Atypical Conjunctival CD5 Positive Mucosa-associated Lymphoid Tissue (MALT) Lymphoma

A 61-year-old woman with intermittent ocular irritation redness and swelling of her eyes was followed up and investigated. The diagnosis was conjunctival CD5 positive mucosa-associated lymphoid tissue (MALT) lymphoma, which is an atypical and rare type of pathology of the eye, in which the clinical course/behavior is not fully understood. Our experience showed that this disease is indolent and responds well to radiotherapy. It can recur in the fellow eye, even after as many as eight years of successful treatment with no evidence of recurrences in the previously affected eye. Therefore, long-term periodic follow-up is mandatory to detect recurrences in such patients. Further studies are also required to elucidate a more conclusive clinical behavior of this disease so that a clearer therapeutic and management plan can be devised for future patients with this disease.     

Clinical Profile,Treatment, and Visual Outcome of Ampiginous Choroiditis

Purpose: To report the clinical profile and management of patients diagnosed to have ampiginous choroiditis in a tertiary care referral centre in India.

Methods: Retrospective cohort study. Twenty-six eyes of 16 patients were included in the study, which was diagnosed as choroiditis, serpiginous choroiditis, and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) or ampiginous choroiditis. Those who were initially diagnosed as having other forms of choroiditis were later classified as having ampiginous choroiditis clinically. Systemic steroids and immunosuppressives were the mainstay of therapy.

Results: There was a male preponderance (7:3). Age at presentation ranged from 22 years to 57 years with a (median 34 years); 81% had bilateral involvement and 35% had recurrences. Vision improved or maintained in 24 eyes, whereas it deteriorated in 2 eyes due to subretinal fibrosis and macula involvement, respectively. Resolution of lesions and improvement or stability of vision can occur with administration of timely steroids and immunosuppressive therapy. Regular follow-up is necessary to monitor the disease progression, recurrences, and involvement of the other eye.

Conclusion: Ampiginous choroiditis is a separate disease entity due to its distinct clinical features. It is a disease with multiple relapses, which can be effectively controlled with a combination of immunosuppressive therapy, and a good visual acuity can be maintained on long-term follow-up.     

Cotton wool spots as possible indicators of retinal vascular pathology in ocular lyme borreliosis

Lyme borreliosis is an underdiagnosed infectious disease caused by a spirochete and transmitted by certain Ixodes ticks. In Lyme disease diagnostic problems are still discussed extensively as the laboratory workup is not standardized and a positive antibody result is not proof of active infection. It is therefore important to appreciate all clinical signs that can prompt us to the diagnostic investigation of Lyme borreliosis. We present a case of a woman with Lyme borreliosis and recurrent unilateral anterior uveitis in her right eye for 2 years, who developed cotton wool spots (CWS) in her left eye, followed by acute and recurrent anterior uveitis in this second eye. An extensive general examination, including blood coagulopathies and ultrasound of the carotid arteries, did not reveal any pathology. The CWS resolved within a few months. The recurrent anterior uveitis could be controlled by topical steroids. After treatment with 2 g of i.v. ceftriaxone for 3 weeks, she remained free of recurrences for 1 year of observation time. CWS can be the first clinical sign of ocular vascular pathology and/or uveitis. Further investigation will be necessary to confirm the relationship between CWS and ocular borreliosis. In patients with otherwise unexplained CWS, the possibility of an infection with borreliosis should be ruled out carefully.     

Long-term follow-up and angiographic findings in serpiginous choroiditis

BACKGROUND: Long-term follow-up and angiographic findings of serpiginous choroiditis, a chronic disease with recurrences of unknown origin, are reported. PATIENTS AND METHODS: A retrospective analysis of the data of 4 patients with serpiginous choroidopathy, who were treated in the eye clinic of Mainz in the past 10-18 years was made. Progression of disease was documented by photography, as well as fluorescein and indocyanine green angiography. Patients with acute lesions were treated with steroids per os for some weeks. RESULTS: All 8 eyes developed 2-7 recurrences with progression of the chorioretinal scars. In cases of macular involvement the functional results were worse. No choroidal neovascularizations were seen. During follow-up 3/8 eyes became blind, 4/8 eyes retained reading vision. Indocyanine green angiography usually demonstrated many more lesions than those seen with fluorescein. In 3 cases acute choroidal lesions were detected only with indocyanine green angiography whereas no sign of inflammation was demonstrated by fluorescein angiography. CONCLUSION: The functional prognosis of serpiginous choroiditis is bad because all eyes developed at least 2 recurrences during follow-up. Use of indocyanine green angiography may help to better describe the full extent of the disease, even before it is seen with fluorescein angiography. It can help the observer to determine the precise clinical progression of the disease.     

Bilateral Coats' disease: long-term follow up

PURPOSE: To report on the long-term follow-up of a female patient with bilateral Coats' disease, who showed marked asymmetry between the two eyes. METHODS: A five year old girl presented in 1978 with leukocoria in a blind right eye. A total exudative retinal detachment and extensive retinal telangiectasiae were noted. In the other eye, there was a localized area of retinal exudation and vascular abnormality in the supero-temporal periphery. Ultrasonography showed no evidence of intraocular tumour in the right eye and a clinical diagnosis of bilateral Coats' disease was made. RESULTS: In 1995, the area or retinal exudation in the left eye increased and laser photocoagulation was applied successfully. To date, no disease recurrences have occurred. CONCLUSION: Although Coats' disease is usually unilateral, bilateral, asymmetrical involvement may occur on rare occasions. Long-term follow-up of the least affected eye is necessary so that late complications can be identified early and treated adequately to prevent visual loss.     

