复杂外伤性睫状体离断的临床特征分析

 目的 探讨复杂外伤性睫状体离断的临床特征。设计 回顾性病例系列。研究对象2013年1月至2015年1月北京同仁医院就诊的复杂外伤性睫状体离断患者44例（44眼）。方法 回顾性分析患者的一般情况及临床表现特点。主要指标 性别、年龄、受伤眼别、致伤原因、视力、眼压、睫状体离断范围、眼部合并症等。结果 患者平均年龄（43±14）岁,男性39例（88.6%）,右眼占52.3%。致伤原因中钝挫伤占95.5%,以铁块崩伤、爆竹崩伤和拳击伤为主。就诊时平均视力（2.3±1.1）logMAR,平均眼压（8.0±3.4）mmHg。就诊时表现低眼压者占79.6%,浅前房占31.8%。眼压与睫状体离断范围无相关性（r=-0.09, P=0.56）。平均睫状体离断范围4.8±3.2个钟点,其中16例（37%）离断范围超过180°,3例离断范围 360°。右眼颞上象限,左眼鼻上和颞上象限易发生离断。眼部其他合并症包括晶状体损伤（84.1%）、前房积血（31.8%）、房角后退（18.2%）、虹膜根部离断（34.1%）、玻璃体积血（54.5%）、视网膜脱离（31.8%）等。结论 复杂外伤性睫状体离断常合并眼部多组织损伤尤其是晶状体损伤。对眼球钝挫伤即使无浅前房、低眼压等表现也需警惕睫状体离断的可能。（眼科, 2018, 27： 301-304）     

IgG4相关性疾病眼部病变的临床及影像学特征分析

目的 探讨IgG4相关性疾病眼部病变的临床及影像学特征。设计 回顾性病例系列。研究对象 25例在2010年10月-2014年5月期间首诊于眼科并经实验室和（或）活组织检查证实的IgG4相关性疾病患者。方法 回顾性分析25例患者眼部病变的临床及影像学表现。主要指标 临床表现,眼眶MRI,生长抑素受体SPECT/CT显像（SRS）。结果 25例患者双眼睑肿胀、眼球突出为主要临床表现,其中23例为双眼受累,22例患者有≥2个器官受累,眼外受累器官多见于鼻部（19例）和涎腺（13例）。眼眶MRI主要表现为弥漫性泪腺增大（22例）、眼外肌增粗（14例）、眶周软组织浸润（10例）等。SRS显示治疗前眼眶摄取示踪剂显著增高（UR=1.87±0.43）;经免疫抑制治疗后活动期眼眶示踪剂摄取减少（UR=1.51±0.24）。结论 IgG4相关性疾病的眼部病变具有较典型的临床特征,泪腺弥漫性增大为眼眶MRI最常见表现,SRS能客观反映受累眼眶的免疫活动程度,对临床疗效评价有较好的价值。 （眼科,2015, 24： 309-312）       

HTLV-1感染者的眼部临床表现

人类T淋巴细胞白血病病毒Ⅰ型(HTLV-1)感染比较少见,主要流行于日本、加勒比海地区、中非和南美洲。已知感染者主要眼部表现包括成人T细胞白血病(ATL)患者的眼部恶性浸润、视网膜变性、眼部神经病变,HTLV-1相关性脊髓病/热带痉挛性瘫痪(HAM/TSP)患者的干燥性角结膜炎及HTLV-1葡萄膜炎(HU)等。HTLV-1相关性眼部病变的范围正在扩大,病程中可能出现免疫调节失常引起的眼部病变或眼部肿瘤,遗传和环境因素可能在不同人群中HTLV-1患者的眼部表现起一定作用。本文就HTLV-1相关眼部表现及最新进展作一综述。     

