with atopic dermatitis (AD) may be sight-threatening. A general understanding of the pathophysiology, diagnosis, and treatment of atopic eye disease may assist dermatologists in knowing when to refer to ophthalmology and in co-managing these diseases with ophthalmologists. Ocular diseases associated with AD include eyelid dermatitis, keratoconjunctivitis, keratoconus, cataract, and retinal detachment. AD patients are also at higher risk for bacterial and viral ocular infections. The objective of this article is to provide a current review of ocular diseases that commonly affect AD patients. The pathogenesis, clinical manifestations, diagnosis, and treatment of ocular co-morbidities of AD will be discussed.

Adjunctive dexamethasone implant in patients with atopic dermatitis and retinal detachment undergoing vitrectomy and silicone oil tamponade: an interventional case series

Background

To report the clinical course and outcomes of adjunctive dexamethasone implants in patients with atopic dermatitis (AD) and retinal detachment (RD) undergoing vitrectomy and silicone oil tamponade.

Methods

This retrospective, interventional case series included AD patients with RD and various degrees of proliferative vitreoretinopathy (PVR) who were scheduled to undergo vitrectomy. Following total vitrectomy and retinopexy, silicone oil tamponade was performed. Finally, an intraocular dexamethasone implant was injected intravitreally. Anatomical and functional outcomes were assessed at 12 months, and extended follow-up data were also collected.

Results

Seven eyes from six patients (five male, one female) were included. The median age was 29 (range, 20–38) years. Preoperatively, six eyes were pseudophakic, two eyes had a history of previous vitreoretinal surgery, and one had uveitis. Postoperatively, best-corrected visual acuity improved in two eyes, worsened in one, and remained similar in four. Retinal attachment was maintained in all eyes at 12 months. The major complication was an increase in postoperative intraocular pressure in six eyes, requiring either medical or surgical treatment. During the extended follow-up period (15–37 months), retinas remained attached in all eyes and stable visual acuity was maintained in five.

Conclusions

Injection of an intraoperative dexamethasone implant to silicone oil-filled eyes appears tolerable and may be beneficial in the surgical management of AD patients with RD and PVR.

Retinal detachment repair and cataract surgery in patients with atopic dermatitis

PurposeThe aim of this study is to report a case series of ocular complications including retinal detachment (RD) and cataract in atopic dermatitis (AD) and surgical management involving a majority of Caucasian patients.Patients and methodsThis study is an observational case series, originally designed as an audit. It involves detailed discussion of history, clinical features, and surgical management of patients presenting with retinal detachment and cataracts secondary to severe AD. Six consecutive patients with diagnosis of severe AD requiring posterior segment and cataract surgery were included in the study.ResultsEight eyes of six patients had retinal detachment. Most of them involved the temporal retina. The retinal breaks were located anteriorly close to the ora serrata in six eyes and Giant tear retinal (GRT) detachment was found in two eyes. Five eyes had proliferative vitreo-retinopathy (PVR) at presentation. All six patients had bilateral cataracts and cataract surgery was performed in eleven eyes. Bilateral simultaneous surgery was essential in two patients. Three eyes had secondary intra-ocular lens (IOL) implantation with pars plana vitrectomy for subluxed lens implant.ConclusionsAnterior retinal breaks and temporal RD are common in retinal detachment secondary to AD. PVR is often present, which makes surgical management difficult. Cataract formation is quite often and late subluxation of IOL may occur.

Evaluation and management of pediatric rhegmatogenous retinal detachment

Pediatric rhegmatogenous retinal detachments are rare, accounting for less than ten percent of all rhegmatogenous retinal detachments. While most retinal detachments in the adult population are related to posterior vitreous detachment, pediatric retinal detachment are often related to trauma or an underlying congenital abnormalities or genetic syndrome. The anatomy of pediatric eyes, the often late presentation of the disease, and the high incidence of bilateral pathology in children all pose significant challenges in the management of these patients. We discuss the epidemiology of pediatric rhegmatogenous retinal detachment, review the genetic syndromes associated with a high incidence of retinal detachment, and examine other common causes of retinal detachment in this age group. We then outline an approach to evaluation and management and describe the expected outcomes of repair of retinal detachment in the pediatric population.

