RESUMEN
We were interested to analyse the composition of the cellular infiltrate and adhesion molecules expression in the conjunctiva before and at least one hundred days after autologous and allogenic bone marrow transplantation (BMT) and its relation with the presence of dry eye. We used immunohistochemistry on cryopreserved human conjunctiva with monoclonal antibodies to T-lymphocytes (CD3, CD4 and CD8), B-lymphocytes (CD19), macrophages (CD14), natural killer cells (NK, CD57), intercellular adhesion molecule 1 (ICAM-1), E-selectin, vascular cell adhesion molecule-1 (VCAM-1), lymphocyte function associated antigen-1 (LFA-1), very late antigen-4 (VLA-4), interleukin 2 receptor (IL2r, CD25) and HLA-DR. Our autologous recipients had no graft-versus-host disease (GVHD) but allogenic patients had chronic GVHD. After autologous BMT the conjunctiva had significantly more: (1) T lymphocytes (CD3+, CD4+, CD8+) in the epithelium; (2) CD4+ and CD14+ cells in the stroma; and (3) VLA-4 expression in the stroma than before BMT. After allogenic BMT, the conjunctiva exhibited a significant increase of: (1) CD3+ and CD14+ cells in the epithelium; (2) T lymphocytes (CD3+, CD4+, CD8+) and CD14+ cells in the stroma; and (3) VLA-4 and LFA-1 expression in the stroma than before BMT. After the engraftment, the comparison between autologous and allogenic recipients revealed that: (1) there were no significant differences in adhesion molecule expression; (2) the epithelium of autologous recipients had significantly more CD3+ cells; and (3) the stroma of allogenic patients had significantly more CD3+ and CD8+ cells. Among allogenic recipients, CD14+ cells were significantly increased both in the epithelium and in the stroma of patients with signs or symptoms of dry eye in comparison with patients without ocular involvement. Additionally, those having keratoconjunctivitis sicca (KCS) had CD4/CD8 ratios significantly higher than those without KCS. In conclusion, in the conjunctiva after autologous BMT a subclinical cell mediated immune reaction seems to take place. The conjunctivitis of chronic GVHD is complex, with T cells and macrophages dramatically contributing to the process.
Asunto(s)
Trasplante de Médula Ósea , Moléculas de Adhesión Celular/metabolismo , Conjuntiva/inmunología , Enfermedad Injerto contra Huésped/inmunología , Queratoconjuntivitis Seca/inmunología , Enfermedad Aguda , Adolescente , Adulto , Niño , Enfermedad Crónica , Femenino , Enfermedad Injerto contra Huésped/metabolismo , Humanos , Queratoconjuntivitis Seca/metabolismo , Células Asesinas Naturales/patología , Macrófagos/patología , Masculino , Persona de Mediana Edad , Subgrupos de Linfocitos T/patologíaRESUMEN
PURPOSE: To describe a case of herpes simplex virus type 2 (HSV-2) acute retinal necrosis syndrome (ARN) in a 13-year-old immunocompetent girl. METHODS: Polymerase chain reaction (PCR), cultures, flow cytometry, and cytology were performed on the vitreous sample. RESULTS: Both PCR studies and vitreous cultures revealed HSV-2 as the cause of ARN. Flow cytometry showed CD4+, CD8+, and natural killer cells. The visual outcome of the patient was 20/200. CONCLUSION: Successful culture of HSV-2 from the vitreous specimen in a patient with ARN proved HSV-2 to be one of the causes of ARN. The successful culture of HSV-2 has not been previously reported.