丫啶橙荧光染色结膜印迹细胞定量检测干燥性角结膜炎

目的应用丫啶橙荧光染色法进行结膜印迹细胞学检查,通过判断结膜细胞功能状态,对干燥性角结膜炎患者的眼部干燥程度进行定量检测,为临床的治疗提供实验室依据。方法选自我院眼科门诊已确诊的干燥性角结膜炎患者23例(38眼),用丫啶橙荧光染色结膜印迹细胞检查法进行检测,并用结膜印迹细胞检查结果评价标准进行评价,按Tseng分类法进行分级。结果干燥性角结膜炎患者23例(38眼)中,25眼细胞分级为Ⅱ～Ⅲ级,13眼细胞分级为Ⅲ—Ⅳ级。结论丫啶橙荧光染色法进行结膜印迹细胞学检查可以确认结膜细胞鳞状化生的程度,为干燥性角结膜炎病变程度提供临床分级、定量诊断,指导临床用药。     

准分子激光角膜屈光手术后开角型青光眼患者的临床特征

目的：观察具有准分子激光角膜屈光手术（简称准分子术）史的开角型青光眼患者的临床特征。方法：回顾 性病例研究。纳入2005─2018年北京大学第三医院眼科中心就诊、具有准分子术史且随访2年以上的 开角型青光眼患者。记录一般情况以及特殊检查结果,选取每例视野较差的眼或双眼相似者随机1眼 作为研究眼。对视野进展分析采用非参数分析（NPA）法。采用独立样本t检验及秩和检验进行分析。结果： 共纳入33例患者,青光眼确诊均在准分子术后,手术至青光眼确诊间隔（10.3±6.1）年,确诊时年龄 （37.5±10.4）岁,最高眼压<21 mmHg（1 mmHg=0.133 kPa）者27例（82%）;中央角膜厚度为（456±47）μm。 眼底照相显示视网膜神经纤维层缺损18例（55%）,无法辨认的15例（45%）;杯/盘比为0.7±0.1。视 野平均缺损（MD）绝对值小于6的有18例（55%）,6～12有8例（24%）,12以上有7例（21%）。其中随 访2年以上21例,随访时间为（4.5±2.2）年;视野进展13例（62%）,视野进展速度为（0.5±0.6）dB/年。 视野进展组与非进展组治疗后降眼压幅度分别为（28.3±20.7）%和（15.4±11.0）%（t=-1.867,P=0.078）, 屈光回退发生率分别为92%和25%（P=0.003）。21例中屈光回退14例（64%）,屈光回退组中12例 （12/14）视野进展,无回退组中1例视野进展（1/7）（P=0.003）;屈光回退组的视野进展[（0.7±0.7）dB/年] 快于无回退组[（0.1±0.1）dB/年]（t=-2.899,P=0.011）。结论：准分子术后的青光眼患者确诊时大多 处于病情早中期,4/5患者眼压在21 mmHg以下,通过眼底照相能明确视网膜神经纤维层缺损的只 占一半病例。随访中约2/3患者视野恶化,可能与屈光回退有关。     

常染色体隐性遗传性卵黄样营养不良并发闭角型青光眼临床特征分析

目的 总结常染色体隐性遗传性卵黄样营养不良（ARB）并发闭角型青光眼（ACG）/房角关闭（AC）患者的临床特征。设计 回顾性病例系列。研究对象 2017-2019年中山眼科中心经基因检测确诊ARB并发ACG/AC患者8例16眼。方法 回顾分析ARB并发ACG/AC患者临床发病特点、眼部改变。主要指标 发病特点，眼部生物学参数，视网膜、视神经及视功能改变。结果 ARB并发ACG/AC患者年龄15~34岁，平均（26.13±6.77）岁。男女各4例。最佳矫正视力0.1~0.8；眼压15~45 mmHg，平均（28.81±8.03）mmHg。平均前房深度（2.09±0.14）mm，平均眼轴（21.85±0.65）mm。房角关闭范围>180°者13眼，其平均垂直杯盘比（C/D） （0.9±0.10），平均视网膜神经纤维层厚度（62.53±149.06）μm，平均视野缺损值（-21.02±12.02）dB。房角关闭范围<180°者3眼，其平均垂直C/D（0.4±0.06），平均视网膜神经纤维层厚度（117±1.73）μm，平均视野缺损值（-5.56±1.53）dB。所有患眼眼底显示后极部多发大小不一、数量不等的视网膜下黄色物质沉积。相干光断层扫描显示后极部视网膜神经上皮层广泛浆液性浅脱离，光感受器外节延长，视网膜色素上皮层与Bruch膜间多灶大小不等高反射沉积物质。12眼（75%）视网膜层间劈裂腔形成，1眼局灶脉络膜下陷。8例眼电图（EOG）光峰／暗谷值（Ardent比）<1.55。结论 ARB并发ACG/AC患者发病年龄较轻，双眼房角狭窄或关闭同时伴有眼底散在卵黄样病灶及后极部视网膜神经上皮层广泛浆液性浅脱离。（眼科， 2020, 29： 370-374）     

