Pseudomonas aeruginosa endophthalmitis masquerading as chronic uveitis

A 65-year-old male presented with decreased vision in the left eye of 15-day duration after having undergone an uneventful cataract surgery 10 months back. He had been previously treated with systemic steroids for recurrent uveitis postoperatively on three occasions in the same eye. B-scan ultrasonography showed multiple clumplike echoes suggestive of vitreous inflammation. Aqueous tap revealed Pseudomonas aeruginosa sensitive to ciprofloxacin. The patient was treated with intravitreal ciprofloxacin and vancomycin along with systemic ciprofloxacin with good clinical response. Even a virulent organism such as P.aeruginosa can present as a chronic uveitis, which, if missed, can lead to a delay in accurate diagnosis and appropriate management.     

Metipranolol-associated granulomatous anterior uveitis.

This paper presents for the first time documented evidence, clinical details, and photographic illustrations of metipranolol-associated granulomatous anterior uveitis in 26 eyes of 15 patients being treated for glaucoma. There were 56 episodes of granulomatous anterior uveitis, all associated with large (mutton-fat) keratic precipitates, flare, cells, and 'white eyes' (except in seven episodes). In 30 (53.6%) of these episodes there was loss of control of intraocular pressure. Metipranolol 0.6% was implicated in 54 of the 56 episodes and metipranolol 0.3% in the remaining two. Fifty-one other cases of metipranolol-associated granulomatous anterior uveitis have so far been reported from other parts of the country to the Committee on Safety of Medicines. As a result multidose metipranolol in 0.1%, 0.3%, and 0.6% strengths has been withdrawn from clinical use in the United Kingdom. The pathogenesis of this adverse drug reaction is uncertain.     

病毒性前葡萄膜炎的临床研究进展

病毒性前葡萄膜炎是临床最常见的葡萄膜炎之一,是重要的致盲性疾病。其病因复杂、机制不清,临床表现多样化,易与其他类型葡萄膜炎混淆,较难及时进行病因诊断;治疗上,由于较难针对病因治疗,常常存在不规范治疗,导致病情迁延反复。本文就疱疹病毒性、巨细胞病毒性及风疹病毒性前葡萄膜炎的临床表现、诊断及治疗进展进行综述,比较了巨细胞病毒、风疹病毒性前葡萄膜炎与疱疹病毒性前葡萄膜炎的临床特点,归纳了病毒性前葡萄膜炎的诊疗思路。     

Current approach in diagnosis and management of anterior uveitis

Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.     

A combined anterior and posterior approach to cataract surgery in patients with chronic uveitis

Although several recent papers have focused on the results of cataract surgery in patients with uveitis, little has been published on specific surgical techniques that are most appropriate to such cases. We have found that a combined anterior and posterior approach using extracapsular techniques (usually phacoemulsification) and pars plana vitrectomy, with or without intraocular lens placement, is best suited for selected uveitis patients who have cataract, vitreous opacities, and cystoid macula edema. This paper discusses the surgical techniques that we have found to be best for the management of these cases.Supported in part by Core Grant EYO 3040 from the National Eye Institute/NIH, Bethesda, Maryland, and by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York.     

Metastatic lung and pleural malignancy presenting as bilateral acute anterior uveitis

Anterior uveitis is associated with a variety of underlying systemic diseases but the association between bilateral acute anterior uveitis (BAAU) and lung and pleural malignancy is not widely recognized. The case is described here of a 61-year-old woman presenting to an eye clinic with BAAU. A routine chest radiograph performed principally to exclude pulmonary sarcoidosis revealed an intrapulmonary mass and she was subsequently found to have widespread lung and pleural malignancies. Evidence is discussed that suggests a link and potential aetiology between BAAU and lung and pleural malignancies. The present case shows the virtue of requesting a chest radiograph in patients presenting with BAAU, even in the absence of other symptoms or clinical findings.     