Asunto(s)
Infecciones Virales del Ojo , Herpes Genital , Herpesvirus Humano 2/aislamiento & purificación , Síndrome de Necrosis Retiniana Aguda/virología , Adolescente , Anticuerpos Antivirales/análisis , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , ADN Viral/análisis , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/virología , Femenino , Citometría de Flujo , Herpes Genital/diagnóstico , Herpes Genital/virología , Herpesvirus Humano 2/genética , Herpesvirus Humano 2/inmunología , Humanos , Inmunoglobulina M/análisis , Células Asesinas Naturales/inmunología , Reacción en Cadena de la Polimerasa , Desprendimiento de Retina/diagnóstico por imagen , Desprendimiento de Retina/virología , Síndrome de Necrosis Retiniana Aguda/diagnóstico , Ultrasonografía , Agudeza Visual , Cuerpo Vítreo/virologíaRESUMEN
PURPOSE: To compare pain control using topical anesthesia with that using sub-Tenon's anesthesia for clear corneal phacoemulsification cataract surgery and foldable intraocular lens (IOL) implantation. SETTING: Departments of Ophthalmology, General Hospital Asklepeion Voulas and General Hospital of Athens, University of Athens, Athens, Greece. METHODS: One hundred consecutive patients scheduled for bilateral cataract surgery 1 to 2 months apart were prospectively randomized to receive topical anesthesia (100 eyes) or sub-Tenon's anesthesia (100 eyes). The randomization was stratified so that one half of first-eye surgeries and one half of second-eye surgeries were assigned to each anesthesia group, with each patient receiving each type of anesthesia once. All patients had clear corneal phacoemulsification with foldable IOL implantation. Patients were asked to rate their pain level on a 10-point scale for 4 periods: during the administration of the anesthetic agent, during surgery, immediately after surgery, and 24 hours postoperatively. The surgeon recorded his subjective assessment of ease of surgery and surgical complications using a standardized template. RESULTS: Eighty-one percent of patients who received topical anesthesia and 8% of patients who received sub-Tenon's anesthesia reported no pain during delivery of the anesthetic agent. The mean pain score was 0.19 +/- 0.39 (SD) in the topical group and 1.35 +/- 0.63 in the sub-Tenon's group. The difference between groups was statistically significant (P <.001). Seventy-two percent of patients in the topical anesthesia group and 86% in the sub-Tenon's anesthesia group reported no pain or slight discomfort during surgery (mean score 1.13 +/- 1.57 and 0.57 +/- 1.28, respectively) (P <.001). Ninety percent of topical anesthesia patients and 100% of sub-Tenon's anesthesia patients reported no pain or slight discomfort 30 minutes postoperatively (mean score 0.80 +/- 0.93 and 0.12 +/- 036, respectively) (P <.001). All patients in the topical anesthesia group and 77% in the sub-Tenon's group reported no pain 24 hours postoperatively (mean pain 0.00 +/- 0.00 and 0.23 +/- 0.40, respectively) (P <.001). Complications including prolonged akinesia of the globe, chemosis, and conjunctival hemorrhage occurred significantly more frequently in the sub-Tenon's than in the topical group (P <.001). CONCLUSIONS: Patients having cataract surgery under topical anesthesia had more intraoperative and postoperative discomfort than patients receiving sub-Tenon's anesthesia. However, patients having topical anesthesia reported less pain during its administration and had fewer complications. Both anesthesia methods provided high levels of pain control without additional sedation.
Asunto(s)
Anestesia Local/métodos , Implantación de Lentes Intraoculares , Facoemulsificación , Anciano , Anciano de 80 o más Años , Anestésicos/administración & dosificación , Tejido Conectivo , Sedación Consciente , Córnea/cirugía , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Estudios ProspectivosRESUMEN
OBJECTIVE: Wegener's granulomatosis (WG) is an etiologically obscure entity with multiple systemic manifestations. Ocular involvement is present in up to 58% of patients with WG. We describe a series of patients with ocular manifestations of WG to evaluate the presence of ocular lesions in the setting of systemic WG and to determine the value of ocular inflammation in the diagnosis of WG. METHODS: A computerized database was used to generate a list of patients cared for in the Ocular Immunology Service of the Massachusetts Eye and Ear Infirmary during the 10 year period 1988-98 with a diagnosis of Wegener's granulomatosis. A detailed chart review was undertaken to determine demographic characteristics, history, initial manifestation of WG, initial ocular presentation, biopsy results, laboratory testing results, treatment, total followup period, and final outcome. RESULTS: Forty-seven patients diagnosed with WG were identified. Twenty-eight were women (59.6%), 19 were men (40.4%). The average age was 53 years (range 18-90). Patients were divided into 4 groups. Group I included 27 patients (57.4%) who had systemic disease first and who subsequently developed an ocular lesion. Group II included 3 patients (6.3%) who had ocular inflammation first and who then subsequently developed systemic manifestations of WG. Group III included 3 patients (6.3%) who presented due to ocular symptoms but, on initial evaluation by us, were found to have occult systemic manifestations consistent with WG or biopsy evidence of WG. Group IV included 14 patients (30%) with ocular lesions and no history or presence of systemic disease at their last followup visit. CONCLUSION: Ocular inflammation can occur with or without obvious systemic manifestations of WG. It may represent the first sign of WG that enables the knowledgeable physician to diagnose this potentially lethal disease.
