Wegener’s Granulomatosis

Clinical manifestations of Wegener’s granulomatosis are nonspecific and indistinguishable from a variety of neoplastic, infectious, and inflammatory diseases. Ophthalmic disease is the presenting feature in nearly one sixth of patients with Wegener’s granulomatosis and will ultimately develop in a majority. The discovery of antineutrophil cytoplasmic antibodies, particularly antiproteinase-3, has changed the clinical approach to evaluating patients suspected of having Wegener’s granulomatosis. These antibodies are distinguished from other related autoantibodies because they produce a coarse granular pattern of cytoplasmic staining on indirect immunofluorescence with ethanol-fixed neutrophils. Treatment of Wegener’s granulomatosis with oral cyclophosphamide and corticosteroids has decreased morbidity and improved survival, but side effects from long-term immunosuppressive therapy are common and sometimes serious. The effectiveness of trimethoprim-sulfamethoxazole in decreasing the number and severity of recurrences of Wegener’s granulomatosis is being investigated. It remains to be determined if wide use of trimethoprim-sulfamethoxazole in limited Wegener’s granulomatosis could further improve the quality of life for some patients. (Surv Ophthalmol 42:458–480, 1998.     

Author’s index

Objective  

To present a unique case of a 34-year-old patient with unilateral functional visual loss after chemical burn with normal visual evoked potentials (VEPs) and absent cognitive response (P300 wave).     

Marathon Runner’s Retinopathy

Purpose: To report a case of an unusual retinopathy in an otherwise healthy 25-year-old marathon runner.

Methods: Case report.

Results: A 25-year-old female marathon runner developed sudden onset of monocular vision loss during a routine training run. The retinal features included a large, central, subhyaloid hemorrhage, multiple intraretinal hemorrhages, disc edema and venous dilation and tortuosity resembling characteristics of both valsalva retinopathy and nonischemic central retinal vein occlusion. Work up for underlying systemic cause was negative. However, the patient did participate in endurance exercise.

Conclusion: Strenuous exercise increases activated platelets and other clotting factor elements. During exercise, this increase in clotting factors in the coagulation cascade is usually balanced by activation of key elements in the fibrinolysis cascade as well. However, certain individuals, especially those who already have a predisposition to clotting or other thrombogenic risk factors may disrupt the balance between coagulation and fibrinolysis during strenuous exercise favoring coagulation which places them at risk for thrombus formation.     

Intraocular pressure after Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty

Purpose  

To evaluate the effect on intraocular pressure (IOP) of increased corneal thickness after Descemet’s stripping automated endothelial keratoplasty (DSAEK) and of non-Descemet’s stripping automated endothelial keratoplasty (nDSAEK) as measured by four different techniques.     

A Case of Non-Hodgkin’s Lymphoma Following Long-Term Corticosteroid Therapy for Addison’s Disease

A 76-year-old Japanese woman had suffered from fatigue, weight loss, and cutaneous hyperpigmentation at the age of 38 years and was diagnosed as having tuberculous Addison’s disease. Since then, corticosteroids had been administered effectively as hormonal replacement. At the age of 75 years, the patient presented with a progressive, painless swelling in the left eyelid due to an ill-defined tumor of rubbery consistency in the superotemporal aspect of the orbit. Computed tomography, magnetic resonance imaging, and scintigraphy revealed a wide distribution of tumors, but not in the adrenal gland, which led to the suspicion of systemic malignant lymphoma. Histopathologic examination of the excised orbital tumor was compatible with non-Hodgkin’s lymphoma of the B-cell type. We believe this is the first report of Addison’s disease presenting with non-Hodgkin’s lymphoma. This disease process was characterized by the development of a lymphoid malignancy after long-term corticosteroid therapy to control the adrenal insufficiency, and by the widespread involvement of the lymph nodes and orbit but not the adrenal gland. Corticosteroid-induced abnormal immune state was considered to be the pathogenesis of this unusual complication.     