病毒性前葡萄膜炎治疗的临床观察

目的 观察局部联合全身应用抗病毒及皮质类固醇激素治疗病毒性前葡萄膜炎的疗效.方法 回顾分析2011年11月至2015年1月在十堰市太和医院眼科中心诊断为病毒性前葡萄膜炎并接受住院治疗患者的病例资料.结果 共有20例病毒性前葡萄膜炎纳入本研究.2例患者在外院诊断为开角型青光眼并行小梁切除术,1例患者诊断为继发性青光眼,因眼压难以控制行前房穿刺治疗,5例患者首次我院门诊诊断为青光眼睫状体炎综合征,10例诊断为虹膜睫状体炎,具体类型不清楚,仅2例患者同时伴有角膜内皮炎诊断正确.经过全身与局部抗病毒及激素对症治疗后,患者均得到治愈.治愈后1例既往有眼外伤的患者最佳矫正视力为0.3,2例行小梁切除术的患者最佳视力分别为0.5和0.6,其余患者最佳矫正视力均≥0.8.在2～ 14个月的随访期间有13例患者(65％)病毒性前葡萄膜炎复发,并再次得到治愈.结论 病毒性前葡萄膜炎的误诊或漏诊率仍较高,应加强认识,提高诊疗水平.正确诊断病毒性前葡萄膜炎,同时局部联合全身应用抗病毒及激素药物可以有效治愈病毒性前葡萄膜炎,但复发率仍较高.     

HLA-B27阳性急性前葡萄膜炎的临床特征

目的 :探讨HLA B2 7阳性急性前葡萄膜炎的诊断及临床特征。方法 :应用磁珠酶联免疫吸附试验对 74例急性前葡萄膜炎患者和 36例健康对照者血液中HLA B2 7抗原进行测定 ,并对HLA B2 7抗原阳性和阴性急性前葡萄膜炎患者的临床特征进行对比分析。结果 :急性前葡萄膜炎患者 74例中 ,HLA B2 7抗原阳性 35例 ,阳性率为 4 7 30 % ;健康对照者 36例 ,阳性 3例 ,阳性率为 8 33% ;两者有显著性差异 (χ2 =16 2 6 ,P <0 0 1)。HLA B2 7阳性急性前葡萄膜炎的临床特点有起病急、前房内有大量纤维渗出和细胞、角膜后沉着物呈细小、灰白色。一般为单眼发病 ,症状重于常见的特发性前葡萄膜炎 ,复发率较高。常伴有玻璃体混浊、黄斑囊样水肿和全身关节病变。结论 :HLA B2 7抗原与急性前葡萄膜炎明显相关 ,HLA B2 7相关性前葡萄膜炎的临床表现重于HLA B2 7阴性前葡萄膜炎 ,并常伴有全身脊柱关节病变。     

Acute anterior uveitis in primary care

Acute anterior uveitis is an important ocular disease of considerable interest to therapeutically and non‐therapeutically qualified optometrists. This review examines the role of optometrists in the primary care setting and gives guidelines for appropriate care of patients with anterior uveitis. Diagnosis and differentiation from other forms of anterior segment inflammation are the initial requirement. In parallel, possible medical conditions associated with acute anterior uveitis must be considered, with appropriate referral to medical practitioners. In uncomplicated cases of recurrent acute anterior uveitis, optometrists can initiate topical treatment and monitor resolution of inflammation, while being aware of possible complications of both the disease and its treatment. It is especially important in new attacks of anterior uveitis to liaise with the patient’s general practitioner about medical investigation for underlying disease. Atypical, complicated or severe anterior uveitis should be promptly referred for specialist care.     