Stevens-Johnson综合征或中毒性表皮坏死松解症24例分析

目的探讨Stevens-Johnson综合征（SJS）或中毒性表皮坏死松解症（TEN）急性期的临床特点、眼部表现及治疗。方法回顾性病例研究。对2012年5月-2014年2月于北京协和医院皮肤科确诊为SJS或TEN的24例患者的病史、眼部表现及治疗进行回顾性分析。结果24例患者均由口服药引起,主要致敏药物为抗生素（7例）、解热镇痛药（6例）和神经精神药（4例）。24例患者中16例出现眼部受累,所有眼部受累患者均为双眼受累,13例出现结膜充血,12例出现结膜渗出,9例累及眼睑,7例出现结膜假膜,7例累及睑缘,3例累及角膜。24例患者均接受全身激素治疗,眼部受累患者联合眼部激素治疗,病情较重者辅以免疫抑制剂,眼部分泌物较多者行人工泪液冲洗,必要时分离睑球粘连。结论SJS或TEN急性期可表现为不同程度的皮肤及黏膜损害,多伴眼部受累,全身和局部足量的糖皮质激素治疗可控制病情发展,减轻眼部损伤。     

合并视网膜色素变性的青光眼临床特征

目的 分析合并视网膜色素变性（RP）的青光眼患者的临床特征。设计 回顾性病例系列。研究对象 2008年8月至2012年9月北京同仁眼科中心RP合并青光眼患者37例（62眼）及未合并青光眼的RP患者109例（215眼）。方法 对上述患者的门诊电子病历结合门诊病案资料进行回顾分析。主要指标 青光眼类型,矫正视力及眼压。结果 37例（62眼）RP合并青光眼者中急性闭角型青光眼9例（18眼,29.0%）,慢性闭角型青光眼21例（34眼,54.8%）,原发性开角型青光眼7例（10眼,16.1%）。RP合并青光眼及未合并青光眼者盲眼（视力<0.05）比例分别为58.9%和33.6%（P=0.000）。RP合并青光眼者的平均眼压（23.1±14.0）mm Hg。结论 此回顾性研究中RP合并的青光眼多为原发性闭角型,且视力损害加重。（眼科,2013, 22：42-44）     

累及眼部的Stevens-Johnson综合征(附22例分析)

目的 :对 2 2例累及眼部的Stevens Johnson综合征 (SJS)作一初步临床分析。方法 :收集 1990～ 2 0 0 0住院的SJS病例 10 5例。回顾性分析其中眼部受累的患者 2 2例 (占 2 0 95 % )。根据致敏药物、发病前所患疾病、临床表现、实验室检查总结分析其可能的病因、眼部表现规律及治疗。结果 :累及眼部的 2 2例SJS病人中 ,肯定或可能是药物过敏引起的占 86 3 6% ,其中 ,抗生素类占 45 45 %。眼部充血是最常见的体征占 10 0 % ,有 5 0 %的病人结膜和 /或角膜形成假膜 ,视力下降占 3 1 82 %。眼部治疗主要是应用抗感染和人工泪液治疗。结论 :药物过敏是SJS最常见的原因。以结膜充血和假膜形成为特征的卡他性结膜炎是SJS眼部受累的最常见表现 ,重者可导致视力下降 ,早期合理的眼部治疗对预防晚期并发症非常重要。     