Night blindness and Crohn’s disease

International Ophthalmology - Signs of malnutrition are common clinical features in Crohn’s disease; and bowel resection, commonly needed in these cases, can aggravate malnutrition. These...     

Ocular Munchausen’s Syndrome induced by introduction of ant’s particles into the conjunctival fornices

Munchausen’s Syndrome is a factitious disorder in which patients manipulate physicians through misrepresented signs and symptoms. The authors describe an 18-year-old woman with self-induced inoculation of ant’s particles inside her conjunctival fornices of both eyes. The crushed particles was confirmed to be crushed ant’s particles. Munchausen Syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnoses when ocular abnormalities cannot be explained. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist.     

Comparison of endothelial cell changes by specular microscopy between Ringer’s and Ringer’s lactate during phacoemulsification

AIM: To compare the difference between using Ringer’s and Ringer’s lactate (RL) solutions as irrigating solutions during phacoemulsification and investigate their effect on corneal endothelium. METHODS: This was a prospective interventional double blinded clinical study that included 100 eyes of 100 patients aged between 50 to 65y suffering from a visually significant age-related cataract and scheduled for routine uncomplicated phacoemulsification. The included eyes were randomly divided into two equal groups (each group included 50 eyes). Group 1 received Ringer’s solution and group 2 received Ringer’s lactate as an irrigating solution. RESULTS: The first group with Ringer’s solution had a mean age of 57.5±8y and the second group with RL solution had a mean age of 58.6±9y. After 3mo, endothelial cell density decreased in group 1 by a mean of 8.5%, and in group 2 by a mean of 3.6% (P=0.013). Additionally, central corneal thickness increased in group 1 by a mean of 6.9% and in group 2 by a mean of 1.5% (P=0.006). By correlating the percentage of change in pachymetry and specular microscopic parameters with volume of irrigation solution used, there was no significant correlation. CONCLUSION: The use of Ringer’s lactate as an irrigating solution is associated with less endothelial cell loss postoperatively in comparison to Ringer’s solution and associated with decreased postoperative edema.     

Treatment modalities in Duane’s Retraction Syndrome

AIM: To assess the influence of near work, time outdoor and parental myopia on the prevalence of myopia in school children in Aba, Nigeria. METHODS: Primary and secondary school children aged between 8 and 15y were randomly recruited from 12 schools in Aba. Information on family history, near work and outdoor activity was obtained using myopia risk factor questionnaire. Cycloplegic refraction was performed using autorefraction technique. Myopia was defined as spherical equivalent refraction (SER) ≤-0.50 D in the poorer eye. Data were analysed for 1197 (male: 538 and female: 659) children with full relevant data. RESULTS: Risk of developing myopia was positively associated with parental myopia [Odds ratio (OR): 6.80; 95%CI, 2.76-16.74; P<0.001) for one myopic parent and (OR: 9.47; 95%CI, 3.88-23.13; P<0.001) for two myopic parents, longer daily reading hour (OR: 1.21; 95%CI, 1.03-1.42; P<0.020) and less time outdoors (OR: 0.8; 95%CI, 0.74-0.87; P<0.001). CONCLUSION: Parental history of myopia was the most important risk factor associated with myopia. In addition, children with both parents being myopic had increased odds of developing myopia than those with one myopic parent. It is recommended therefore, that children spend more time outdoors as this could reduce the prevalence and progression of myopia.     

Capsule contraction syndrome in Behcet’s disease

We reported the case of a 39-year-old patient with inactive Behcet's syndrome developed capsule contraction syndrome after uneventful phacoemulsification and a foldable intraocular lens implantation. Two weeks after the operation, the patient was accepted to hospital with severe decrease of visual acuity (VA) on the operated eye. Capsule opening area had been reduced considerably by fibrotic tissue, which evaluated with full dilated pupil. Since capsule contraction syndrome (CCS) had been diagnosed in very early stage and which structure was not severely thick, the fibrotic band was treated successfully, 360 degree circular shape, by neodymium YAG (Nd:YAG) laser. Capsule opening area was remained stable during follow up period of one month. But a significant reocclusion was developed that need surgical reopening 3 months after initial operation. Continuous curvilinier capsulorhexis (CCC) may be recurred again after a successful treatment in patient with uveitis like Behcet's disease.     