Asunto(s)
Oftalmopatías/etiología , Oftalmopatías/patología , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/patología , Vasculitis/etiología , Vasculitis/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Conjuntivitis/etiología , Conjuntivitis/patología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Renales/etiología , Enfermedades Renales/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Escleritis/etiología , Escleritis/patología , Uveítis/etiología , Uveítis/patologíaRESUMEN
We report the clinical and angiographic features as well as the natural course of an optic disk and juxtapapillary combined pigment epithelial and retinal hamartoma in a 23-year-old white girl. The patient presented 3 episodes of recurrent vitreous hemorrhages in the first 4 years of follow-up, which were spontaneously and totally absorbed. During the last 6 years, she was absolutely free of any ocular symptom. The tumor did not show any growth during the 10 years of follow-up. The digital indocyanine green angiography, which was normal in the early frames, revealed a mild, patchy hyperfluorescence corresponding to the tumor location in the late phase.
Asunto(s)
Angiografía con Fluoresceína , Hamartoma/complicaciones , Verde de Indocianina , Epitelio Pigmentado Ocular/patología , Enfermedades de la Retina/complicaciones , Hemorragia Vítrea/etiología , Adulto , Femenino , Fondo de Ojo , Hamartoma/diagnóstico , Humanos , Recurrencia , Enfermedades de la Retina/diagnósticoAsunto(s)
Endoftalmitis/etiología , Infecciones Bacterianas del Ojo/etiología , Técnicas de Sutura/efectos adversos , Antiinfecciosos Locales/uso terapéutico , Endoftalmitis/microbiología , Endoftalmitis/prevención & control , Infecciones Bacterianas del Ojo/prevención & control , Humanos , Povidona Yodada/uso terapéuticoAsunto(s)
Herpes Genital/complicaciones , Enfermedades de la Retina/etiología , Vasos Retinianos , Vasculitis/etiología , Aciclovir/uso terapéutico , Adulto , Anticuerpos Antivirales/análisis , Antivirales/uso terapéutico , Humor Acuoso/virología , ADN Viral/análisis , Quimioterapia Combinada , Angiografía con Fluoresceína , Fondo de Ojo , Glucocorticoides/uso terapéutico , Herpes Genital/tratamiento farmacológico , Herpes Genital/virología , Herpesvirus Humano 2/genética , Herpesvirus Humano 2/inmunología , Herpesvirus Humano 2/aislamiento & purificación , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/tratamiento farmacológico , Vasos Retinianos/patología , Vasculitis/diagnóstico , Vasculitis/tratamiento farmacológico , Agudeza VisualRESUMEN
We present the cases of 2 consecutive siblings with bilateral macular lesions, for which there is strong clinical and laboratory evidence supporting the diagnosis of congenital ocular toxoplasmosis. These cases raise the possibility of maternal parasitemia during Toxoplasma gondii reinfection, leading to transmission to the fetus and congenital ocular toxoplasmosis despite prior immunity and lack of an immune disturbance in the mother.
