[Clinical characteristics and treatment of syphilitic posterior uveitis]

OBJECTIVE

To study clinical characteristics, treatment and prognosis of syphilitic posterior uveitis.

METHODS

A retrospective study was conducted in 26 patients with syphilitic posterior uveitis. The diagnosis was confirmed by clinical and laboratory tests.

RESULTS

There were 26 patients, 16 males and 10 females, mean age was 40 years. Fourteen patients were bilateral. The symptoms included impaired vision and floaters. In 40 eyes, yellow-white lesions in the posterior pole were present in 8 eyes, 22 eyes showed mild congestion of optic discs and loss of reflex in the fovea, and 6 eyes showed significant congestion and swelling of the optic disc. Fluorescein angiography showed staining or hyperfluorescence of optic disc in 40 eyes, venous leakage in 26 eyes, retinal pigment epithelium damage with dye pooling in 6 eyes, and cystoid macular edema in 6 eyes. ICGA: squamous or disseminative hypofluorescence damage was present in all 40 eyes. After the treatment, 32 eyes had improved vision and fundus damage.

CONCLUSIONS

Syphilitic posterior uveitis has typical symptoms and signs. This is a curable disease, early diagnosis and prompt treatment are important for the improvement of prognosis.

Brucellosis and uveitis

A 30-year-old-lady, (Case 1) was found to have brucella uveitis in her left eye. Serum agglutination (SAT) and SAT/Coombs titers were positive at 1:320 and 1:160, respectively. In Case 2, a 12-year-old-girl diagnosis of left brucellosis uveitis was made. Both SAT and SAT/Coombs titers were positive at 1:1280. This report confirms that Brucellae organisms as a cause of uveitis.

Vitrectomy for the Diagnosis and Management of Uveitis of Unknown Cause

PURPOSE

To determine the diagnostic yield of tests commonly used for vitreous fluid analysis in eyes with suspected intraocular infection or malignancy.

DESIGN

Noncomparative interventional case series.

PARTICIPANTS

Forty-four consecutive patients (45 eyes) treated from 1998 through 2006 with posterior segment inflammation who underwent pars plana vitrectomy for diagnostic purposes.

INTERVENTION

Vitreous specimens obtained via pars plana vitrectomy were analyzed by microbiologic culture, cytologic analysis, and flow cytometry.

MAIN OUTCOME MEASURES

Diagnostic yield and sensitivity of each test performed on vitreous specimens and visual outcomes of eyes that underwent diagnostic vitrectomy (DVx).

RESULTS

Preoperative diagnoses were infection in 15 eyes and malignancy in 30 eyes. Overall, vitreous analysis identified a specific cause in 9 (20%) of 45 eyes. The overall sensitivity of DVx was 63.6%. The sensitivities of individual tests were: culture, 50%; cytologic analysis, 66.7%; and flow cytometry, 83.3%. The yields of diagnostic tests were: culture, 5.7%; cytologic analysis, 14.3%; and flow cytometry, 20.6%. Final diagnoses were infection in 6 eyes, malignancy in 9 eyes, and idiopathic in 30 eyes. Mean visual acuity improved significantly in the first 6 months after DVx. Visual acuity improved in 60% of eyes, with 37.8% of eyes improving by 3 lines or more.

CONCLUSIONS

Analysis of vitreous fluid by widely available tests is useful in identifying intraocular infection or malignancy. Most patients experienced a substantial improvement in vision.

The presence of Propionibacterium spp. in the vitreous fluid of uveitis patients with sarcoidosis

PURPOSE

An immunological reaction to a bacterial antigen, such as Mycobacterium tuberculosis or Propionibacterium spp., is suspected to be an initial mechanism in the disorder known as sarcoidosis. We investigated whether or not P. acnes, P. granulosum or M. tuberculosis are present in the vitreous fluid of eyes suffering from uveitis with sarcoidosis.

METHODS

Using polymerase chain reaction, we analysed the presence of P. acnes, P. granulosum and/or M. tuberculosis DNA in vitreous samples taken from six eyes with sarcoidosis and six control eyes.

RESULTS

Among the six uveitis eyes with sarcoidosis, we detected P. acnes DNA in two eyes, P. granulosum DNA in four eyes, and both P. acnes and P. granulosum DNA in one eye, but no Propionibacterium spp. in the control eyes. M. tuberculosis DNA was not present in any of the patient or control eyes.

CONCLUSIONS

This is the first report indicating the presence of Propionibacterium spp. and/or its DNA in the vitreous fluid of sarcoidic eyes with uveitis. This, therefore, supports the idea that Propionibacterium spp. are involved in the aetiology of uveitis in sarcoidosis.

INDOCYANINE GREEN ANGIOGRAPHY ANOMALIES IN OCULAR SYPHILIS

OBJECTIVE

To report indocyanine green (ICG) angiography anomalies in ocular syphilis.

DESIGN

A noncomparative, interventional case series.

PARTICIPANTS

Eight patients (16 eyes) affected by ocular syphilis.

METHODS

All patients presenting with a diagnosis of active ocular syphilis between January 1994 and December 2001 were evaluated by a standard fluorescein and ICG angiography protocol. ICG angiography was repeated after completion of systemic antitreponemal and antiinflammatory treatment.

RESULTS

ICG angiography anomalies were detected in 12 (75%) of 16 eyes. Two types of anomalies were observed: late-phase scattered hyperfluorescent spots (11 eyes) and persistent staining of retinal vessels (1 eye). Of these 12 eyes, 4 had no alteration by concomitant fluorescein angiography. When ICG angiography was repeated (5 +/- 1 weeks after the beginning of treatment), ICG angiography anomalies disappeared.