Clinical characteristics and surgical outcomes of pediatric retinal detachments with lens disorders

PURPOSE

To describe the clinical characteristics and outcomes of eyes with retinal detachments with lens disorders and compare them to eyes with retinal detachments without lens disorders.

METHODS

A retrospective chart review of 42 eyes of 37 children who had retinal detachments with lens disorders was performed. Eyes were compared based on epidemiological data, characteristics of retinal detachment, and anatomical and functional surgical outcomes and were then compared to 254 eyes with retinal detachment without lens disorders.

RESULTS

In eyes with lens disorders, the retina was reattached after the first operation in 13 (31%) eyes and at the end of the intervention in 22 (52%) eyes. Surgical and visual outcomes appeared to be slightly better in the subluxation and dislocation group compared with cataract and aphakia or pseudophakia groups. In eyes without lens disorders, the retina was reattached in 202 (80%) eyes after the first intervention and in 228 (90%) eyes at the end of the intervention.

CONCLUSION

Pediatric retinal detachment with a lens disorder is associated with unsatisfactory surgical and visual outcomes compared to those without lens disorders. Primary internal and external approaches are suggested in children with complicated retinal detachment with lens disorders.

Intraocular lens implantation after atopic cataract surgery decreases incidence of postoperative retinal detachment

PURPOSE

To investigate the efficacy of intraocular lens (IOL) implantation in reducing the incidence of postoperative retinal detachment after cataract surgery in patients with atopic dermatitis.

DESIGN

Retrospective review.

PARTICIPANTS

One hundred sixty-nine eyes of 126 patients who underwent cataract surgery for atopic cataract were followed for more than 1 year. None of the eyes previously had a retinal detachment or retinal detachment surgery.

METHODS

The eyes were divided into 132 eyes of 95 patients with an IOL implantation (IOL group) and 37 eyes of 31 patients without an IOL implantation (aphakia group). The postoperative visual acuity and incidence of postoperative retinal detachment were compared between the 2 groups. The effects of the location of the causative retinal breaks, intraoperative posterior capsule rupture, and postoperative posterior capsulotomy on the incidence of retinal detachments were evaluated.

MAIN OUTCOME MEASURES

The postoperative corrected visual acuity, incidence of postoperative retinal detachment, and influence of intraoperative posterior capsule rupture on the retinal detachment.

RESULTS

The final visual acuity was better than or equal to 20/20 in 128 eyes (97.0%) of the IOL group and in 29 eyes (78.4%) of the aphakia group (P = 0.0007). Retinal detachment after an uncomplicated cataract surgery occurred in 3 eyes (2.3%) of the IOL group and in 8 eyes (25.8%) of the aphakia group (P<0.0001, Mantel-Cox). Two of 3 eyes (66.7%) in the IOL group and 1 of 8 eyes (16.7%) in the aphakia group that later developed a retinal detachment had an intraoperative posterior capsule rupture. Posterior capsulotomy by yttrium-aluminum-garnet laser did not seem to alter the incidence of postoperative retinal detachment in either the IOL (2.0%) or the aphakia group (25.0%).

CONCLUSIONS

The rate of postoperative retinal detachment in eyes with IOL and no intraoperative posterior capsule rupture seems to be low. Intraocular lens implantation with capsular bag fixation may reduce the incidence of postoperative retinal detachment triggered by lens surgery for atopic cataract.

Characteristics and surgical outcomes of paediatric retinal detachment

PURPOSE

To report the clinical features and surgical and visual outcomes of rhegmatogenous retinal detachment (RRD) in the paediatric population.

METHODS

A retrospective review of children (aged 0-15 years) who underwent primary surgical repair for RRD at the Hiroshima University Hospital between 1988 and 2001.