Asunto(s)
Toxoplasmosis Ocular/congénito , Toxoplasmosis Ocular/genética , Adolescente , Adulto , Fondo de Ojo , Humanos , Mácula Lútea/patología , Masculino , Persona de Mediana Edad , Toxoplasmosis Ocular/patologíaRESUMEN
PURPOSE: To report a series of patients with uveitis and cataract who had undergone cataract extraction with posterior chamber intraocular lens implantation and who subsequently had the intraocular lens removed because of progressive intraocular damage from inflammation. METHODS: Review of the records of 19 patients after removal of a posterior chamber intraocular lens. The decision to perform surgery was based on standard criteria after evaluation at a single uveitis referral center. RESULTS: The complications leading to intraocular lens removal were perilental membrane (eight eyes), chronic low-grade inflammation not responding to anti-inflammatory treatment (eight eyes), and cyclitic membrane resulting in hypotony and maculopathy (three eyes). After intraocular lens removal the inflammation subsided and the visual acuity improved or stabilized in 14 of the 19 eyes. The causes of further reduction in the visual acuity of the other five patients were macular edema (two patients), maculopathy resulting from hypotony (one patient), retinal detachment (one patient), and vitreous hemorrhage (one patient). CONCLUSIONS: Intraocular lens implantation can form part of a reasonable plan for visual rehabilitation of patients with uveitic cataract, but inclusion of an intraocular lens in the plan is not always in the overall long-term best interest of the patient. Intraocular lens removal may salvage useful vision for patients who continue to exhibit complications secondary to uveitis after cataract extraction and intraocular lens implantation, provided the intraocular lens is removed before irreparable damage has been done to macula or optic nerve.
Asunto(s)
Extracción de Catarata , Implantación de Lentes Intraoculares , Lentes Intraoculares , Complicaciones Posoperatorias/cirugía , Uveítis/complicaciones , Enfermedad Aguda , Adulto , Anciano , Catarata/etiología , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Agudeza VisualRESUMEN
PURPOSE: To describe a case of a patient who had worn the same therapeutic soft contact lens (TSCL) continuously for twelve years, since he had failed to attend normal follow-up visits. METHODS: Microbiological histological and scanning electron microscopic (SEM) studies of conjunctiva, cornea and TSCL were done. RESULTS: Cultures were negative. Corneal histology revealed mild stromal edema and mild epithelial parakeratosis. Corneal SEM was remarkable for the preservation to some extent of normal corneal epithelial specialization with microtricae and microvillae. SEM of the TSCL showed a ruffed multi-layer surface with several cracks including different types of cells. CONCLUSIONS: The patient showed surprising tolerance to the continuous wear of the same contact lens for 12 years.
Asunto(s)
Conjuntiva/microbiología , Conjuntiva/patología , Lentes de Contacto Hidrofílicos/efectos adversos , Córnea/microbiología , Córnea/patología , Anciano , Movimiento Celular , Lentes de Contacto Hidrofílicos/microbiología , Humanos , Masculino , Microscopía Electrónica de Rastreo , Factores de TiempoRESUMEN
PURPOSE: To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy. METHOD: A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis was placed on protease inhibitors when his CD4+ T lymphocyte counts dropped to 8 cells/mm3. Three months later, after his CD4+ T lymphocyte counts had increased to 196 cells/mm3 he complained of micropsia and metamorphopsia in his right eye of 1 week duration. The patient had a complete ocular examination including fluorescein angiography (FA). RESULTS: Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transseptal injections of corticosteroids were administered 2 weeks apart in the right eye as treatment of the CME. The patient reported gradual visual improvement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically. CONCLUSIONS: CME in our case is associated with inactive CMV retinitis and gradually increasing number of CD4+ T lymphocytes after initiation of treatment with protease inhibitors. It may be amenable to regional administration of corticosteroids without reactivation of retinitis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Retinitis por Citomegalovirus/complicaciones , Edema Macular/etiología , Inhibidores de Proteasas/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Adulto , Recuento de Linfocito CD4 , Retinitis por Citomegalovirus/tratamiento farmacológico , Retinitis por Citomegalovirus/inmunología , Quimioterapia Combinada , Angiografía con Fluoresceína , Fondo de Ojo , Glucocorticoides/uso terapéutico , VIH , Humanos , Edema Macular/diagnóstico , Edema Macular/tratamiento farmacológico , Masculino , Agudeza VisualRESUMEN
PURPOSE: To evaluate the presence and the evolution of cyst formation in optic disc pit maculopathy. METHODS: In this prospective study, 18 cases with optic disc pit maculopathy were studied. Five of them showed cyst formation in the fovea at the initial examination. The fundus findings were documented with slit-lamp biomicroscopy, indirect ophthalmoscopy, and stereoscopic photography of the posterior pole. All 5 patients were treated with a macular scleral buckle procedure. RESULTS: The presence of cysts in the elevated macula depends on the grade of the disease. Cyst formation can develop not only in the later stage of the disease but also quite early. In all 5 patients cyst formation gradually decreased and finally disappeared after the surgical procedure. CONCLUSIONS: Cyst formation is an entity which accompanies the macular detachment associated with optic disc pit. The development of the cysts has been noticed after the establishment of the schisis-like separation and before or in conjunction with the formation of a lamellar macular hole which usually accompanies the optic disc pit maculopathy.