CONCLUSIONS

ICG angiography may be a valuable tool in the assessment of patients with active ocular syphilis. Retinal and choroidal vascular anomalies can be determined that would otherwise go undetected by funduscopy and/or fluorescein angiography. It can also be useful in monitoring antitreponemal therapy.

[Differential diagnosis between toxoplasmosis and leptospirosis of 26 Mexican cases with posterior uveitis]

26 patients with active posterior uveitis were studied by methodologies for the confirmation of leptospirosis. ELISA-IgG was positive in 10 patients and MAT in 21. Leptospiras were observed in blood and urine. The results suggest that posterior uveitis may be caused by pathogenic leptospiras.

Ocular manifestations of tuberculosis

OBJECTIVE

To present the clinical and histopathologic findings in five cases of tuberculosis (TB) with various ocular manifestations.

DESIGN

Observational case series.

METHODS

Retrospective review of clinical findings, course, and treatment of five patients. Diagnostic techniques, including biomicroscopic, histopathologic, and molecular biologic test results, are presented.

MAIN OUTCOME MEASURES

Visual acuity, slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography results.

RESULTS

The ocular manifestations of TB in our patients included panophthalmitis, endophthalmitis, posterior uveitis with choroidal tubercles, keratitis, and a lid mass. Mycobacterium tuberculosis was identified in four cases in ocular specimens using acid-fast bacilli microscopy and in three cases by culture. Rapid diagnosis using polymerase chain reaction was obtained in one case. Extraocular foci of TB were identified in three cases with an intraocular infection at presentation. No patients had the human immunodeficiency virus (HIV) and none were immunocompromised. Two eyes could not be saved using antituberculous treatment because of delayed diagnosis and treatment.

CONCLUSIONS

In this age of the HIV pandemic, TB is becoming more common. Because it is curable, heightened awareness and better understanding of the disease's ocular manifestations should be of concern to all ophthalmologists.

[Specific features of tuberculous uveitis pathomorphology]

There have been great changes in the clinical picture and course of ocular tuberculosis in the 90s versus the 70-80s. There has been a upward trend in the incidence of ocular tuberculosis in the population, in children and teenagers in particular. Patients with tuberculous uveitis involving the posterior eye makes up over 70%. A specific eye tissue inflammatory process is mainly exudative and infiltrative with rapid development of the complications masking a tuberculous focus, which hampers treatment and causes a significant decrease in visual functions.

[Current pathomorphism and specific features of complex tuberculous uveitis treatment]

The study has indicated that in the 1990th, there has been considerable changes in the clinical picture and course of ocular tuberculous lesions. Their morbidity has tended to increase in children, adolescents, and young individuals. Patients with tuberculous uveitis with posterior eyeball lesions are more than 70%. The specific inflammatory process is primarily exudative and infiltrative, followed by rapid development of complications that prevail over the major focus, prevent treatment and substantially deteriorate visual functions. The findings are important not only for understanding the pathogenetic development of an ocular tuberculous process and they provide evidence for the approach to be used in the treatment of various manifestations of ocular tuberculosis.

The etiology of uveitis: the role of infections with special reference to Lyme borreliosis

PURPOSE

To assess the distribution of different uveitis entities and to evaluate their associations with infections, especially Lyme borreliosis.

METHODS

During a one-year period 160 consecutive uveitis patients were evaluated in a university clinic. Selected tests were performed depending on the medical history of the patient and the clinical picture of the ocular inflammation.

RESULTS

Uveitis was classified into selected entities for 74.4% of the patients. A direct infection was suggested to be linked with uveitis in 23 patients (14.4%). Lyme borreliosis, toxoplasmosis, and herpetic infections were the most frequently seen, in seven patients (4.3%) each. All patients with Lyme uveitis had manifestations of the posterior segment of the eye, such as vitritis, retinal vasculitis, neuroretinitis, chorioretinitis, or optic neuropathy.

CONCLUSION

Infections are an important cause of uveitis in a university clinic. Lyme borreliosis is a newly recognised uveitis entity which should be kept in mind in the differential diagnosis of intermediate or posterior uveitis in areas endemic for Lyme borreliosis.

[Endogenous posterior uveitis and toxoplasma infection: a case-control study]

The present study was first carried out to evaluate the effects of toxoplasma infections on endogenous posterior uveitis in Tian in city. In this report, 118 cases of endogenous posterior uveitis and 236 clinical and health controls were studied by 1:2 pair match case-control method. The clinical controls were OPD patients without uveitis and the health controls were normal persons. The prevalence rate of toxoplasma infection in three groups were 31.4%, 11.9% and 9.3% respectively. The differences of three groups was higher significant. The odds ratio (OR) of toxoplasma infection in posterior uveitis was 3.72 (2.17-6.39). The difference of the two controlled groups was not significant. The odds ratio of toxoplasma infection in central exudative retinochoroiditis and panuveitis were 4.78 and 3.33. The toxoplasma infection was not significantly related to the optic retinitis. The results suggest that toxoplasma infection as a suspect agent of endogenous posterior uveitis.

Bilateral mammary abscess and uveitis caused by Brucella melitensis--report of a case

Soft tissue locations of Brucella are a rare finding. We report the isolation of Brucella melitensis from a suspected breast tumour of a woman who also showed signs of uveitis. Three weeks after surgical drainage and despite antimicrobial therapy a new abscess developed on the other breast whose culture also yielded Brucella. As observed, unusual localization of brucellosis without previous penetrating injury may be the only manifestation of chronic infection.