RESULTS

In all 53 eyes of 49 patients were identified; paediatric RRD accounted for 3.1% of 1779 eyes with RRD operated on during this period. The causes of RRD included blunt trauma (27%), myopia (25%), idiopathic (20%), familial exudative vitreoretinopathy (13%), and others. Among 55 eyes, 12 (22%) already had proliferative vitreoretinopathy (PVR) of grade C or D preoperatively. The median initial visual acuity (VA) was 0.3. Retinal reattachment was achieved with a single operation in 78%. Final retinal reattachment was achieved in 87%. Retinal reattachment rates with and without PVR were 42% and 100%, respectively (P<0.01). Median final VA was 0.7. Final VA was > or =0.1 in 73% and > or =0.5 in 53%; four eyes had a final VA of no light perception. The presence of preoperative PVR (P=0.03) and the initial VA (P<0.0001) significantly affected final VA.

CONCLUSIONS

Paediatric RRD is characterised by a delay in diagnosis, as evidenced by the high rate of PVR at presentation. Retinal reattachment was adversely affected by the presence of PVR. Final VA correlated with the initial VA and was significantly affected by preoperative PVR. Early diagnosis may improve the visual prognosis of paediatric retinal detachment.

RETINAL DETACHMENT IN ATOPIC DERMATITIS CAN MASQUERADE AS ACUTE PANUVEITIS WITH RAPIDLY PROGRESSIVE CATARACT

PURPOSE

To report two cases of retinal detachment in young patients with atopic dermatitis masquerading as acute panuveitis.

DESIGN

Retrospective observational clinical case reports.

PATIENTS

Patients with atopic dermatitis presenting with acute panuveitis and subsequently diagnosed with retinal detachment at the Singapore National Eye Centre.

METHODS

A review of the clinical case records.

RESULTS

Two young patients aged 19 and 21 years with a history of atopic dermatitis presented with acute unilateral moderately severe panuveitis. Both developed rapidly progressing cataracts that made detailed visualization of the fundus difficult. Hypotony persisted in one eye despite partial response of uveitis to therapy. The other patient developed ocular hypertension when the vision in the affected eye suddenly deteriorated. Both eyes demonstrated partial response to steroid therapy. The diagnosis of shallow retinal detachment with anteriorly located incriminating retinal breaks was made after partial resolution of vitreous haze in one case and on repeated ultrasonography in the other case.

CONCLUSION

A high index of suspicion is required when examining young patients with atopic dermatitis who present with acute panuveitis and a rapidly progressive cataract, which may mask the presence of a shallow retinal detachment.

Frequency of ciliary body or retinal breaks and retinal detachment in eyes with atopic cataract

AIM

To determine the frequency of ciliary body or retinal breaks and retinal detachment in eyes with atopic cataract.

METHODS

The records of 106 eyes (74 patients) with atopic cataract that underwent cataract extraction were reviewed. The frequency of ciliary body or retinal breaks and retinal detachment was classified by their presence preoperatively and postoperatively, and by cataract type.

RESULTS

Breaks were detected preoperatively in 27 eyes (25.5%) of 17 patients in the ciliary body (20 eyes, 18.9%), near the ora serrata (five eyes, 4.7%), and in undefined locations (two eyes, 1.9%). Among these, 16 eyes (15.1%) had already developed retinal detachment. After surgery, a ciliary body break occurred in one eye (0.9%) and retinal detachment in four eyes (3.8%) of three patients. The breaks that caused postoperative retinal detachment were in the ciliary body. When classified by cataract type, the highest frequency of breaks was associated with mature cataracts (35.0%), and all eyes with breaks developed retinal detachment.

CONCLUSIONS

One fourth of eyes with atopic cataract had breaks in the ciliary body or ora serrata, or retinal detachment preoperatively. The highest frequency of either breaks or retinal detachment was associated with mature cataract. The frequency of breaks or detachment that occurred postoperatively (approximately 5%) was lower than that present preoperatively.