Asunto(s)
Quistes/patología , Mácula Lútea/patología , Disco Óptico/anomalías , Enfermedades del Nervio Óptico/patología , Adolescente , Adulto , Quistes/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Mácula Lútea/cirugía , Masculino , Enfermedades del Nervio Óptico/congénito , Enfermedades del Nervio Óptico/cirugía , Estudios Prospectivos , Curvatura de la Esclerótica , Agudeza VisualRESUMEN
PURPOSE: To determine the efficacy of medical treatment of cystoid macular edema (CME) in patients with uveitis. METHODS: Retrospective study of 40 patients (57 eyes) with uveitis and CME. Inclusion criteria were presence of CME with minimal and no macular pathology, or vascular disease which could account for CME. Patients who had undergone intraocular surgery or had visual acuity (VA) of > or = 20/40 were excluded. The diagnosis of CME was based on clinical and/or angiographic findings. Three treatment groups were defined: (1) transseptal injection of steroids (n=13 eyes); (2) systemic non steroidal anti-inflammatory drugs (NSAIDs) (n=11 eyes); both 1 and 2 (n=33 eyes). RESULTS: Overall, 79% of eyes improved 3 or more lines of Snellen VA after treatment: 51% improved 4 or more lines. The average number of lines improved was 3.8 for eyes treated with transseptal injections of steroids, 2.9 for eyes treated with NSAIDs, and 4 for eyes treated with both. For all 3 treatment groups between 60-70% of eyes improving 2 or more lines reached best VA only after a minimum of 6 months of follow up. CONCLUSIONS: CME, a vision threatening complication of uveitis, respond fairly well to medical treatment; however, the best VA is achieved after several months. The improvement in VA did not differ markedly among the three treatment groups.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Glucocorticoides/uso terapéutico , Edema Macular/tratamiento farmacológico , Uveítis Anterior/complicaciones , Uveítis Intermedia/complicaciones , Uveítis Posterior/complicaciones , Adolescente , Adulto , Anciano , Cámara Anterior/patología , Antiinflamatorios no Esteroideos/administración & dosificación , Inhibidores de Anhidrasa Carbónica/administración & dosificación , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Niño , Vías de Administración de Medicamentos , Quimioterapia Combinada , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Glucocorticoides/administración & dosificación , Humanos , Mácula Lútea/patología , Edema Macular/complicaciones , Edema Macular/diagnóstico , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Uveítis Anterior/diagnóstico , Uveítis Anterior/tratamiento farmacológico , Uveítis Intermedia/diagnóstico , Uveítis Intermedia/tratamiento farmacológico , Uveítis Posterior/diagnóstico , Uveítis Posterior/tratamiento farmacológico , Agudeza Visual , Cuerpo Vítreo/patologíaRESUMEN
PURPOSE: To describe a case of a patient who had worn the same therapeutic soft contact lens (TSCL) continuously for twelve years, since he had failed to attend normal follow-up visits. METHODS: Microbiological histological and scanning electron microscopic (SEM) studies of conjunctiva, cornea and TSCL were done. RESULTS: Cultures were negative. Corneal histology revealed mild stromal edema and mild epithelial parakeratosis. Corneal SEM was remarkable for the preservation to some extent of normal corneal epithelial specialization with microtricae and microvillae. SEM of the TSCL showed a ruffed multi-layer surface with several cracks including different types of cells. CONCLUSIONS: The patient showed surprising tolerance to the continuous wear of the same contact lens for l2 years. (Eur J Ophthalmol 1999, 9: 312-14).
