1/18. Long-term posterior and anterior segment complications of immune recovery uveitis associated with cytomegalovirus retinitis.PURPOSE: To identify and describe long-term posterior and anterior segment complications of immune recovery uveitis in patients with inactive cytomegalovirus retinitis who are undergoing highly active antiretroviral therapy-mediated recovery of immune function.methods: A prospective cohort study at a university medical center. Twenty-nine eyes of 21 patients with immune recovery uveitis and inactive cytomegalovirus retinitis were followed for 14.5 to 116 weeks (median, 43 weeks) after diagnosis of immune recovery uveitis. RESULTS: Nine eyes of nine patients developed visually important complications involving the posterior segment, anterior segment, or a combination of both. Posterior segment complications included severe proliferative vitreoretinopathy in three eyes and spontaneous vitreous hemorrhage from avulsion of a blood vessel secondary to contraction of the inflamed vitreous in one eye. Proliferative vitreoretinopathy recurred in all cases after surgery, severely compromising the visual outcome. Anterior segment complications included posterior subcapsular cataracts with vision decrease in five eyes and persistent anterior chamber inflammation after cataract extraction, resulting in posterior synechiae and large visually important lens deposits in three eyes.CONCLUSION: Persistent inflammation in immune recovery uveitis may lead to vision-threatening complications, such as proliferative vitreoretinopathy, posterior subcapsular cataracts, and severe postoperative inflammation. Immune recovery uveitis is a chronic inflammatory syndrome that may result in complications months to years after the onset of inflammation.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/18. Chronic postoperative endophthalmitis due to pseudomonas oryzihabitans.PURPOSE: To report a case of chronic postoperative endophthalmitis caused by the gram-negative bacterium pseudomonas oryzihabitans.DESIGN: Interventional case report.methods: A 77-year-old man was referred to our service for nonpainful uveitis in the right eye accompanied by increased intraocular pressure of 2 years' duration with onset 4 months after uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens implantation. The uveitis partially responded to topical corticosteroid therapy but was recurrent with tapering of steroids. An anterior chamber tap and vitreous biopsies sent for cultures were negative. Owing to the persistence of inflammation despite intraocular vancomycin injection, the lens implant and capsule were removed and culture of the latter revealed the bacterium P. oryzihabitans.RESULTS: There was no recurrence of inflammation after removal of the lens implant and capsule.CONCLUSIONS: Unlike other gram-negative organisms, which are associated with poor outcomes, P. oryzihabitans may masquerade as chronic uveitis because of its low virulence.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/18. Bilateral blinding uveitis in a child after secondary intraocular lens implantation for unilateral congenital cataract.A 3-year-old boy underwent secondary implantation of an iris supported intraocular lens following extraction of a unilateral congenital cataract. Eight months later, he developed a bilateral plastic uveitis which, in spite of intensive medical treatment, resulted in NPL (no perception of light) in the implanted eye and 2/60 vision in the fellow eye. Sympathetic ophthalmia possibly played a role in the pathogenesis of the uveitis.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/18. Cataract surgery and intraocular lens implantation in patients with uveitis.The authors reviewed the outcome of extracapsular cataract extraction (ECCE) in 44 eyes of 38 patients with uveitis. Thirty-two of the 44 eyes received a posterior chamber lens implant; 87% of these achieved a stable visual acuity of 20/40 or better. Sixty-seven percent (8 of the 12 eyes) not receiving an implant achieved this level. The authors' results and current literature suggest that absolute control, preoperatively and postoperatively, of all uveitis inflammation and careful selection of patients as lens implant candidates are crucial for successful cataract surgery in uveitis patients. Complete removal of lens cortex and placement of an all-PMMA posterior chamber lens within the capsular bag are also believed to be important.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/18. Inflammatory pigmented paravenous retinochoroidal atrophy.A 47-year-old Japanese man had a progressive degeneration of the retina and choroid along the retinal veins associated with uveitis of two years' duration. The lesion was characteristic of paravenous retinochoroidal atrophy: a contiguous atrophy of the retinal pigment epithelium and choroid of one-half to one disc diameter in size was present along most of the veins from the posterior pole to the far periphery. fluorescein angiography showed a window defect in the retinal pigment epithelium, with hyperfluorescence representative of retinal pigment epithelium and choriocapillaris degeneration. Good visual acuity was attained after extracapsular cataract extraction for complicated cataract and vitrectomy for severe vitreous opacity had been performed in both eyes. The cause of this new inflammatory disease was unknown.