葡萄膜炎并发白内障两种手术方法的探讨

目的 介绍2种小瞳孔下行葡萄膜炎并发性白摧障摘出和瞳孔成形的手术方法。方法 30例34只葡萄膜炎严重后粘连并发性白内障的眼接受了该2种手术，手术方法：91）剪除瞳孔区机化的前囊膜，瞳孔缘剪开，水分离核，囊袋内晶关於 本圈匙反转娩出晶状体体核。人工晶状体（IOL）植入；（2）上方虹膜根部切除，分离并剪开上方虹膜，超声乳化白内障摘出，IOL植入，最后缝合上方虹膜，人造圆形瞳孔。结果 术后34眼瞳孔均在3.0-3.5mm，并保持圆形，均无后囊膜破裂，无严重并发症发生，视力均比术前有不同程度的提高。结论 葡萄膜炎并发白内障。在采用所介绍的2种手术方法后能获得良好的视力和圆形瞳孔，而无严重并发症。     

Frequency and clinical features of intraocular inflammation in Tokyo

Background:  To investigate frequencies and clinical features of intraocular inflammation (uveitis) in Tokyo, Japan.
Methods:  Records of 834 consecutive new referral patients (352 men, 482 women) examined at the Kyorin University Hospital from April 2000 to December 2007 were retrospectively reviewed.
Results:  Mean age at onset was 44.8 years for men and 47.0 years for women. By anatomical classification, 229 patients (27.4%) had anterior uveitis, 10 (1.2%) had intermediate uveitis, 183 (21.9%) had posterior uveitis and 412 (49.4%) had panuveitis. The most common diagnoses were Vogt-Koyanagi-Harada (VKH) disease (11.0%), sarcoidosis (6.9%), acute anterior uveitis (6.5%), Behçet's disease (5.8%) and tuberculosis (4.3%). In the third and fourth decades, the most common diseases were Behçet's disease for men and VKH for women, whereas over 60 years of age, the most common diseases were VKH for men and sarcoidosis for women. Systemic corticosteroids were used in 25.5% of patients, and other immunomodulatory agents were required in 8.7% of patients.
Conclusions:  The most frequent diagnoses were sarcoidosis, VKH disease, acute anterior uveitis, Behçet's disease and tuberculosis, with Behçet's disease being common in young men and sarcoidosis being common in elderly women. One-fourth of patients received systemic corticosteroids and 8.7% of patients required other immunomodulatory agents.     

Immunological concepts and the eye: A review of the classical and ocular Arthus reactions

Inflammatory processes can involve any tissue in the eye. Despite advances in therapy, the sequelae of inflammation continue to be a major cause of visual impairment. Knowledge of disease pathogenesis in clinical ocular inflammations remains imprecise, and defined models are crucial in developing this understanding and evolving rational approaches to treatment. This review analyzes the contributions that studies of the classical and Arthus ocular Arthus-type reactions have made as to how the eye functions as an immunological entity. The anticipated development of therapeutic agents that may modulate immune processes with remarkable specificity, gives a new impetus to such experimental studies.     

Uveitis with autoimmune hepatic disorders

Many cases of uveitis are thought to be autoimmune in nature. We report two cases of panuveitis, one of which was associated with chronic active hepatitis and the other with primary biliary cirrhosis. This suggests that the autoimmune disturbance may have been responsible for the development of the intraocular inflammation.     

Clinical Experience with Adalimumab in the Treatment of Ocular Behçet Disease

Purpose: To describe the clinical outcome of refractory ocular Behçet disease with adalimumab therapy.

Method: Retrospective review of records.

Results: Twenty-one eyes of 11 male patients with ocular Behçet disease received adalimumab therapy. Of the 21 eyes, 17 had improvement of visual acuity by more than 3 lines after the average follow-up of 10.8 months. Ten out of 11 patients showed complete resolution of inflammation by 4 weeks. The dosages of corticosteroids and immunosuppressive drugs were reduced in most of the patients and stopped altogether in 3 and 6 patients, respectively. One patient on infliximab showed improvement of inflammation after switching over to adalimumab. No serious side effects were observed in any of the patients.

Conclusion: Adalimumab appears to be effective in Behçet disease. It has been shown to improve visual acuity and also to have a corticosteroid and immunosuppressive sparing effect. It can induce and maintain sustained remission of the disease.     

Dos casos de retinopatía externa oculta zonal aguda: importancia del diagnóstico multimodal

A presentation is made of two cases of acute zonal occult outer retinopathy (AZOOR); a 19-year-old man, and the other a 42-year-old woman. The young man complained of unilateral scotoma and photopsia. The woman presented with bilateral visual loss and photopsia. Multimodal imaging, including fundus photography, fluorescein angiography, fundus autofluorescence, spectral-domain optical coherence tomography, and visual field testing, supported the diagnosis of AZOOR.The differential diagnosis is complicated, since it has clinical features in common with other retinopathies. This means that it is essential to use modern imaging tests, especially those where the characteristic trizonal pattern is shown, such as in autofluorescence and OCT.     

Increased presence of Epstein-Barr virus DNA in ocular fluid samples from HIV negative immunocompromised patients with uveitis

AIMS—To investigate whether routine testing for Epstein-Barr virus (EBV) is necessary in the examination of a patient with uveitis.
METHODS—Intraocular EBV DNA was determined in 183 ocular fluid samples taken from patients with AIDS and uveitis, HIV negative immunocompromised uveitis, acute retinal necrosis, toxoplasma chorioretinitis, intraocular lymphoma, anterior uveitis, and miscellaneous uveitis of unknown cause. In 82 samples from this group of patients paired serum/ocular fluid analysis was performed to detect local antibody production against EBV. Controls (n=46) included ocular fluid samples taken during surgery for diabetic retinopathy, macular pucker, or cataract.
RESULTS—Serum antibody titres to EBV capsid antigen proved to be significantly increased in HIV negative immunocompromised patients with uveitis (p<0.01) compared with controls. Local antibody production revealed only three positive cases out of 82 patients tested, two results were borderline positive and one patient had uveitis caused by VZV. EBV DNA was detected in three out of 46 control ocular fluid samples. In the different uveitis groups EBV DNA was noted, but was not significantly higher than in the controls, except in six out of 11 HIV negative immunocompromised patients (p=0.0008). In four out of these six cases another infectious agent (VZV, HSV, CMV, or Toxoplasma gondii) had previously been identified as the cause of the uveitis.
CONCLUSIONS—When comparing various groups of uveitis patients, EBV DNA was found more often in HIV negative immunocompromised patients with uveitis. Testing for EBV does not have to be included in the routine management of patients with uveitis, since indications for an important role of this virus were not found in the pathogenesis of intraocular inflammation.

Keywords: Epstein-Barr virus; intraocular fluid; polymerase chain reaction; uveitis     

Treatment of ocular symptoms of Behçet's disease with interferon α2a: a pilot study

AIM—To study long term effects of interferon α_2a (IFNα_2a) on panuveitis in seven patients with Behçet's disease in a prospective, open clinical trial.
METHODS—Seven patients were treated with IFNα_2a for a mean of 23.6 months (14-37 months). They received an initial dose of IFNα_2a of 6×10⁶ IU/day, followed by 3×10⁶ IU/day after 1 month and 3×10⁶ IU every other day after 3 months. Two patients received low dose prednisolone (between 0.2 and 0.4 mg/kg/body weight) additionally at the beginning of the therapy. Complete cessation of IFNα_2a was possible in three patients (observation period 22, 6, and 4 months).
RESULTS—Marked improvement occurred in six patients who had ocular manifestations of Behçet's disease for the first time or with minor damage during their course of chronic relapsing panuveitis. In one patient with advanced ocular Behçet's disease, new relapses were prevented. Retinal infiltrates resolved within 2 weeks; vasculitis, macular oedema, infiltration of the anterior chamber and vitreous resolved within 4 weeks. Mean posterior uveitis score before treatment (nine affected eyes) was 6.6, 4 weeks after IFN it was reduced to 0.4. The mean observation period is 27.6 months, ranging from 14 to 42 months.
CONCLUSION—Treatment of ocular symptoms of Behçet's disease with IFNα_2a alone or in combination with low dose steroids led to complete remission of ocular vasculitis in all patients treated in this open, uncontrolled trial. Treatment with IFNα_2a may prevent permanent retinal or optic nerve damage due to vascular occlusion. No severe side effects occurred. Controlled randomised studies are warranted in order to prove the efficacy of IFNα_2a in ocular Behçet's disease and to compare it with other, established treatments such as azathioprine or cyclosporin A.

Keywords: Behçet's disease; uveitis; interferon α_2a