Corneal donor material selection.

Histologic study of eyes used as donor material for corneal transplant revealed one instance of massive leukemic infiltration with leukemic keratic precipitates on the fellow eye. In another eye, microabscesses composed of acute and chronic inflammatory cells containing Crytococcus neoformans were present. In a third patient metastatic anaplastic cells were present in the choroid. We think donor eyes are absolutely unacceptable if death was caused by any chronic neurologic disorder, unless clearly secondary to trauma. Eyes from patients with septecimia, hepatitis, jaundice and any evidence of any active viral infection, syphilis, and positive serology are also unacceptable. Extreme caution should be used in selecting eyes of patients with ocular or systemic malignancy, long-term diseases, particularly if immunosuppressive agents were used, where a history of eye disease exists, including corneal disease or dystrophy, iritis, absolute glaucoma or acute glaucoma, and eyes with a history of previous intraocular surgery.     

Leopard spot chorioretinopathy. Initial manifestation of recurrent acute lymphocytic leukemia]

An 11-year-old girl with a history of acute lymphocytic leukemia of the central nervous system had attained complete remission for almost 3 1/2 years after combination chemotherapy and radiotherapy when she developed iritis and chorioretinopathy of the right eye. Neither an anterior chamber tap nor a diagnostic vitrectomy revealed leukemic cells. Both nonspecific anti-inflammatory therapy and antiviral treatment were unsuccessful. Finally, lymphoblasts were detected in the cerebrospinal fluid and in the bone marrow after repeated lumbar puncture and bone marrow aspiration. Combination chemotherapy alone was resumed, resulting in the resolution of all acute ocular symptoms and bone marrow involvement. Only the leopard-spot-like pigmentary fundus changes persisted. The child has now remained in continuous complete remission for 1 1/2 years.     

Phacoanaphylactic endophthalmitis secondary to capsular block syndrome

A 65-year-old white man presented with sudden onset of painless decrease in vision and a red eye 5 days after cataract surgery. The visual acuity was 20/400 with mild injection. Marked iritis was present, and a hypopyon could be seen behind the intraocular lens (IOL) in the capsular bag. The posterior segment was clear. The iritis worsened despite 4 days of hourly topical corticosteroid treatment. Anterior chamber washout was performed, with clearing of the material behind the IOL. The iritis subsided 4 weeks later, and visual acuity recovered to 20/20. Capsular block syndrome can present as phacoanaphylactic endophthalmitis if cortical material is left in the capsular bag, requiring surgical intervention.     

Recurrent iritis as the initial symptom in plasmacytoma (IgG type)

The author presents a case report on a 47-year-old man with recurrent serofibrinous iritis. As a result of intensive investigations an IgG-type myeloma was finally diagnosed with the aid of serum electrophoresis, immunoelectrophoresis, and sternal puncture. Apart from ocular symptoms of acute iritis all findings were normal. General clinical findings were also normal and the patient was subjective free of complaints.     

Recurrent iritis after implantation of an iris-fixated phakic intraocular lens for the correction of myopia Case report and clinicopathologic correlation

The iris-claw intraocular lens (IOL) was recently approved by the U.S. Food and Drug Administration for the correction of refractive disorders. Previous reports are not uniform regarding its potential to induce inflammatory reaction. We report the case of a young healthy patient who experienced persistent and intolerable iritis after implantation of an iris-claw IOL. The iritis was resolved only after explantation of the IOL.     

Association of foveomacular retinitis, ankylosing spondylitis, iritis, and acquired iris atrophy

A case of foveomacular retinitis, ankylosing spondylitis, iritis, and iris dissociation is described. Only ankylosing spondylitis was present in other family members. The differential diagnosis is discussed. The iritis of ankylosing spondylitis must be considered in cases of developmental full-thickness iris holes.     

Free-Floating Iris Cyst in a Patient with Recurrent Iritis

PurposeWe describe an unusual clinical finding of a free-floating iris cyst in a patient with recurrent iritis.MethodThe clinical finding of a free-floating iris cyst was recorded using slit-lamp photography.ResultsA 39-year-old male with a 5-year history of recurrent right iritis was found to have a small mobile iris cyst within his right anterior chamber, first identified 3 years ago. The patient did not experience any discomfort or visual symptoms resulting from the cyst.ConclusionSurgical removal is not indicated for asymptomatic non-progressive free-floating iris cysts. The significance of a free-floating iris cyst in the setting of recurrent iritis remains unknown.Key Words: Free-floating iris cyst, Anterior chamber, Iritis     

Iritis presumed as secondary to disseminated coccidioidomycosis.

BACKGROUND: Coccidioidomycosis is a systemic disease caused by a fungus found in soil and transmitted through inhalation. It is prevalent in western and southwestern United States, Mexico, and South and Central America. Results of skin testing, serologic testing, and tissue cultures confirm the diagnosis. Coccidioidomycosis can manifest in various ways: the infected individual may present asymptomatically, with an acute respiratory infection, or, in more severe or chronic cases, with a multiorgan presentation. Ocular involvement may include anterior segment, posterior segment, or extraorbital involvement. CASE REPORT: A case concerning a patient with iritis presumed as secondary to disseminated coccidioidomycosis is discussed. The patient initially presented to our clinic with signs and symptoms of acute, unilateral iritis and a recent history of iritis in the contralateral eye. The active inflammation was treated topically with Pred Forte and cyclopentolate and resolved without sequelae. Because the presentation was bilateral with an asymmetric timecourse, laboratory tests were ordered to rule out systemic association. Because all tests yielded negative results, the known history of disseminated coccidioidomycosis was presumed to be the etiology of this iritis. CONCLUSION: Although eye findings are rare, disseminated coccidioidomycosis is an important differential to consider when a patient presents with uveitis. For this reason, awareness and recognition of ocular signs and symptoms of this disease is significant in proper patient care and management.     

Goniosurgery for glaucoma secondary to chronic anterior uveitis: prognostic factors and surgical technique

PURPOSE: To describe the preoperative prognostic factors that correlate with the surgical success of goniosurgery for glaucoma complicating chronic anterior uveitis and to describe the surgical technique. METHODS: The medical records of 31 patients with 31 eyes with glaucoma secondary to chronic anterior uveitis for which 38 goniotomy procedures were performed were reviewed. Uveitis etiology, gender, age of onset of iritis, duration of iritis before recognition of glaucoma, duration of iritis and duration of glaucoma until initial goniosurgery, preoperative gonioscopic findings, lens status, surgical outcome, age at initial goniosurgery, duration of postoperative observation, lens status, preoperative and postoperative intraocular pressures, topical steroid, and glaucoma medication use were reviewed. Complete success was defined by an intraocular pressure (IOP) < or = 21 mm Hg, and qualified success as IOP < or = 21 mm Hg with use of glaucoma medications. The surgical technique used to perform the goniosurgery was reviewed. RESULTS: Overall surgical success was achieved in 22 (71%) of 31 eyes. The mean age at surgery was 10.2 +/- 4.2 years (range, 4-21 years). All but 8 patients were female. Mean follow-up interval was 10.3 +/- 6.4 years (range, 1.5-22 years). Significant correlation was found between outcome and age at initial surgery, lens status, duration of glaucoma before goniosurgery, duration of iritis before glaucoma surgery, and hours of peripheral anterior synechia (PAS). The mean number of clock hours of preoperative (PAS) was 0.5 hours in eyes with success versus 2.5 hours in eyes with failure. Age of onset of iritis, duration of iritis before recognition of glaucoma, trabecular meshwork pigmentation (TM), TM opacification, and circumferential ciliary body band narrowing did not correlate with surgical outcome. CONCLUSION: Goniosurgery is an effective treatment of glaucoma secondary to chronic anterior uveitis. The outcome of surgery was unfavorably influenced by older age, longer duration of glaucoma, and evidence of more advanced preoperative filtration angle abnormalities secondary to uveitis. Goniosurgery for this secondary glaucoma can be successfully performed utilizing the standard goniotomy technique.     

Bilateral hypopyon iritis in a patient with diabetes mellitus

A 47-year-old man with diabetes mellitus complained of decreased vision and ocular pain in his right eye. On examination, hypopyon was found in that yee. He also had compound periodontitis. Six days later, hypopyon developed in the left eye. After topical instillation of betamethasone, ofloxacin, and atropine, the bilateral hypopyon iritis decreased. we suggest that an acute bacterial infection in patients with diabetes mellitus may lead to hypopyon iritis.     

外伤性白内障伴严重虹膜炎的人工晶状体二期植入

目的评价穿孔伤性白内障合并严重虹膜炎时的白内障搞出和二期人工晶状体植入的时机、方法和疗效。方法积极抗炎治疗,1－6月后二期植入人工晶状体,术中行后囊切开。结果16例随访6月-4年,视力>0．5者13眼占81％。结论炎症控制后,行二期人工晶状体植入,对减少术后并发症恢复视功能有重要作用。     

Intraocular large cell lymphoma presenting as massive thickening of the uveal tract

A 46-year-old woman with a history of biopsy-proven extranodal large cell lymphoma of the maxillary sinus presented four months after this condition was diagnosed with signs of unilateral iritis. After an initial response to topical corticosteroid therapy, the iritis relapsed, the eye rapidly becoming blind and painful. Histopathological examination of the enucleated globe showed a diffuse infiltration of the entire uveal tract by malignant lymphocytes consistent with large cell lymphoma. Systemic examination revealed no concurrent foci of malignancy. This dramatic presentation of ocular involvement is quite unusual for large cell lymphoma.     

Keratoconus with spontaneous perforation of the cornea

A 24-year-old woman with a 5-year history of bilateral keratoconus who was in her eighth month of pregnancy presented with central corneal edema and mild acute iritis in her right eye. The iritis responded rapidly to therapy with topical corticosteroids, which was stopped after 1 week. The patient returned 1 week later with a markedly edematous central cornea, which had perforated. Management included a therapeutic soft contact lens, patching and, eventually, penetrating keratoplasty. The authors discuss the possible role of the pregnancy and of the topical corticosteroids in the development of the corneal perforation, a rare complication of keratoconus.     

Ocular manifestations of electrical injury: a case report and review of the literature.

PURPOSE: To report a case of electrical shock resulting in multiple ocular manifestations, including anisocoria, acute bilateral iritis, bilateral cataracts, and macular cyst formation, and to provide a review of the literature on electrically induced ocular injuries. METHODS: Case report and review of the literature. RESULTS: The case presented demonstrates a sequential occurrence of anisocoria, bilateral cataract formation, iritis, and macular cyst formation, with resolution following medical and surgical treatment. CONCLUSIONS: Electrically induced injuries can have many ocular manifestations that may occur simultaneously or sequentially, occasionally occurring later than the inciting event. The most common ocular finding is cataract formation.     

Cogan's syndrome: a treatable cause of neurosensory deafness

Cogan's syndrome, nonsyphilitic interstitial keratitis associated with vestibuloauditory deficits, can vary in its presentation. This paper describes an unusual case in which deafness developed while the patient was receiving topical therapy with prednisolone and homatropine for mild bilateral iritis and right-sided nodular episcleritis. The 10-year-old boy's hearing improved dramatically with high-dose systemic steroid therapy. The importance of being aware that deafness may occur in children undergoing treatment for "routine" iritis is emphasized.     

Clinical statistics of endogenous uveitis: comparison between general eye clinic and university hospital

We compared uveitis patients who attended a general eye clinic (n = 183) with those who attended the ophthalmology department of a university hospital (n = 550) to examine factors that affect the clinical statistics of uveitis outpatients. We observed that diabetic iritis and herpetic iritis were significantly more frequent in the clinic whereas Vogt–Koyanagi–Harada disease and Behcet’s disease were significantly more common in the university hospital. Among the so-called three leading uveitis, Behcet’s disease and Vogt–Koyanagi–Harada disease were relatively rare in the general clinic; they might be concentrated in the university hospital setting because these diseases require treatment at specialist hospitals. In addition, uveitis secondary to underlying diseases such as diabetic iritis and transient non-granulomatous iridocyclitis was generally not referred to specialist hospitals. These factors may account for the differences in disease frequencies observed between the two facilities.     