Eye health is everyone’s responsibility: China’s first Western-style eye hospital improves in the prevention of blindness

AIM: To investigate the relationship between China’s first Western-style eye hospital development and the prevention of blindness in China and determine the main factor influencing eye health today.METHODS: Data about eye health, blindness and cataract surgery rate of China from public website of World Health Organization (WHO), ORBIS International, Ministry of Health (MOH) of China, Pubmed center and Historical Archives of Zhongshan Ophthalmic Center (ZOC) were reviewed and analyzed.RESULTS: ZOC is China’s first Western-style eye hospital. In 2012, the ORBIS Flying Eye Hospital has chosen ZOC once again as one of its destinations, 30 years after ORBIS expanded internationally to train eye care professionals and treat underserved patients in developing countries in 1982. During the past 30 years, cataract surgery rate and public awareness of blindness prevention were improved greatly in China, in which ZOC plays a very important role.CONCLUSION: ZOC, as China’s first Western-style eye hospital,has improved in the prevention of blindness. Eye health has become everyone’s responsibility.     

Koch’s postulates and the polymerase chain reaction

To investigate the clinical manifestations of human T-lymphotropic virus type-1 uveitis (HU), 112 HU patients who were followed up periodically for more than one year were retrospectively analyzed with respect to their ophthalmological and systemic complications. The gender ratio (female/male ratio) of the HU patients was 2.0 and the initial complications were foggy vision in 34.5%, ocular floaters in 33.3%, and blurred vision in 15.5%. As for the ocular symptoms, the majority (78.6%) of patients were classified as intermediate uveitis with vitreous inflammation. Recurrence of uveitis episodes was seen in one half of the patients (51.8%); 12 patients had more than six uveitis episodes. The interval of uveitis episodes varied from two weeks to 10 years. Nearly one half of the patients (43.8%) had ocular complications: e.g., cataract in 22 patients, persistent vitreous opacities in 17 patients, and glaucoma in 16 patients. Although the visual prognosis was essentially good, 11 patients had poor visual prognosis (&;lt;0.1). The causes of poor vision in these patients were cataract, cystoid macular edema, epiretinal membrane, and optic nerve atrophy. Of the 112 HU patients, two developed HTLV-I-associated myelopathy (TSP/HAM) after the onset of HU, while none developed adult T-cell leukemia. Sixteen HU patients had a previous history of Graves' disease and a past history of methimazole therapy, while Graves' disease was found in another HU patient only after HU onset and methimazole was not administered before the onset of HU. The present data of long-term follow-up indicate that (1) HU causes various ocular complications and its visual prognosis can be poor, (2) TSP/HAM can be induced even after the onset of HU, and (3) methimazole is not a risk factor of HU after Graves' disease.     

Can reliable values of Young’s modulus be deduced from Fisher’s (1971) spinning lens measurements?

The current textbook view of the causes of presbyopia rests very largely on a series of experiments reported by R.F. Fisher some three decades ago, and in particular on the values of lens Young's modulus inferred from the deformation caused by spinning excised lenses about their optical axis (Fisher 1971) We studied the extent to which inferred values of Young's modulus are influenced by assumptions inherent in the mathematical procedures used by Fisher to interpret the test and we investigated several alternative interpretation methods. The results suggest that modelling assumptions inherent in Fisher's original method may have led to systematic errors in the determination of the Young's modulus of the cortex and nucleus. Fisher's conclusion that the cortex is stiffer than the nucleus, particularly in middle age, may be an artefact associated with these systematic errors. Moreover, none of the models we explored are able to account for Fisher's claim that the removal of the capsule has only a modest effect on the deformations induced in the spinning lens.