维胺酸眼膏治疗干燥性结角膜炎

目前,对于口眼干燥性角结膜炎尚无理想的药物治疗方法。我科用中国医学科学院药物研究所提供的维胺酸眼膏,治疗干燥性角结膜炎获得初步效果,介绍如下。药物由中国医学科学院药物研究所提供维胺酸原料,配制成0.05%维胺酸眼膏。于1989年至1990年共治疗干燥性角结膜炎19例,男性2例,女性17例。患者年龄19—63岁,平均44.3岁。病程3—12个月,平均病程为5.7个月。用0.05%维胺酸眼膏,每月2—3次,同时用人工泪液,每日4次或每2小时1次点眼。19例中有17例为口眼干燥综合证,1例为原因不明的角膜变性,1例为stven-gheon 综合证。每例患者都有眼干、畏光,无泪,异物感或烧灼感,视力轻微下降。从观察结果来看,视力提高不太显著。因为有些患者有不同程度的老年性白内障。Schuimer 试验:用药前,右眼平均为0.04mm 左眼为0.08mm,用药后,右眼为     

Immunosuppression in Behçet's disease Clinical management and long-term visual outcome

The authors review the visual prognosis of 44 patients with Beh?et's disease referred to the Ophthalmology and Rheumatology Departments (Hospital S. Jo?o-one of the two major referral centers in Northern Portugal), due to ocular complaints or for routine examination, in the last ten years. All fulfilled the clinical criteria for diagnosis of Beh?et's disease. Twenty-six were male and 18 female, with mean age 37 years (range 23-66). The mean evolution time since the first clinical manifestations was ten years (range 1-21). Aphthous stomatitis (100%) and genital ulcers (77.3%) were the initial manifestations preceding eye involvement. HLA-B(51)(5) was present in 27 of 36 typed patients (75%). Ocular manifestations were present in 33 patients (75%)-22 patients with panuveitis, eight with hypopyon, four with chronic anterior uveitis and three with episcleritis. Mean age of onset of ocular complications was 32 years (range 20-54). Retinal vaso-occlusive vasculitis was diagnosed in 26 patients (22 with panuveitis and four with posterior uveitis). To prevent ocular relapses, all needed immunosuppression with corticosteroids (drops, depo or systemic), combined with cyclosporine A (CsA) (5 mg/kg/day) in 13 patients and with chlorambucil or cyclophosphamide in six patients, when sight threatening uveitis had previously been refractory to treatment with systemic steroids. The 13 patients under CsA were observed for a period ranging from eight months to five years. Lowdose CsA was found to abrogate the intraocular inflammation, was well tolerated and had no major adverse effects. Regardless of the type of treatment, 21% (14/66) of the eyes lost useful vision five to ten years after initial diagnosis.     

Clinical and Investigative Profile of Biopsy-Proven Sarcoid Uveitis in India

Purpose: Retrospective analysis of the clinical features, investigative profile, response to treatment, and final visual outcome in histopathologically confirmed cases of sarcoid uveitis. Methods: Retrospective case series analysis was done of 15 eyes of 9 patients seen between July1999 and August 2003 with biopsy-proven sarcoid uveitis. There were 3 were males and 6 females. The mean age at presentation was 44.1 years (range 11–62 years), The mean follow-up was 28.4 months. Results: Six patients had bilateral ocular involvement and 3 had unilateral involvement. Five out of 9 patients had primarily ocular involvement. The most common presentation was intermediate uveitis and granulomatous anterior uveitis in 7 patients. Eight of 9 patients responded well to the medical treatment with systemic and periocular steroids. Conclusions: Ocular lesions can be the primary manifestation of systemic sarcoidosis. Sarcoid uveitis in the Asian Indian population often presents an intermediate uveitis with granulomatous anterior uveitis.     

