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- Neovascular Glaucoma Induced by Peripheral Retinal Ischemia in Neurofibromatosis Type 1: Management and Imaging Features. [JOURNAL ARTICLE]
- Case Rep Ophthalmol 2013 1; 4(1):69-73.
To report the case of a young patient affected by neurofibromatosis 1 (NF-1) with peripheral retinal ischemia-induced neovascular glaucoma and the peculiar spectral-domain optical coherence tomography (SD-OCT) features.A 13-year-old boy affected by NF-1, as diagnosed according to established criteria, was referred with a diagnosis of hypertensive uveitis in his left eye. He underwent a complete ophthalmic examination and comprehensive blood work with viral and immunological tests. The case was documented with fluorescein angiography (FA) and SD-OCT. When the intraocular pressure (IOP) of the left eye decreased and the cornea cleared, FA revealed retinal ischemia and leakage from pathologic retinal vessels. SD-OCT revealed foveal hypoplasia secondary to the complete absence of the retinal nerve fiber layer.Peripheral retinal ischemia-induced neovascular glaucoma was diagnosed. The patient underwent Ahmed valve implantation to control his IOP, and subsequent retinal photocoagulation by argon laser and intravitreal bevacizumab injection were performed to control neovascularization.Retinal ischemia in NF-1 might lead to neovascular glaucoma: lowering of the IOP with surgical implantation of an Ahmed valve, regression of neovascularization by argon laser panretinal photocoagulation and intravitreal injection of bevacizumab can be a helpful way to control such a complication.
- Indocyanine green angiography in posterior uveitis. [JOURNAL ARTICLE]
- Indian J Ophthalmol 2013 Apr; 61(4):148-159.
Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression.
- What causes relapses of autoimmune diseases? The etiological role of autoreactive T cells. [JOURNAL ARTICLE]
- Autoimmun Rev 2013 May 16.
Most human autoimmune diseases have a relapsing-remitting or a chronic progressive course, while animal models are usually acute and monophasic. In our experimental animal model the disease can be either monophasic or remitting, depending on the autoantigen used for induction, and it appears to lie in the effector phenotype of the elicited T helper cell response. Since both, monophasic and relapsing courses of disease are induced by immunization as well as by adoptive transfer of peptide-specific, CD4(+) T cells, we were able to directly compare the transcriptomes of pathogenic T cell lines by gene array analysis and qPCR as well as protein expression. Upregulated genes were only determined in T cells inducing relapsing uveitis and belong to certain pathways of antigen presentation, activation, inflammation, migration and survival, comprising WNT, Hedgehog, MAP-kinase and JAK/STAT-pathways. These pathways are partially interacting with each other, and the central molecule upregulated in T cells causing relapsing disease was found to be IFN-γ. Here the course of the autoimmune diseases strictly depends on the characteristics of the autoreactive T cells, which are already determined at their early stage of antigen-specific activation. Our rat models of experimental autoimmune uveitis could help elucidating the immune mechanisms behind relapsing autoimmunity in order to develop better therapeutic strategies.
- [Immediately sequential bilateral cataract surgery in dogs: A retrospective analysis of 128 cases (256 eyes).] [JOURNAL ARTICLE]
- J Fr Ophtalmol 2013 May 16.
OBJECTIVE:To describe postoperative complications and visual outcomes after immediately sequential bilateral cataract surgery (ISBCS) and to assess whether additional risk is incurred by operating on the fellow eye immediately following the first. ANIMALS STUDIED: A retrospective review of 128 dogs (256 eyes) that underwent ISBCS in three veterinary ophthalmology centers between May 2007 and December 2011 was performed.
PROCEDURE:Visual status at final evaluation was recorded and intra- and postoperative complications were recorded and analyzed. Data for the first operated eye (FE) and then the second eye (SE) were statistically analyzed to assess whether performing surgery on the SE immediately after the FE resulted in any negative consequences for the second eye.
RESULTS:No serious intraoperative anesthetic incident occurred due to prolonged surgery. Phacoemulsification times were significantly shorter for the SE than for the FE. On final examination, 239 eyes out of 256 (93.36%) exhibited functional vision (score 2), and three dogs were completely blind due to long-term bilateral postoperative complications. The most common postoperative complications were uveitis (58 eyes, 22.66%), postoperative ocular hypertension (POH; nine eyes, 3.5%), glaucoma (nine eyes, 3.5%) and total retinal detachment (seven eyes, 2.73%). No case of endophthalmitis was reported. These results were no worse than those typically reported for unilateral phacoemulsification. In addition, the risk of blindness and other postoperative complications was not significantly increased in the SE.