Chronic cicatrizing conjunctivitis

Conjunctival fibrosis may result from chronic inflammation and may lead to alterations of conjunctival architecture. This results in ocular dryness, entropion and trichiasis, and corneal complications. Causes of conjunctival cicatrization are not limited to autoimmune diseases, such as ocular cicatricial pemphigoid, a severe disease associated with poor ocular prognosis. Other well-known causes include thermal and chemical burns, postinfectious conjunctivitis, and Stevens-Johnson syndrome. Ocular rosacea and atopic keratoconjunctivitis often are underdiagnosed causes of conjunctival fibrosis. Medical history, physical exam, and laboratory tests often allow for diagnosis of the underlying disease. Medical management varies according to specific causes, and many surgical strategies are available to restore corneal transparency and normal palpebral architecture.

Cataract and retinal detachment in patients with severe atopic dermatitis who were withdrawn from the use of topical corticosteroid

Many patients with severe atopic dermatitis (AD) in Japan are afflicted with persistent erythema of the face (atopic red face) that is not only resistant to topical corticosteroid, but often becomes worse with its use. During a three-year period (1991-1993), we treated 79 inpatients with severe AD by a combination of careful daily skin care, use of emollients, and exclusion of exacerbating factors. Occular complications before and after treatment were examined in these cases. After withdrawal of topical corticosteroid, almost all of the patients showed a temporary worsening of their skin condition. Immediately thereafter, their occular symptoms did not change. Cataract was found in 20 cases (25.3%), and retinal detachment in 9 (11.4%). After 2 months, 11 cases of cataract and 5 cases of retinal detachment in the peripheral retina were observed. However, these incidences were similar to the numbers reported in Japan during conventional treatment with topical corticosteroid. The development of cataract or retinal detachment had no relationship to serum IgE levels, personal history of respiratory atopy, the duration of topical corticosteroid use on the face, or treatment with systemic corticosteroid. Our observations suggest that patients who habitually tap or rub their faces strongly tend to develop cataract or retinal detachment at a statistically significant higher frequency. Patients with AD should have ophthalmologic examinations every one to two months for at least one year after a facial oozing attack or withdrawal of corticosteroid.

Ultrasound biomicroscopy for detection of breaks and detachment of the ciliary epithelium

PURPOSE

To elucidate details of the pathologic changes in the ciliary epithelium associated with atopic dermatitis and blunt ocular trauma.

METHODS

We examined prospectively 52 eyes of 42 patients with detachment of the nonpigmented epithelium of the ciliary body associated with atopic dermatitis and blunt ocular trauma. All the eyes underwent ultrasound biomicroscopic examination as an adjunct to binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy.

RESULTS

Of the 52 eyes examined, high-resolution ultrasound biomicroscopy and conventional diagnostic methods (that is, binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy) disclosed breaks at the anterior vitreous base border in 40 eyes, at the pars plicata of the ciliary body in 27 eyes, and at the white midline (that is, the line located in the mid pars plana anterior to the anterior vitreous base border) in four eyes. In 40 eyes the breaks at the anterior vitreous base border could be detected with conventional methods but in only 28 eyes could they be diagnosed with ultrasound biomicroscopy. Conversely, in 27 eyes the breaks of the pars plicata could be observed with ultrasound biomicroscopy but in 25 eyes they were detected with conventional methods. In 21 eyes with breaks only at the anterior vitreous base border, the detachment of the nonpigmented ciliary epithelium was limited posterior to the white midline. In all 27 eyes with the nonpigmented ciliary epithelial detachment anterior to the white midline, the breaks of the pars plicata were identified by ultrasound biomicroscopy.

CONCLUSION

Because of the minimum deformation of the globe during examination, ultrasound biomicroscopy contributed to the diagnosis of detailed structural change in the ciliary body associated with atopic dermatitis and blunt ocular trauma in relation to the white midline. In our sample of patients, the white midline may act as a barrier against ciliary nonpigmented epithelial detachment, and detachment of the nonpigmented epithelium anterior to the white midline indicated the presence of the pars plicata break in most cases.