Ocular manifestations of multiple sclerosis

PURPOSE OF REVIEW: Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system that is commonly manifested by visual system involvement and that may initially present with ophthalmologic symptoms. This paper reviews recent findings regarding the ocular manifestations in multiple sclerosis. RECENT FINDINGS: Manifestations of multiple sclerosis in the eye include both the afferent and efferent visual pathways. Optic neuritis, the most common ocular manifestation of multiple sclerosis, may be the initial clinical disease manifestation. Recent long-term follow-up data show that most patients with demyelinating optic neuritis have an excellent prognosis for recovery of central visual acuity. Evidence is emerging, however, for significant and broad reduction in both contrast sensitivity and color perception in multiple sclerosis patients despite near-normal visual acuities. Ocular motor deficits in multiple sclerosis include internuclear ophthalmoplegia and nystagmus, resulting in diplopia, oscillopsia, blurred visual, loss of stereopsis, and reading fatigue. Multiple sclerosis also may be associated with ocular inflammatory diseases, in particular pars planitis and retinal periphlebitis. SUMMARY: Ocular findings may be initial manifestations of multiple sclerosis and may predict additional demyelinating events. Recognizing these syndromes and signs will help clinicians to properly evaluate the patient, formulate an appropriate differential diagnosis, be able to discuss the prognosis with the patient, and help develop an effective therapeutic plan.     

严重眼外伤患者眼内硅油长期存留18例

目的 探讨严重眼外伤患者玻璃体视网膜手术后硅油在眼内长期存留的可行性。设计 回顾性病例系列。研究对象2005-2010年北京同仁眼科中心眼外伤科眼内硅油存留至少2年者18例18眼。方法 患者均行标准20G经睫状体平坦部玻璃体视网膜联合手术,填充普通硅油。术后每3个月随访1次视力、眼压、裂隙灯显微镜及眼底等。主要指标 硅油眼眼部表现。结果 18例均为男性,平均年龄（37.83±14.92）岁,复杂眼外伤17例,急性视网膜坏死1例。硅油眼内存留2～14年,平均（6.41±3.97）年。随访期内3例严重硅油乳化而取出,15例未取出硅油。保留硅油的原因为保留眼球8例（53.33%）、独眼者3例（20.00%）、二次玻璃体手术2例（13.33%）及术后低眼压2例（13.33%）。术后矫正视力无光感～0.2。视网膜复位15例（83.33%）。硅油长期存留的并发症包括继发性青光眼（33.33%）、角膜变性（27.78%）和硅油乳化（22.22%）。结论 对于复杂眼外伤、独眼者、多次手术、低眼压、术后视网膜未复位或有明显增生者,在随访观察无严重并发症时可使硅油眼内长期存留以保持患者眼球外观和视功能。（眼科,2013, 22：58-61）     

Ocular tuberculosis masquerading as ocular tumors

Tuberculosis has re-emerged as a serious public health problem in recent years. The ocular manifestations of tuberculosis are uncommon and diverse. Occasionally, patients initially present with ocular symptoms that simulate intraocular malignancy or other inflammatory conditions. We present five patients with ocular tuberculosis who were referred with the suspicion of ocular malignancy. Four of the five patients had recently emigrated to the United States. The presenting features of these patients were panophthalmitis (one patient), endophthalmitis leading to scleral perforation (one patient), active choroidal granuloma associated with uveitis (two patients), and amelanotic choroidal lesion without inflammatory signs (one patient). Of these five cases, two had a known history of systemic tuberculosis, while the ocular findings in the other three cases were the presenting manifestation of systemic tuberculosis. Multi-drug antituberculous regimen were employed in all cases for a mean of 9 months (median 6 months, range 6-12 months). Three patients responded well to therapy with salvage of the globe and the two remaining patients underwent primary enucleation for blind painful eye or perforated eye. In conclusion, ocular tuberculosis can have variable clinical manifestations and occasionally appears as an intraocular or epibulbar tumor. A high degree of clinical suspicion is important, especially in immigrants from developing countries.     