CONCLUSIONS:The results of this study suggest that ISBCS is not associated with an increased incidence of intra- or postoperative complications compared to classic unilateral cataract surgery and might be a viable option for selected patients. The risk of blindness or postoperative complications was not higher in SEs than in FEs.
- Serum Prolactin Levels in Behçet's Disease. Is There a Relationship between Behcet's Disease and Prolactin as in Other Autoimmune Diseases? [JOURNAL ARTICLE]
- Acta Dermatovenerol Croat 2013 May; 21(1):52-58.
Behçet's disease (BD) is a multi-system disorder (etiologically unknown) presenting with oral and genital aphthae, arthritis, cutaneous lesions, eye lesions and central nervous system involvement. Although found worldwide, it is mostly reported in Turkey and Japan, followed by Middle East and Mediterranean area as other regions according to its prevalence (1,2). Diagnosis is made clinically. In addition to recurrent aphthous ulceration, at least two symptoms of recurrent genital ulceration, typical eye lesions, typical dermatologic lesions, and positive pathergy test are needed for BD diagnosis. There is no specific laboratory test (3). In its etiology, many factors have been postulated, such as heredity, autoimmunity, infective agents and inflammatory mediators. BD tends to manifest in autoimmune disorders. Prolactin is a pre-hypophysis hormone considered to be strongly related to autoimmunity. Supported by many researches, prolactin can accompany the progress of some autoimmune diseases (systemic lupus erythematosus, uveitis, rheumatoid arthritis, multiple sclerosis, autoimmune thyroiditis, psoriatic arthritis, etc.) and it can also arise in some autoimmune diseases. In the light of these ideas, we studied whether there is a relationship between BD and serum prolactin level, and compared it with similar studies reported in the literature. Serum prolactin levels rise in many autoimmune diseases. Prolactin levels were determined in patients in active BD stage with dermatologic diagnosis but taking no therapy for the disease, in order to demonstrate the relationship between BD, which has been increasingly defined as an autoimmune multisystem disease, and the level of serum prolactin, an immunostimulating hormone of adenohypophysis; in addition, the results obtained were compared with literature data. The study included 43 patients, 21 female and 22 male, and 20 healthy age- and sex-matched subjects as control group. Patients in BD group were in the active stage of the disease with manifest oral aphthae, genital aphthae, erythema nodosum and positivity for pathergy. In addition, arthralgia accompanied the disease in 20 patients. BD patients had not received any treatment for the past six months. In order to obviate the effect of sleep and food, blood samples were collected in fasting state, between 8.30 and 10.30 a.m. Serum prolactin levels were measured on an Immulite 2004 device using the immunometric assay, with 3.0-20.0 ng/mL (female) and 2.5-17.0 ng/mL (male) accepted as normal values. Study group included 43 BD patients, 21 (48.8%) female and 22 (51.2%) male. Control group had included 20 healthy subjects, 11 (55%) female and 9 (45%) male. There was no sex difference between the patient and control groups (p=0.941). The mean prolactin level was 11.63 ng/mL in BD group and 10.19 ng/mL in control group, yielding no significant between-group difference in the mean prolactin level (t=1.272; p=0.264). The mean serum prolactin level in BD patients was 11.6 ng/mL; 9.84 ng/mL in female and 9.27 ng/mL in male BD patients. The mean serum prolactin level in the healthy control group was 8.24 ng/mL; t-test produced no statistically significant difference between the BD patient group and control group. However, although there was no statistically significant difference, higher prolactin levels were measured in the group of BD patients as compared with control group. On the contrary, there are study reports on high serum prolactin levels in BD. In their study, Proença et al. from Portugal showed the mean serum prolactin levels to be significantly higher in BD patients as compared with control group (19.34ng/mL vs. 9.83 ng/mL) (4). Our results are similar to those reported in the literature. However, additional studies are needed to clarify the issue. We believe that future in-depth research should identify these differences as being significant or nonsignificant.
- Ocular histiocytic sarcoma in a cat. [JOURNAL ARTICLE]
- Vet Ophthalmol 2013 May 20.
A 13-year-old male neutered British blue cat presented with uveitis, hyphema, and dyscoria in the right eye. Light microscopic examination revealed that the ciliary body, iris root, drainage angle, and adjacent choroid were infiltrated by sheets of large neoplastic mononuclear and multinucleate round to polygonal cells. Neoplastic cells stained immunopositive for CD18 and HLA-DR (MHC class II) and were immunonegative for CD3, CD79a, MUM-1, CD117 (c-Kit), and S100. These findings were consistent with a histiocytic sarcoma. The cat later developed multiple cutaneous masses composed of a similar neoplastic cell population to that seen in the eye. Eight months following enucleation, the cat developed respiratory distress and was euthanized. Postmortem examination revealed multiple pulmonary tumors associated with a pleural effusion.
- Photo quiz: a 38-year-old man with uveitis, cholestasis, and rash. [Journal Article]
- J Clin Microbiol 2013 Jun; 51(6):1657.
- Hyaluronan-modified core-shell liponanoparticles targeting CD44-positive retinal pigment epithelium cells via intravitreal injection. [JOURNAL ARTICLE]
- Biomaterials 2013 May 13.
Retinal inflammation, a common process of posterior ocular diseases, may lead to severe vision loss or even blindness. Retinal pigment epithelium (RPE) cells are generally considered as the therapeutic target of inflammation pathogenesis. However, the lack of retina-specific distribution for general intravitreous drug delivery systems makes the anti-inflammation treatment inefficient. In the present study, a hyaluronan (HA)-modified core-shell liponanoparticles (HA-LCS-NPs) was designed to improve the treatment efficiency by increasing RPE-targeted distribution. Our in vitro RPE cell uptake study showed that a higher HA grafting density (5.8%) and a higher molecular weight (200-400 kDa) modification of HA improved the intracellular uptake of HA-LCS-NPs. In addition, in vivo distribution evaluation in experimental autoimmune uveitis (EAU) rats revealed that HA-LCS-NPs could specifically target RPE cells through the interaction between the CD44 receptor and the HA ligand, while chitosan nanoparticles (CS-NPs) were limited to the vitreous cavity and the core-shell liponanoparticles (LCS-NPs) only reached the inner layers of the retina. At 7 d post-injection, approximately 75% of the fluorescence of HA-LCS-NPs still remained in the RPE/choroid. In conclusion, HA-LCS-NPs might present a promising intraocular drug delivery system to achieve RPE-targeted distribution and prolonged intraocular residence.
- Lipoic acid lessens Th1-mediated inflammation in lipopolysaccharide-induced uveitis reducing selectively Th1 lymphocytes-related cytokines release. [JOURNAL ARTICLE]
- Free Radic Res 2013 May 17.
Abstract Inflammation results in the production of free radicals. We evaluated the anti-inflammatory and antioxidant capacity of lipoic acid in an experimental uveitis model upon a subcutaneous injection of endotoxin into Lewis rats. The role of oxidative stress in the endotoxin induced uveitis model is well-known. Besides, the Th1 response classically performs a central part in the immunopathological process of experimental autoimmune uveitis. Exogenous sources of lipoic acid have been shown to exhibit both antioxidant and anti-inflammatory properties. Our results show that lipoic acid treatment plays a preventive role in endotoxin-induced oxidative stress at 24 h post-administration and reduced Th1 lymphocytes-related cytokines by approximately 50-60%. Simultaneously, lipoic acid treatment caused a significant reduction in uveal histopathological grading and in the protein concentration in aqueous humors, but not in cellular infiltration.
- [Post-ooperational acute inflammation of an eye in patients with cataracts]. [English Abstract, Journal Article]
- Georgian Med News 2013 Apr; (217):26-30.
Despite the implementation of the newest highly efficient equipment into the practice of modern clinical ophthalmology, improvement of technical skills of ophthalmologist surgeons, the cases of post-operational acute endophthalmitis development, toxic syndrome of anterior segment of an eye, reactive aseptic inflammatory process are rather negatively reflected in the course of a post-operational process of rehabilitation. Under our supervision there were 1100 patients with the senile and complicated cataracts, who underwent operational intervention microcoaxial phacoemulsification. Differential diagnostics was carried out on the basis of the standard objective and subjective methods of research accepted in ophthalmology. On the basis of obtained data is found that clinical symptomatology of autoimmune aseptic anterior uveitis, in particular, the eye inflammation associated with the broken syndrome of an eye anterior chamber-associated immune deviation (ACAID), considerably differs from clinical implications of acute endophthalmitis and a toxic syndrome of the anterior chamber of an eye. In overwhelming majority of cases under the complicated cataracts, precisely the autoimmune aseptic inflammatory process, which originated due to withdrawal of regional immune reactions responsible for ACAID, was observed in postoperative period.