Cataract progression in patients with atopic dermatitis

PURPOSE

To evaluate the possible causes of cataract progression in Japanese patients with atopic dermatitis.

SETTING

Department of Ophthalmology, Toyama Medical and Pharmaceutical University, Toyama, Japan.

METHODS

This prospective study comprised 41 patients (81 eyes) with atopic dermatitis. Cataract progression was determined by photographs and visual acuity results. Mean follow-up was 2.5 years (range 1.0 to 3.5 years).

RESULTS

Of 41 patients, 10 (24.4%) had progression of cataract. Of 81 eyes, 10 (12.3%) had slow progression and 9 (11.1%), rapid. Cataract progression was not statistically significantly related to patient sex or severity of systemic skin lesions but was to facial skin lesions. Soft contact lens wear and eye rubbing were also correlated with cataract progression.

CONCLUSION

Patients with facial atopic dermatitis, contact lenses, or both may rub their eyes more frequently than those with lesions on other body parts, increasing their risk of cataract progression.

Ultrasound biomicroscopic view of detachment of the ciliary epithelium in retinal detachment with atopic dermatitis

PURPOSE

The authors evaluated the effectiveness of ultrasound biomicroscopy to determine the condition of the ciliary body during perioperative examinations of patients with atopic dermatitis and retinal detachment.

METHODS

The authors compared two groups of patients with atopic dermatitis and retinal detachment. Parameters included patient age, gender, eye, cataract, type and location of breaks, macular involvement, detachment of the ciliary epithelium, and preoperative and postoperative best-corrected visual acuities. Group 1 included six patients (nine eyes) who were examined before surgery and after surgery using ultrasound biomicroscopy, with which the authors also measured the maximum height of the detachment of the ciliary epithelium. Group 2 included 10 patients (13 eyes) who did not undergo ultrasound biomicroscopy.

RESULTS

In group 1, ultrasound biomicroscopy showed ciliary epithelium detachment in all eyes before surgery and in eight of nine eyes after successful retinal reattachment. The height of the ciliary detachment, however, decreased dramatically after surgery. Although almost all the parameters between groups 1 and 2 were similar, the authors observed a significant difference in the incidence of preoperative diagnosis of ciliary detachment (P = 0.023).

CONCLUSION

Ultrasound biomicroscopy is beneficial in detecting detachment of the ciliary epithelium. The residual shallow detachment that remains after successful surgery suggests the fragility of the ciliary body.

Evaluation of non-steroidal ointment therapy for adult type atopic dermatitis: inquiry analysis on clinical effect

Clinical analysis was performed on non-steroidal ointment therapy for 70 patients with refractory adult-type atopic dermatitis by the clinical data and patient's own evaluation of the therapy obtained through enquiries after discharge from the hospital. Forty cases (57%) were between 20 and 30 years old and the male and female ratio was 39/31. The clinical evaluations were subdivided into five groups; conditions worsened (n = 9), no-change (n = 9), slightly improved (n = 14), much improved (n = 29) and cured (n = 9). Although statistically not significant, the age of onset of atopic dermatitis and the start of use of steroid ointment was much higher while the duration of the atopic dermatitis was much shorter in the remission patients. The duration of steroid ointment therapy for the facial skin was significantly shorter in the remission group when compared to groups with worsened symptoms and no-change in symptoms. Family history and complications of atopic diseases, laboratory data including IgE titer, eosinophils and RAST score were not statistically significant in any group except for a higher prevalence of IgE antibodies against inhalant and food allergens in the group with worsened symptoms. Most patients still used steroid ointment on the trunk lesions while they ceased using from the topical steroid on the facial lesions after discharge. Most frequent precipitating factors pointed out by the patients were emotional stress, irritation by sweat or UV light and longstanding use of steroid ointment. Complications of cataracta and retinopathy were found in 12 cases. These results suggest that remission of adult-type refractory atopic dermatitis can be achieved by the combination of careful daily skin care, use of non-steroidal topical ointment and minimizing the precipitating factors.