Limited gallium scans and angiotensin converting enzyme in granulomatous uveitis

The use of serum angiotensin converting enzyme (ACE) and limited gallium scans of the head, neck, and chest for patients with granulomatous uveitis is described. Mean serum ACE activity was elevated in patients with granulomatous uveitis regardless of the presence of systemic sarcoidosis. Furthermore, pathologic gallium uptake was noted in lacrimal glands, parotid glands, and lungs in some cases. These results indicate that sarcoidosis may be more common than previously believed in these patients.     

Surgical outcomes of complicated cataract with pediatric trematode granulomatous uveitis

AIM: To describe the clinical characteristics and surgical outcomes of complicated cataract with pediatric trematodal granulomatous uveitis (TGU).METHODS: Patients of cataract with TGU in the membranous (inactive) stage underwent cataract surgery with intraocular lens (IOL) implantation. Preoperative history and ophthalmic examination were conducted for all cases, whereas Schimphlug imaging and corneal topography were done for some patients. Postoperative follow up was done on the 1st, 2nd, and 5th postoperative days after surgery. Then, it was done at least at one, three, and six months postoperatively. Intraoperative and postoperative complications and the methods of their management were reported.RESULTS: Twelve eyes of 12 male children were included in this study ranging from 8 to 16y. The mean best corrected Snellen visual acuity (BCVA) was significantly improved from 0.09±0.06 preoperatively to 0.37±0.11 at the final visit 6mo postoperatively (P<0.001). Schimphlug imaging and corneal topography showed flattening of the anterior surface of the inferior cornea. Intraoperative difficulties and complications included the poor dilatability of the drown down pupil, strong posterior synechia between the anterior lens capsule and the iris at the site of the inferior retrocorneal vascularized membrane and hyphema. All cases underwent primary hydrophobic IOL implantation.CONCLUSION: Surgery for this type of cataract is relatively safe and effective. It is associated with some specific difficulties and complications that should be considered during surgery and follow up.     

急性前葡萄膜炎的临床治疗

目的:探讨急性前葡萄膜炎的药物治疗方法,并观察其疗效和复发情况,为规范化前葡萄膜炎的药物治疗提供临床依据。方法:对48例急性前葡萄膜炎病例给予局部复方妥布霉素眼药水及复方托吡卡胺眼药水点眼,部分重症患者采用局部结膜下注射地塞米松3mg(0.6mL),1次/d,连用7d,对于伴有明确全身疾病病因者,加用口服激素冲击治疗3d,记录患者视力、眼压、前房反应、并发症情况,并随访1a,记录其复发情况。结果:所有病例于3d后症状体征缓解,1wk视力恢复,未发生眼局部严重并发症及全身并发症,6mo内无1例复发,1a内复发患者数为2例,复发率为4%。结论:绝大部分急性前葡萄膜炎单纯进行局部药物治疗,可获得良好的治疗效果,而全身激素治疗仅适用于有明确全身病病因患者且病变处于活动期。     

Recent advances in Toll‐like receptors and anterior uveitis

Uveitis involves acute, recurrent or chronic inflammation of the uvea, and occurs when the normal state of ocular immune privilege has broken down. Accumulating evidence implicates the role of microbial triggers in the development of various forms of immune‐mediated uveitis in addition to its causative role in infectious uveitis. Toll‐like receptors (TLRs) are the most important pattern‐recognition receptors of the innate immune system that recognize pathogen‐associated molecular patterns of microbes. Activation of TLRs by pathogen‐associated molecular patterns leads to the induction of an inflammatory cascade and activation of both innate and adaptive arms of the immune response. TLRs have been implicated in the pathogenesis of various inflammatory diseases, including uveitis. This review provides an update on recent progress in TLR research and uveitis, specifically summarizing new evidence for the role of TLRs in anterior uveitis. There have been important observations from studies involving human ocular tissue, clinical uveitis and from experimental animal models of uveitis, such as endotoxin‐induced uveitis. The ‘Toll rush’ has certainly gained momentum, and future advances in this field have the potential for selectively targeting the TLR pathway and ultimately translating into better therapies for patients with sight‐threatening uveitis.