1/203. An overlap syndrome with features of atypical cogan syndrome and Wegener's granulomatosis. A 48 year old women developed serous otitis, scleritis, myalgia, vertigo, polyneuropathy, crescentic glomerulonephritis, general cerebral dysrythmia, hilar adenopathy, and retroorbital granulomatous inflammation. Pulmonary manifestations were absent and antibodies against neutrophilic cytoplasmic antigens (ANCA) could not be detected. The clinical picture was classified as an overlap syndrome with features of both atypical cogan syndrome and Wegener's granulomatosis. The patient responded to treatment with high dose corticosteroids and pulse cyclophosphamide. ( info) |
2/203. Surgically induced necrotizing scleritis in a patient with ankylosing spondylitis. We present the case of a 75-year-old man with ankylosing spondylitis who developed surgically induced necrotizing scleritis (SINS) more than 3 years after uneventful extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient presented with a painful eye and increasing vertical diplopia. To our knowledge, neither the association of SINS and ankylosing spondylitis nor vertical diplopia as its presenting complaint has been described. ( info) |
3/203. Episcleritis associated with pigmentary retinal degeneration in an HTLV-I carrier. Human T-cell lymphotropic virus type I (HTLV-I) has been reported as the cause of a kind of endogenous uveitis (HTLV-I associated uveitis; HAU). We observed a case of episcleritis in a HTLV-I carrier with pigmentary retinal degeneration. HTLV-I infection might be associated with the development of episcleritis and pigmentary retinal degeneration. patients with episcleritis or pigmentary retinal degeneration should be examined for HTLV-I infection. ( info) |
4/203. Squamous cell carcinoma with necrotizing scleritis. PURPOSE: To report on a case of limbal squamous cell carcinoma (SCC) with necrotizing scleritis in a young, previously healthy, white Australian male. methods: A 31-year-old man presented with a left limbal lesion intermittently causing a red eye and foreign body sensation. He had enjoyed surfing for many years. Repeat hiv tests were negative and the lesion was biopsied. RESULTS: biopsy showed a well-differentiated SCC apparently arising in an intra-epithelial (in situ) carcinoma of the conjunctiva. The lesion was excised and a corneoscleral graft repair was performed. CONCLUSION: The present case highlights the potential for a significant increase in the prevalence of ocular surface neoplasia in healthy young people who have had excessive UV-B exposure. ( info) |
5/203. Severe Acanthamoeba sclerokeratitis in a non-contact lens wearer. PURPOSE: To report a case of severe Acanthamoeba sclerokeratitis. methods: A 70-year-old male non-contact lens wearer was examined for severe pain in the left eye which began about 40 days after cataract surgery. In spite of a careful search, it required 6 weeks to detect Acanthamoeba. Systemic and topical fluconazol and miconazol did not help and the keratitis progressed into necrotic sclerokeratitis with protrusion of uveal tissue through the thin sclera. RESULTS: Those findings slowly got worse before the Acanthamoeba sclerokeratitis resolved 6 months later with scar formation. CONCLUSION: We describe the terminal and cicatricial stages of acanthamoeba keratitis, and report that the healing process can follow the terminal stage and the eye does not need to be enucleated. ( info) |
| AIMS: To describe the clinical course and treatment of haemophilus influenzae associated scleritis. methods: Retrospective case series. RESULTS: Three patients developed scleritis associated with ocular H influenzae infection. Past medical history, review of systems, and laboratory testing for underlying collagen vascular disorders were negative in two patients. One patient had arthritis associated with an antinuclear antibody titre of 1:160 and a Westergren erythrocyte sedimentation rate of 83 mm in the first hour. Each patient had ocular surgery more than 6 months before developing scleritis. Two had cataract extraction and one had strabismus surgery. Nodular abscesses associated with areas of scleral necrosis were present in each case. culture of these abscesses revealed H influenzae in all patients. Treatments included topical, subconjunctival, and systemic antibiotics. Scleral inflammation resolved and visual acuity improved in each case. CONCLUSION: H influenzae infection may be associated with scleritis. Accurate diagnosis and treatment may preserve ocular integrity and good visual acuity. ( info) |
7/203. The treatment of Pseudomonas keratoscleritis after pterygium excision. PURPOSE: To assess the effect of intensive topical and intravenous antibiotics plus oral prednisolone and surgical debridement in Pseudomonas keratoscleritis after pterygium excision. methods: We describe three cases of P. aeruginosa-induced keratoscleritis occurring 10 days to 18 months after uncomplicated pterygium excision. Treatment included early conjunctival debridement, topical and intravenous antibiotics, and low-dosage oral prednisolone. RESULTS: All three patients responded to the combined therapy. Microorganisms were eliminated, and ulcers were healed within 8 weeks. Treatment was not extended beyond that, and infection did not recur. No evisceration was required. The patients' best corrected visual acuities are 20/200, 20/400, and 20/120, respectively. CONCLUSION: early diagnosis and prompt, intensive medical and surgical treatment may save a patient's vision and forestall evisceration. ( info) |
8/203. Three cases of pustulotic arthro-osteitis associated with episcleritis. Three cases of pustulotic arthro-osteitis (PAO) associated with episcleritis were described. In each patient, the episcleritis developed more than 10 years after the onset of PAO. These episcleritis were treated with topical corticosteroids. PAO is classified as a member of the seronegative spondylarthritis group of diseases. Though complications of seronegative spondylarthritis include uveitis and episcleritis. PAO associated with episcleritis was not reported. Episcleritis should be considered as a complication of PAO. ( info) |
9/203. Episcleritis as the primary clinical manifestation in a patient with polyarteritis nodosa. PURPOSE: To alert ophthalmologists to ocular manifestations that could indicate polyarteritis nodosa. CASE: A 71-year-old man exhibited unilateral episcleritis as the primary clinical manifestation of polyarteritis nodosa. OBSERVATIONS: The patient's ocular symptoms did not respond well to either topical betamethasone eye drops or low-dose oral prednisone. Five months after the onset of ocular symptoms, the patient progressively developed fever, pneumonia, and renal dysfunction. Positive antineutrophil cytoplasmic antibody indicated polyarteritis nodosa as the underlying systemic disease. Intravenous methylprednisolone (1 g/day) was started; however, the patient succumbed 10 days later after intracranial hemorrhage. CONCLUSIONS: Ophthalmologists should be aware that such a common ocular manifestation as episcleritis can be the initial manifestation of polyarteritis nodosa and that its early diagnosis can reduce mortality from this disease. ( info) |
10/203. Severe sclerokeratitis due to pseudomonas aeruginosa in noncontact-lens wearers. PURPOSE: To review the clinical presentation, treatment and outcome in four cases of severe anterior segment infection by pseudomonas aeruginosa unrelated to contact lens wear. methods: Four cases presenting over an 18 month period were reviewed. RESULTS: The cases had variable presenting features and outcomes. Complications such as persistent infection, corneal thinning and phthisis bulbi were noted. Possible factors influencing adherence and tissue disruption are discussed. CONCLUSIONS: Suspicion of infection by P. aeruginosa and prompt isolation of the organism is needed early in the course of disease. Intensive and prolonged treatment with parenteral and topical antibiotics combined with judicious use of topical steroid gives the best chance of a favourable outcome. ( info) |