RESUMEN
OBJECTIVE: To compare the efficacy and safety of topical 2.0% dorzolamide hydrochloride with oral acetazolamide in preventing intraocular pressure (IOP) rise following neodymium:YAG (Nd:YAG) laser posterior capsulotomy. DESIGN: A prospective, randomized, double-masked, placebo-controlled study. PATIENTS: Two hundred ten patients undergoing Nd:YAG laser posterior capsulotomy. INTERVENTION: Pretreatment with dorzolamide, acetazolamide, or placebo. Dorzolamide administration as a single drop (1 drop approximately 20 microL) 1 hour before capsulotomy. Acetazolamide administration as a single dose of 125 mg orally 1 hour before capsulotomy. RESULTS: At first and third hour postoperatively, IOPs and IOP changes from baseline were significantly (P<.001) higher in the placebo group than in the dorzolamide or acetazolamide group. At the same time, IOPs and IOP changes from baseline were similar (P>.50) in the dorzolamide and acetazolamide groups. No patient treated with dorzolamide or acetazolamide experienced an IOP higher than 30 mm Hg after capsulotomy, but 15.7% of patients receiving placebo had an IOP above this level (P<.001). Of patients receiving placebo, 5.7% experienced IOP higher than 35 mm Hg. No serious side effects were recorded in any of the studied patients. CONCLUSION: Topical 2.0% dorzolamide and oral acetazolamide, given prophylactically as a single administration 1 hour before Nd:YAG laser posterior capsulotomy, have comparable high efficacy and safety in preventing IOP elevation following this procedure.
Asunto(s)
Acetazolamida/administración & dosificación , Inhibidores de Anhidrasa Carbónica/administración & dosificación , Presión Intraocular/efectos de los fármacos , Terapia por Láser/efectos adversos , Cápsula del Cristalino/cirugía , Complicaciones Posoperatorias/prevención & control , Sulfonamidas/administración & dosificación , Tiofenos/administración & dosificación , Acetazolamida/uso terapéutico , Administración Oral , Administración Tópica , Anciano , Anciano de 80 o más Años , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Extracción de Catarata , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Hipertensión Ocular/etiología , Hipertensión Ocular/prevención & control , Soluciones Oftálmicas , Estudios Prospectivos , Seguridad , Sulfonamidas/uso terapéutico , Tiofenos/uso terapéutico , Resultado del TratamientoRESUMEN
Mooren's ulcer is strictly a peripheral ulcerative keratitis (PUK) with no associated scleritis. It occurs completely in absence of any diagnosable systemic disorder that could be responsible for the progressive destruction of the cornea. The aetiology of Mooren's ulcer remains uncertain. However, recent studies indicate that it is an autoimmune disease directed against a specific target molecule in the corneal stroma, probably triggered in genetically susceptible individuals by one of several possible provocateurs. Advances have been made in the management of this disease. Immunosuppressive therapy has been shown increasingly successful in patients unresponsive to conventional treatment and in bilateral progressive destructive ocular disease.
Asunto(s)
Trasplante de Córnea , Úlcera de la Córnea/terapia , Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Enfermedades Autoinmunes , Sustancia Propia/patología , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/inmunología , Diagnóstico Diferencial , Vías de Administración de Medicamentos , Glucocorticoides/administración & dosificación , Humanos , Inmunosupresores/administración & dosificaciónRESUMEN
Although cataract surgery for senile cataract is routine and easily performed, the decision to remove the cataract in a patient with a history of uveitis is considerably more complex and usually involves multiple considerations, related not only to the cause of the uveitis but also to the appropriate surgical procedures. The problems confronting the ophthalmologist caring for the patient with uveitis begin with the first visit. Establishing a diagnosis and controlling the inflammation are the critical elements in the treatment of the patient; these two factors will determine the incidence of cataract formation and other complications, the appropriate time for cataract removal, and the surgical strategy, as well as determine the visual outcome long before surgery occurs. Diagnosis, control of inflammation, preoperative management, particularities of the surgical techniques, and postoperative complications in patients with a history of uveitis have been reviewed previously in this section. Our aims in this article are to review the literature on this subject over the past year and to reemphasize the idea of a model of zero tolerance for inflammation to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision.