Frequency and complications of chronic iridocyclitis in ANA-positive pauciarticular juvenile chronic arthritis

Chronic iridocyclitis (CI) is among the most important extra-articular manifestations of juvenile chronic arthritis (JCA) and is most often observed in young girls with pauciarticular JCA and circulating antinuclear antibodies (ANAs). The frequency of CI found in 39 children with ANA-positive pauciarticular JCA was 56%. None of the patients developed ocular complications during follow-up. We think that this favourable outcome was primarily due to the early diagnosis and to our choice of using atropine as a mydriatic agent and to prolong atropine, after having spaced its administration further apart, up to one year or longer after the remission of ocular manifestations.Abbreviations ANA antinuclear antibody - CI chronic iridocyclitis - JCA juvenile chronic arthritis - RF rheumatoid factor     

Newborn chronic follicular conjunctivitis

CASE REPORT: A case of chronic follicular conjunctivitis in an infant presenting with ptosis and dacryorrhea is reported. Polymerase chain reaction (PCR) test identified Chlamydia trachomatis as the causative agent. The patient was treated with topic and systemic erythromycin. The infection was probably transmitted during delivery. DISCUSSION: Chronic follicular conjunctivitis in infants is very uncommon in our environment. The most sensitive and specific diagnostic test is PCR. It is necessary to identify the original focus of infection and to provide specific treatment to all the carriers as soon as possible to avoid and prevent chronic complications.     

Personalities and chronic glaucoma

This survey has investigated the occurence of psychopathological affections and their relationship with compliance in open angle glaucomatous patients. Three groups have been considered: 48 severe glaucomas, 37 early glaucomas and 48 control patients, under treatment for other ophthalmological affections. These groups have taken a psychiatric interview, compliance evaluating scale and psychological assessment (inducling: Vocabulaire Binois Pichot, Cattel's 16 Personality Factors and Autoanalyse, Thematic Aperception Test and the Rorschach Test analysed through Exner's Synthetic System). Anxiety personality and disoders are more frequent in the glaucomatous group than the control or early (P = 0.0156). Patients in the early group appeared to be most compliant. Personality structure play a role in the acceptance of the disease and in the degree of cooperation with treatment. Maximal compliance is observed at the beginning of the disease. Personality scales show that glaucomatous patients have difficulties in coping with aggressive pulsions and tend to react to affect loaded situations by a defensive or avoiding attitude.     

Classification of chronic blepharitis

Since last thoroughly evaluated over three decades ago, the clinical spectrum of chronic blepharitis has changed. The relative prevalence of Staphylococcus aureus alone or in combination with seborrheic blepharitis has decreased. The relative prevalence has increased of seborrheic blepharitis with or without associated excess meibomian secretions (meibomian seborrhea) or inflammation (meibomitis). Primary meibomitis appears not to be a primarily infectious entity but to represent a facet of generalized sebaceous gland dysfunction and to be found in association with seborrheic dermatitis or acne rosacea. The keratoconjunctivitis found in association with primary meibomitis may be contributed to by the production of bacterial lypolytic exoenzymes that split neutral lipids, resulting in an increased level of free fatty acids in the tears. A frequent finding of keratoconjunctivitis sicca in this patient population, especially the S. aureus group (50%), is of note. Of particular importance is that these entities be recognized as chronic diseases requiring control and ones for which there is no "cure."     

N-acetylcysteine in chronic blepharitis

PURPOSE: To investigate the effects of N-acetylcysteine (NAC) in chronic posterior blepharitis. METHODS: This was a prospective randomized, controlled study that included 79 eyes of 40 patients with chronic posterior blepharitis. Routine ophthalmologic examination, Schirmer-1 test, fluorescein break-up time (FBUT), and mucous fern tests were carried out during the first visit of all patients. A topical steroid, topical antibiotic, and artificial tears were started in 36 eyes of 18 patients. The therapy group (43 eyes of 22 patients) was administered three daily doses of 100 mg oral NAC. All patients were examined weekly for 1 to 4 months (average, 24 +/- 0.7). A Schirmer-1 test and FBUT were administered at every visit, but mucous fern tests were administered every two weeks. The results of the first and last Schirmer-1 tests, FBUT, and mucous fern test were compared between the therapy and control groups. Student's t and Mann-Whitney U tests were used for statistical analysis. RESULTS: FBUT was significantly increased (p < 0.0001), and the mucous fern pattern was also significantly improved (p = 0.0096) in the therapy group. CONCLUSION: NAC is thought to increase FBUT and improve mucous fern pattern by blocking lipid peroxidation in chronic blepharitis.     

Vitrectomy for chronic macular holes

PURPOSE: To address the efficacy of surgical intervention for chronic macular holes. METHODS: The cases of 22 patients (23 eyes) who underwent pars plana vitrectomy with or without internal limiting membrane (ILM) peeling and use of 10% to 16% C3F8 gas for macular holes of duration of >1 year (mean, 4.2 years; range, 1.2-15 years) were retrospectively reviewed. Preoperative visual acuity ranged from 20/60 to 5/200 (mean, 20/278). Thirteen eyes (56.5%) had stage 3 macular holes, and 10 eyes (43.5%) had stage 4 macular holes. The mean age of the patients was 70.2 years (range, 47-78 years), and 20 (87%) were female. RESULTS: Nineteen (83%) of 23 macular holes were closed at final follow-ups at >/=9 months (mean, 4.67 years; range, 0.9-10.8 years). With one operation that included ILM peeling, 13 (81%) of 16 eyes had holes that closed. Seven eyes on which initial surgery without ILM peeling failed underwent reoperation with ILM peeling, and all but one had closed holes. ILM peeling was significant for surgical success of one operation (Fisher exact test, P = 0.0005). Postoperative visual acuity ranged from 20/30 to 20/800 (mean, 20/166). Improved vision with halving of the visual angle occurred in 16 eyes (70%). Nine eyes (39%) achieved visual acuity of 20/70 or better, and two eyes (8.7%) achieved visual acuity of 20/40 or better. One eye (4%) had worse visual acuity, and three eyes (13%) remained unchanged. Cataract was a possible cause of decreased vision in six eyes (26%) at the end of follow-up. CONCLUSION: Chronic macular holes can be surgically closed with visual improvement in most patients. ILM peeling is an important surgical factor for closure of the macular hole with one operation.     

Microbiological analysis of chronic dacryocystitis

AIMS: To investigate the microbiology of specimens from patients with chronic dacryocystitis. METHODS: A total of 100 samples were obtained from the contents of the lacrimal duct in 91 consecutive patients with chronic dacryocystitis, including nine bilateral cases. These samples were cultured for aerobic and anaerobic bacteria and fungi with a routine microbiological technique. Positive cultured isolates were identified. RESULTS: A total of 180 strains were isolated from the 85 bacterial samples, including 150 strains of aerobic bacteria and 30 strains of anaerobic bacteria. Fungi were found in eight samples and actinomyces in three samples. The bacterial species that were most frequently found were Staphylococcus species, representing 34.5% of all strains, followed by Corynebacterium diphtheroides (15.5%). The sensitivity tests revealed that levo-ofloxacin and amikacin were the most effective antibiotics. CONCLUSIONS: Gram positive cocci was the predominant pathogen of chronic dacryocystitis. Levo-ofloxacin and amikacin had the best effect in vitro.     

Ocular involvement in chronic sarcoidosis

Although spontaneous remissions often occur in sarcoidosis, chronic persistent disabling disease is also observed. Of a series of 183 patients with chronic sarcoidosis, 47 (26%) had ophthalmic involvement. In this series, chronic sarcoid was defined as disease for a minimum of five years. Patients were followed primarily for their systemic disease for a mean of 13 years. Uveitis developed in 35 patients (19%) and was an early manifestation in 32 (91%). The course of the ocular disease did not necessarily parallel that of the systemic disease. Despite the chronic nature of the underlying disease, the anterior uveitis did not pursue a chronic course in 15 of 33 patients (45%) and was generally characterized by a single episode at the onset of disease. Chronic uveitis and secondary glaucoma were poor prognostic signs, as eight of 11 patients with uveitis and glaucoma suffered severe visual loss.     

Acute and chronic orbital myositis

Ocular muscle diseases fall into two distinct groups: acute or subacute exophthalmic myositis and chronic oligosymptomatic myositis. The diagnosis can only be established with certainty by means of B-scan sonography and CT scanning; these examinations demonstrate the irregular thickening of one or several eye muscles. The disease is apparently primitive; in some cases concomitant autoimmune factors may be found. The course is spontaneous, with continual recurrence, and may have sequelae in the form of a definitive exophthalmos or an acquired retraction syndrome. It responds remarkably well to corticotherapy and, if necessary, immunosuppressors; in general, these lead to rapid and - if treatment is started in time - total regression of the disease.     

慢性泪囊炎的手术治疗

慢性泪囊炎是鼻泪管阻塞或狭窄等引起的常见泪道病,目前无有效的药物疗法,不同疗法目的均为使用器械解除梗阻,重建引流通道.本文复习文献资料,比较了当前临床上治疗慢性泪囊炎的7种方法,认为鼻内窥镜下泪囊鼻腔吻合术效果好,微创、美观,是治疗慢性泪囊炎高效安全的方法.泪道内窥镜可在直视下对狭窄部位进行疏通,结合泪道置管,也具有很...     

Calcinosis conjunctivae in chronic blepharitis

We present a case of a 53-year-old female patient with chronic blepharitis and conjunctival overgrowth of the cornea. Histologically the conjunctival overgrowth contained foreign body granulomas around calcification focuses. This could have been promoted by the application of phosphate-containing eye drops and the presence of chemokines like TNF-alpha, which occur in chronic blepharitis. Thus, we recommend the application of phosphate-free eye drops in patients with chronic blepharitis.