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/18. Pseudophaco--anaphylactic endophthalmitis? P.M.M.A. related.The pathological findings of pseudophacoanaphylactic endophthalmitis are described in a patient with a combined trabeculectomy, extracapsular cataract extraction and an "in-the-bag" posterior chamber lens implant, and who developed sympathetic ophthalmitis following a perforating eye injury within hours of his operation. Apart from the typical sympathetic histological findings, the eye revealed a pseudophaco-anaphylactic endophthalmitis reaction which appeared to be totally related to the polymethylmethacrylate (P.M.M.A.) optic. The "in-the-bag" polypropylene closed loops revealed no significant histological reaction.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/18. Vogt-Koyanagi-Harada's disease in brazil.A retrospective analysis of 33 patients with Vogt-Koyanagi-Harada disease (VKH disease) seen in Sao Paulo, brazil, from 1976 to 1985 at a uveitis referral clinic revealed that VKH disease represents 2.5% of the total uveitis cases seen. All cases were bilateral, 30% being men and 70% women. The ethnic distribution was the following: 60% white (with variable Indian or black extraction), 24% darkly pigmented, 9% Orientals (Sansei, third-generation Japanese) and 6% black. The frequency among Orientals was 7 times higher than what would be expected according to the relative frequency of Japanese in the Brazilian population. The age distribution at the onset of the disease was as follows: 12% less than 20 years of age, 60% between 20 and 40 years of age and 27% over 40 years of age. The disease was classified into 3 types with variable extraocular signs. Type I disease was present in 24% of the patients, type II in 51% and type III disease in 24% of the patients. Cataract was present in 40% of the cases and glaucoma was present in 9%. No correlation was found between sex, age at onset, race, type of extraocular involvement and number of extraocular manifestations in considering either visual status or visual prognosis. All patients were treated with systemic steroids. Most of them also received cytotoxic immunosuppressive agents. In this uncontrolled clinical study cytotoxic drug-treated patients seemed to have a better clinical course.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/18. diagnosis and surgical management of phacoanaphylactic uveitis following extracapsular cataract extraction with intraocular lens implantation.One year after a successful extracapsular cataract extraction with posterior chamber lens implantation of a Cilco Kratz modified J-loop lens, the patient, a 79-year-old white female, developed a severe granulomatous uveitis unresponsive to topical or systemic steroid therapy. All usual uveitis tests were negative, and no evidence of masquerade-syndrome-type uveitis was found. The possibility of lens-induced uveitis was considered. A B-scan ultrasound revealed high density echoes in the superotemporal portion of the capsular bag, and an operative procedure consisting of a sector iridectomy, removal of the implant, removal of white cortical material in the capsular bag as well as residual lens capsule, and an anterior vitrectomy was done. Pathologic examination of the specimens revealed lens material engulfed by large macrophages, foam cells, and plasma cells. The patient's uveitis rapidly subsided. She is now off all medication and has normal aphakic vision. The differential diagnosis, surgical management, and implications of this problem are discussed.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
9/18. Expulsive choroidal effusion during cataract surgery (in a case with Fuchs' heterochromic cyclitis).A case of massive choroidal detachment during cataract extraction is described. Some thoughts about the pathophysiology of expulsive detachment in this case are discussed (Fuchs' heterochromy cyclitis and high blood pressure). The prognosis is good without need of posterior sclerotomy but with steroid treatment for a longer period.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/18. Phacoanaphylactic endophthalmitis associated with extracapsular cataract extraction and posterior chamber intraocular lens.We describe the clinicopathologic findings in a patient who underwent extracapsular cataract extraction (ECCE) with insertion of a posterior chamber intraocular lens (IOL). The patient had a sterile hypopyon and anterior uveitis that temporarily subsided but recurred. The inflammation actually worsened after removal of the IOL, and the eye was enucleated. Histopathologic examination showed a pattern consistent with phacoanaphylactic endophthalmitis. We therefore postulate that the patient's complications were due to hypersensitivity to her own lens protein, which remained after the ECCE, rather than to the IOL itself.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
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