Ocular manifestation and visual outcomes in herpes zoster ophthalmicus: a prospective study from a tertiary hospital of Eastern India

AIM: To estimate the magnitude of different ocular manifestation in clinically established herpes zoster ophthalmicus (HZO) patients and assessment of the visual outcome after two months of initial examination. METHODS: An observational prospective study was conducted on 42 clinically diagnosed Tzanck smear positive cases HZO to observe the occurrence and frequency of different ocular manifestation and their visual outcome in 10-month period with 2mo follow up. Full ophthalmological examination using slit lamp, non-contact tonometry, applanation tonometry, direct and indirect ophthalmoscope were performed. RESULTS: Out of 42 patients of HZO, 33 had one or more type of ocular manifestation staring from lid skin involvement to conjunctivitis, keratitis, uveitis, increased intraocular pressure (IOP) and optic neuritis but no retinal manifestation. More number of HZO cases and ocular manifestation were found with advancement of ages. Young HZO patients were more associated with human immunodeficiency virus (HIV) infection and HIV infected people with HZO infection had more ocular manifestation. Male to female ratio was 2:1 among HZO cases but ocular manifestation occurred more among males. Female with advanced age were involved more. Lid involvement (73.81%), conjunctivitis (69.05%), and keratitis (59.52%) were most common ocular manifestation followed by anterior uveitis (30.95%) and episcleritis (11.90%). Ocular hypertension (42.86%) was associated with almost every ocular manifestation. Among the cases of more than 45 years of age, 9.52% patients acquired 6/6 vision compared to 7.14% patients at and below 45 years of age after 8wk of follow up. CONCLUSION: The visual outcomes are poor in HZO with advanced age group. Visual outcome of the affected eyes is poor than unaffected eyes. The loss of vision is mainly due to keratitis, anterior uveitis, posterior uveitis, and optic neuritis.     

Late-onset Behçet’s disease: demographic, clinical, and ocular features

Background

To evaluate the demographic, clinical, and ocular features of patients with Behçet’s disease (BD) who had first symptom onset after 40 years of age and fulfilled the diagnostic criteria afterwards.

Methods

This retrospective study included 42 patients with initial BD symptom onset after 40 years of age who fulfilled the diagnostic criteria afterwards, according to the International Study Group for BD. Patients were divided into two groups based on the presence of ocular involvement: group 1 had uveitis and group 2 did not have uveitis. The ocular characteristics of patients in group 1 were further examined according to age groups. Group 1A included patients between 40–50 years of age, and group 1B included patients older than 50 years of age. Clinical and demographic features of uveitic and non-uveitic patients were compared. Ocular manifestations, treatment protocols, and ocular complications in uveitic patients were noted. The ocular characteristics of group 1A and group 1B were further evaluated.

Results

Twenty-six patients (61.9%) had uveitis (group 1) and 16 (39.1%) had no uveitis (group 2). There was no significant difference between groups according to sex, age at initial admission, age at the time of initial symptom of BD, and period between initial symptom and the diagnosis of BD. The most frequent initial manifestation was oral ulcer in both groups. No statistical difference between the groups was detected with regard to the mean age of onset of each symptom. Anterior uveitis (73.1%) was the most frequent type of uveitis followed by panuveitis (19.2%) and sclerouveitis (7.7%). Uveitis was bilateral in 80.8% of patients. The incidence of anterior uveitis was higher in group 1B than in group 1A (P?=?0.023). Cataract was the most common ocular complication, followed by macular edema sequelae, glaucoma, optic disc paleness, and branch retinal vein occlusion.

Conclusion

Late-onset BD usually affects both genders equally, and the prognosis of ocular involvement is usually good. The incidence of panuveitis decreases as age increases, while the incidence of anterior uveitis increases. Ocular involvement is usually bilateral and there is no correlation between gender and uveitis type.     