Synergistic antiherpetic effect of acyclovir and mycophenolate mofetil following keratoplasty in patients with herpetic eye disease: first results of a randomised pilot study

Purpose The main reasons for graft failure following penetrating keratoplasty in patients with herpetic eye disease are recurrence of herpetic disease and allograft rejection. In a randomised trial the effect of systemic acyclovir and mycophenolate mofetil (MMF) on these post-keratoplasty complications was evaluated.Patients and methods Patients with typical clinical findings of recurrent herpetic keratitis were enrolled in this single-centre study after contraindications to systemic immunosuppression were ruled out. In a prospective randomised trial 30 patients were treated in three groups. In group A patients received acyclovir 200 mg five times/day for 3 weeks. In group B patients were treated with acyclovir 200 mg five times/day for 1 year, and patients in group C received acyclovir 200 mg five times/day in combination with MMF 1 g twice daily for 1 year.Results In group A 3 patients experienced seven herpes recurrences. One patient had a moderate and one further patient a severe allograft rejection. In group B three severe allograft rejections were observed. Herpes recurrences did not occur while receiving acyclovir prophylaxis, but only once after the prophylaxis had been stopped. In group C no herpes recurrence was observed, and only two mild allograft rejections occurred while being under combined acyclovir—MMF therapy. Another mild and one moderate allograft rejection were observed after cessation of MMF.Conclusions These results demonstrate that systemic acyclovir protects the grafts from recurrences of herpetic disease as long as it is administered at efficient doses. Simultaneously administered mycophenolate mofetil does not trigger herpes recurrences and protects the graft from severe allograft rejections, but mild, less dangerous immune reactions may still occur while receiving MMF. The combination of systemic acyclovir and mycophenolate mofetil therefore is recommended for patients at high risk for herpes recurrence and allograft rejections.     

Lysozyme tear level in patients with herpes simplex virus eye infection.

The lysozyme level in tears of patients with HSV eye infection was examined and correlated with the clinical findings and presence of virus. The concentration of the enzyme in tears of patients during acute attack was 2.83 mg./ml. This value was significantly lower than that in tears from healthy controls (6.1 mg./ml.) and tears from the patient's healthy eye (4.46 mg./ml.). After termination of treatment with either IUDR or poly I:C, the lysozyme level rose to an average of 4.34 mg./ml. During the latent period of the disease the level increased (5.34 mg./ml.), but it remained lower than in healthy subjects who had never suffered from HSV eye infection. This may be an indicator of possible future recurrences.     

Prospects for developing an effective vaccine against ocular herpes simplex virus infection

One of the hallmarks of herpes simplex virus (HSV) infection is the establishment of a lifelong latent infection accompanied by periods of recurrent disease. Primary HSV infections or repeated clinical recurrences do not elicit immune responses capable of completely preventing recurrences of endogenous virus. It is therefore questionable if vaccination approaches that seek to mimic the immune response to natural infection will reduce infection or disease due to an exogenous viral challenge. Approaches to the induction of protective responses by altering or enhancing both innate and adaptive immunity, using novel vaccines specifically tested in models of HSV infections of the eye, such as recombinant viral vaccine vectors and DNA vaccines, are detailed in this review.     

Wegener肉芽肿与眼

Ｗｅｇｅｎｅｒ肉芽肿是一种系统性炎症性疾病,其临床表现不特异。眼部表现约为１／６患者的首发症状,而且大多数患者最终都将出现眼部症状。眼前节和后节的任何组织都可受累。抗中性粒细胞胞浆抗体（尤其是抗蛋白酶－３）的发现,改变了临床上对Ｗｅｇｅｎｅｒ肉芽肿可疑患者的评价方法。口服环磷酰胺和糖皮质激素治疗Ｗｅｇｅｎｅｒ内芽肿可降低发病率,提高生存率。有人正在研究三甲氧苄氨嘧啶－黄胺甲异恶唑对降低Ｗｅｇｅｎｅｒ肉芽肿复发次数及严重程度的作用。     

The clinical course of serpiginous choroidopathy.

We closely observed nine patients (17 eyes) with serpiginous choroidopathy for time periods ranging from two to ten years. There were seven men and two women with ages ranging from 22 to 58 years, average age was 46 years. Eight patients were bilaterally affected; one patient had only one eye. The clinical course of the disease was characterized by multiple recurrences. The recurrences and progression of the disease often were not noticed by patients if the macular area was not involved. Serial fundus photographs proved to be invaluable in establishing progression. Although the disease usually progresses in a centrifugal manner from the disk toward the periphery, three patients demonstrated centripetal progression and one of these three permanently lost central acuity. Visual acuity was affected only when the foveal or parafoveal areas became involved, but in nine of the 17 eyes, visual acuity returned to a variable degree. None of the patients had any general systemic illness. However, five of the patients reported chronic exposure to an unusual variety of chemicals.