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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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Caplash S, Paez-Escamilla M, Westcott M, Dansingani KK, Indermill C, Kisma N, Frau E, Sahel JA, Bodaghi B, Jhanji V, Errera MH. Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist. J Ophthalmic Inflamm Infect 2024; 14:14. [PMID: 38594487 PMCID: PMC11004105 DOI: 10.1186/s12348-024-00396-z] [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: 06/17/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. BODY: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. CONCLUSIONS We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.
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Affiliation(s)
- Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mark Westcott
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Nacima Kisma
- Universite Libre de Bruxelles, Hopital Universitaire de Bruxelles, 808 route de Lennik 1170, Bruxelles, Belgium
| | - Eric Frau
- Department of Ophthalmology, Centre hospitalier National des Quinze-Vingts, Paris, France
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013, Paris, France
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Kogawa S, Suzuki Y, Furukawa A, Kurosaka N, Nozuki N, Ueno S. Bilateral simultaneous endophthalmitis after immediately sequential bilateral cataract surgery. Am J Ophthalmol Case Rep 2023; 32:101886. [PMID: 37533701 PMCID: PMC10393531 DOI: 10.1016/j.ajoc.2023.101886] [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: 11/26/2022] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose Immediately sequential bilateral cataract surgery (ISBCS) has recently been considered effective due to faster visual rehabilitation and further improvements in quality of life. We report on the treatment course of a case of early postoperative endophthalmitis in both eyes after ISBCS. Observations The patient was a 75-year-old woman undergoing anticancer treatment for lung cancer, who had been receiving eye drops for bilateral uveitis and secondary glaucoma since 2019. She underwent ISBCS at another hospital in 2022. In that surgery, the same instruments were used for the surgery of both eyes, without resterilization between eyes. On the night of the following day, she became aware of vision loss in both eyes, and at the examination the next day, hypopyon and corneal edema were found and she was diagnosed with bilateral postoperative endophthalmitis, and referred to our hospital. On the same day, anterior chamber irrigation, posterior capsulotomy, and vitrectomy were performed on both eyes, and the intraocular lenses were preserved. There was no recurrence of postoperative inflammation, and visual acuity was 20/30 in both eyes 6 months after vitrectomy. Conclusion ISBCS is recommended to be performed with complete aseptic separation of the patient's two procedures. This important rule was not followed in this case. ISBCS should be performed in accordance with accepted protocols, such as those of the International Society of Bilateral Cataract Surgeons, the Royal College of Ophthalmologists, and the Canadian Ophthalmological Society.
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Affiliation(s)
- Satomi Kogawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Ami Furukawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Naruki Kurosaka
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Narumi Nozuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Shinji Ueno
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
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Balamurugan S, Kaur K, Gurnani B, Agrawal A. Bilateral acute vision loss as the initial presentation of chronic myeloid leukemia in a young female. Indian J Cancer 2023; 60:578-582. [PMID: 38206079 DOI: 10.4103/ijc.ijc_573_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/16/2021] [Indexed: 01/12/2024]
Abstract
Chronic myeloid leukemia (CML) is a hematological malignancy characterized by structural/functional changes and increased neutrophils. Rarely, ophthalmic manifestations are the first clue toward underlying pathology. We report a case of a 34-year-old woman who presented with sudden-onset diminution of vision in both eyes. On examination, she was diagnosed with panuveitis in the right eye and choroiditis in the left eye. Further investigations revealed an underlying CML in the accelerated phase. The patient was managed with systemic immunomodulators along with topical and periocular steroids. Prompt diagnosis and management in collaboration with an oncologist and hematologist helped us achieve a good outcome.
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Affiliation(s)
- Sivaraman Balamurugan
- Department of Uvea Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Kirandeep Kaur
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Bharat Gurnani
- Department of Cornea and Refractive Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Anushri Agrawal
- Department of General Ophthalmology, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
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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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Yassin MA, Ata F, Mohamed SF, Alkhateeb A, Naeem U, Al-Qatami AI, Nashwan AJ, Fernyhough LJ. Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review. Surv Ophthalmol 2022; 67:530-543. [DOI: https:/doi.org/10.1016/j.survophthal.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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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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Yassin MA, Ata F, Mohamed SF, Alkhateeb A, Naeem U, Al-Qatami AI, Nashwan AJ, Fernyhough LJ. Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review. Surv Ophthalmol 2021; 67:530-543. [PMID: 34252423 DOI: 10.1016/j.survophthal.2021.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/26/2022]
Abstract
The presentation of chronic myeloid leukemia (CML) can be variable and related to the phase of the disease. It can manifest a wide range of symptoms and signs; ocular involvement is reported in patients with leukemia at the time of diagnosis. We describe ophthalmic manifestations as an initial presentation in patients with CML. We identified 38 publications between 1971 and 2020 describing ocular manifestations in CML. Ophthalmic problems occur either from direct or indirect infiltration of neoplastic cells or from secondary causes. Although nearly all ocular structures may be affected, leukemic retinopathy is the most frequent clinical manifestation. Others include iris infiltration, anterior uveitis, hypopyon, exudative/serous retinal detachment, and optic nerve infiltration.
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Affiliation(s)
- Mohamed A Yassin
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Shehab F Mohamed
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ameen Alkhateeb
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Usman Naeem
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ahmed I Al-Qatami
- Ophthalmology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdulqadir J Nashwan
- Hematology Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation (HMC), Doha, Qatar.
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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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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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