Putative side effects of prostaglandin analogs

Anecdotal case reports describe the occurrence of cystoid macular edema, iritis, herpes simplex keratitis, periocular skin darkening, and headaches in patients treated with prostaglandin analogs for glaucoma. The purpose of this article is to critically analyze these anecdotal case reports in light of a few well-controlled, randomized clinical studies to determine whether conclusions can be made about a causal relationship between the use of prostaglandin analogs and the occurrence of these side effects. None of these putative side effects has been proven to be causally related to latanoprost therapy using valid scientific methodology. These possible side effects occur rarely. Cystoid macular edema, iritis, and herpes simplex keratitis occur in eyes with risk factors. To scientifically establish a causal relationship between drug therapy and rare side effects, repeated rechallenging with masked controls is required. With rare exception, such methodology has not been used with any of these putative side effects. Nevertheless, even without firm establishment of a causal relationship, caution is advised with the use of prostaglandin analogs in eyes with risk factors for cystoid macular edema, iritis, and herpes simplex keratitis until properly designed, large, controlled studies provide more definitive information.     

Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus

A 21-year-old woman had crosslinking for keratoconus in the right eye; the left eye was scheduled for penetrating keratoplasty. Five days postoperatively, she presented with geographic epithelial keratitis and iritis. Analysis of tear samples by polymerase chain reaction confirmed the diagnosis. The patient was treated with oral steroids and acyclovir, with significant improvement. Two months postoperatively, the visual acuity was improved and there was no evidence of herpetic disease recurrence. Crosslinking can induce herpetic keratitis with iritis even in patients with no history of herpetic disease. Early diagnosis and proper treatment are essential for a favorable outcome.     

Collamer intraocular lens implantation with active uveitis

Two patients with active iritis developed cataracts and had successful cataract surgery with implantation of a Collamer (Staar Surgical, AG) intraocular lens (IOL). Both patients developed severe bilateral uveitis, which in 1 patient was refractory to control. Different IOL materials have been used in iritis patients with varying degrees of success. The IOLs used in these patients remained free of cellular and noncellular deposits, such as those that frequently develop on the anterior surface of IOLs in uveitis patients. Two of the 3 eyes developed a secondary membrane that was successfully treated by a neodymium:YAG laser posterior capsulotomy.     

Tübingen 1895-1899. Incidence, diagnosis and therapy of selected optic nerve, uveal and retinal diseases 100 years ago

BACKGROUND: The records of the University Eye Clinic are almost completely preserved at the historical archive of the University of Tübingen since 1865 and shell now be reduced. MATERIALS AND METHODS: 150 records from the historical archive of the University of Tübingen were selected. We were interested in those patients treated for the first time at the University Eye Clinic between 1895 and 1899. Only diseases of the optic nerve, the uveal tract and the retina were considered. The records were distributed into groups following historical classification and statistics of the same period. These statistics were also used to compare our selection with all patients treated. For information about frequency, diagnostics and therapy a questionnaire was developed. RESULTS: Glaucoma: The data of the subgroup "Glaucoma simplex" showed high correspondence with the historical data regarding the frequency (24.3 vs. 25.5%). The data of the subgroup "Glaucoma secundaria" differed (34.5 vs. 25.5%). Testing the visual acuity was the first step of examination here and in all groups (100%). Measurement of intraocular pressure with digital palpation followed (86.3%). First of all Eserin eye drops were applicated (76.5%). Iritis: The frequency of acute iritis was 16.8 vs. 25.0%, and of chronic iritis 59.6 vs. 52.2%. As typical symptoms ciliar injections, fixed anisocore pupil and exudation were often seen (80.0%). Chronic iritis showed as typical symptom posterior synechia (80.9%). Atropin eye drops were firstly applied in acute iritis (100%), chronical iritis was treated by iridectomy (57.1%). Myopia: In all subgroups our data differed from the historical data. Staphyloma posticum was the characteristic diagnosis (65.8%). Myopia was treated by decision of the lens. Retinal detachment: The frequency 37.2 vs. 28.0%. In nearly all cases retinal detachment was described after ophthalmoscopic examination (92.8%). The first therapeutical step was to keep the patients staying in bed (53.8%). CONCLUSIONS: As expected, diagnostic and therapeutical options were strongly limited in Tübingen 100 years ago. Nevertheless, therapeutic successes were achieved in certain cases.