梅毒性眼病的临床分析

目的：探讨以眼后节表现为主的梅毒性眼病的临床特点。

方法：回顾性病例研究。回顾性分析2007-01/2012-01本院收治的首诊于眼科的梅毒性眼病13例23眼,分析其临床表现、治疗方法、预后等。13例患者按神经梅毒除1例因青霉素过敏予静滴头孢曲松治疗,其余全部予静滴青霉素治疗。

结果：患者13例中,9例17眼患者表现为脉络膜视网膜炎,2例3眼患者表现为视神经视网膜炎,1例1眼患者表现为视神经炎,1例2眼患者表现为渗出性视网膜脱离。抗梅毒治疗后,所有炎症消退,12例22眼患者视力提高,平均视力0.56±0.23。患者RPR滴度下降4倍,平均1：16.6。

结论：梅毒性眼病表现多样,容易漏诊、误诊,临床上应提高警惕,及早发现,及早治疗。     

Long-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome

PURPOSE: To investigate the spectrum of ocular involvement, to examine the clinical outcome, and to analyze the influence of treatment in patients with chronic ocular manifestations of Reiter's syndrome (RS) referred to a tertiary care ocular immunology service. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-five patients with RS evaluated at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1981 through 2001. METHODS: Charts of patients were reviewed and data on age, gender, follow-up time, ocular symptoms, extraocular involvement, ocular complications, therapy, and visual acuities were recorded. MAIN OUTCOME MEASURES: Visual acuity, ocular complications, disease progression, clinical outcome, and systemic treatment. RESULTS: Twenty-five patients (20 male and 5 female) diagnosed with RS, with a mean age at presentation to our service of 37 years, were studied. The mean follow-up was 48.5 months. Eighty-five percent of patients tested were positive for human leukocyte antigen B27. Sixty-four percent of patients had a positive family history. All patients had oligoarthritis and enthesitis, most commonly affecting the back (56%), Achilles tendon (52%), and sacroiliac joint (24%). Eighty percent had a history of infection, most frequently urethritis (68%). Forty-four percent had a history of mucocutaneous lesions. All patients demonstrated ocular involvement at the time of diagnosis (68% with unilateral and 32% with bilateral disease), 84% had evidence of uveitis, 3% had scleritis, 2% had conjunctivitis, and 1% had pars planitis and iridocyclitis. During follow-up, the ocular complications included conjunctivitis (96%), anterior uveitis (92%), posterior uveitis (64%), keratitis (64%), cataract (56%), intermediate uveitis (40%), scleritis (28%), cystoid macular edema (28%), papillitis (16%), and glaucoma (16%). Systemic treatment for ocular inflammation was initiated in all patients. Ninety-six percent were treated with nonsteroidal anti-inflammatory agents. Eighty-eight percent were treated with corticosteroids, 64% requiring systemic prednisone. Immunosuppressive therapy was initiated in 52% of patients, with all receiving methotrexate. Seven patients required more than one immunosuppressive agent. The mean initial visual acuity was 20/25 in the right eye and 20/30 in the left eye. The mean final visual acuity was 20/25 in the right eye and 20/25 in the left eye. CONCLUSIONS: Reiter's syndrome may be associated with chronic recurrent ocular inflammation. Systemic therapy (including immunosuppressive treatment) typically is required to control the ocular inflammation and to prevent progressive visual loss.     

Risk factors for ocular sarcoidosis

We reviewed 121 consecutive patients with biopsy-proven sarcoidosis who visited the sarcoidosis clinic of the University Hospital in Amsterdam, to determine the risk factors for the development of ocular manifestations. Of 121 patients 52 (43%) were black. Ocular disease developed in 50 (41%) patients and was more common in female and in black patients. Uveitis was the most frequent manifestation of ocular sarcoidosis (29 out of 50 or 58%). There were no differences in the extra-ocular manifestations of the sarcoidosis between patients with and without ocular disease or between uveitis and non-uveitis patients. This study covered a mixed racial population and shows that different types of uveitis are seen in white and black patients. Anterior uveitis was more frequent in black patients (P < .001), whereas posterior uveitis was more common in white patients (P < .01). Chronic posterior uveitis with complications occurred most frequently in white female patients with late onset of the systemic disease. Uveitis was an early feature of sarcoidosis (25 out of 29 or 86%); moreover in 9 out of 29 (31%) cases, uveitis preceded the non-ocular detectable signs of sarcoidosis by more than one year. This emphasizes the importance of periodic re-evaluation of uveitis patients for sarcoidosis.