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Vogt-Koyanagi-Harada syndrome (VKH) is an uncommon multi-system autoimmune inflammatory disorder characterized by bilateral granulomatous panuveitis with serous retinal detachment accompanied by neurological, auditory, and cutaneous manifestations like headache, hearing loss, vitiligo, and poliosis. It has a female preponderance, usually in middle age. We report the case of a 20-year-old male who presented to us with rapidly progressive visual loss accompanying granular panuveitis, complicated cataract, and a mixed mechanism neovascular glaucoma with acute angle closure. He was treated for IOP control and underwent aggressive immunosuppression and, later, bilateral laser iridotomies. It wasn't until one month after the initial presentation that he presented with vitiligo and poliosis of the eyebrows and eyelashes, clinching the diagnosis of VKH syndrome. This case highlights the diagnostic challenge faced due to acute neovascular glaucoma being the initial presenting feature of VKH; hitherto not documented before, although acute angle closure glaucoma or crisis has occasionally been reported at presentation; the classical VKH presentation being an acute posterior segment uveitis or less commonly, a chronic, recurrent panuveitis presenting with/ without complications. This case underlines the importance of considering VKH syndrome in a patient with bilateral granulomatous panuveitis, as dermatological involvement can emerge later in the disease course, by which time vision might have already been compromised significantly.

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PURPOSE: To report a case of recalcitrant pseudomonas keratitis with a rare presentation of hyphaema. OBSERVATION: A 45-year-old female was noted to have contact lens-related pseudomonas keratitis with hyphaema. The organism was refractory to multiple antibiotics and only responded to Tazocin eye drops. CONCLUSION AND IMPORTANCE: Hyphaema is a rare presentation in bacterial keratitis and could represent infection with an especially virulent organism. Use of Aspirin could precipitate hyphaema in infective keratitis. Alternative antibiotic choices such as Tazocin, colistin, meropenem, and imipenem can be considered when standard therapy is ineffective for multidrug-resistant Pseudomonas keratitis.

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PURPOSE: To assess Uveitis-Glaucoma-Hyphaema syndrome (UGH syndrome) with focus on resolution, glaucoma development and risk factors. METHODS: This retrospective case-control study with a cross-sectional component was performed to compare three groups with 71 patients each: UGH syndrome, dislocated intraocular lens (IOL) without UGH syndrome and ordinary pseudophakia. Main outcome measures were resolution of the UGH syndrome, best-corrected visual acuity (BCVA) and the need of glaucoma therapy. We also assessed the IOL-iris contact signs and the use of blood thinners. RESULTS: Uveitis-Glaucoma-Hyphaema (UGH) syndrome resolved in 77 % of patients who underwent various kind of IOL surgery. Intraocular pressure (IOP) decreased and BCVA improved in the operated cases (p = 0.02 and p < 0.001, respectively), but not in the cases treated conservatively. Intraocular pressure (IOP) ≥22 mmHg at the first haemorrhage predicted the need of glaucoma therapy after UGH syndrome resolution (p = 0.002, area under the curve = 0.8). Fifty-one per cent of patients without preexisting glaucoma needed glaucoma therapy after UGH syndrome resolution. Pseudophacodonesis was seen more frequently in the UGH group than in the ordinary pseudophakia group (p = 0.001). Iris defects were not more frequent in the UGH group than in the Dislocated group but the types of defects differed (p < 0.0001). Blood thinners were not more frequent in UGH. CONCLUSION: In UGH syndrome, the results are better with surgical intervention than with conservative treatment, but surgery does not guarantee resolution. Pseudophacodonesis is a risk factor for UGH syndrome, but blood thinners are not, and iris defects are not specific to UGH syndrome. A high IOP at the first haemorrhage increases the risk for needing subsequent IOP-lowering therapy.

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PURPOSE: Pseudophakic glaucoma is a secondary glaucoma in which intra-ocular pressure is elevated following cataract removal. The current study aimed to evaluate the role of ultrasound biomicroscopy (UBM) in assessing post-operative pseudophakic glaucoma. PATIENTS AND METHODS: This is a case series, prospective, observational and analytical study. It included 29 eyes of 29 patients with post-operative pseudophakic glaucoma. The patients were evaluated by medical history, detailed ophthalmologic examination and UBM. RESULTS: UBM examination has unmasked different causes of pseudophakic glaucoma. The detected causes were classified into 3 main groups, including intraocular lens (IOL)-related causes, lens remnants and intra-ocular inflammation. Haptic-related causes were present in 9 eyes, while 6 eyes had decentered or tilted IOLs. Soemmering's ring was the main cause in 3 eyes while in one eye the cause was lens particle in the anterior chamber (AC). Silicone oil in AC with seclusio pupillae was the main cause in one eye. Peripheral anterior synechiae were detected in 8 eyes while, posterior synechiae were evident in 7 eyes. Uveitis induced by anterior chamber IOL (ACIOL) was found in 3 eyes and one eye had peripheral anterior synechiae due to neovascular glaucoma. CONCLUSION: UBM is a helpful diagnostic tool to evaluate causes of pseudophakic glaucoma through adequate visualization of different angle structures.

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PURPOSE: To demonstrate a case of massive vitreous haemorrhage obscuring the underlying diagnosis of a large mixed-cell choroidal melanoma which had undergone spontaneous necrosis. CASE REPORT: A 49-year-old man in good general health suddenly lost vision in his right eye due to an extensive vitreous haemorrhage 1 day after a workout at the gym. He reported good vision prior to that without any symptoms of flashes, floaters, or shadows. He was referred to the vitreoretinal department of a tertiary eye hospital, where he presented with a drop in vision to light perception only in the right phakic eye. Pars plana vitrectomy was performed in the right eye, which revealed intraoperatively massive retinal ischemia and choroidal haemorrhage, but no obvious tumour mass that could have been biopsied. The vitrectomy cassette specimen was sent for histopathology, where "ghost-like" melanoma cells were identified. The eye was subsequently enucleated, revealing an extensively necrotic and haemorrhagic choroidal melanoma of mixed cell type with only small viable tumour foci at the base and almost complete lysis of the detached retina. CONCLUSION: Some uveal melanomas (UMs) undergo spontaneous necrosis due to rapid growth, with the centre of the tumour outstripping its established blood supply in the "watershed area" of the eye, and becoming hypoxic with associated necrosis of intraocular structures. Such UMs are often associated with haemorrhage and/or inflammation and usually cause significant destruction of ocular tissues, resulting in enucleation as the only treatment option.

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Moraxella keratitis can lead to important complications. Moraxella nonliquefaciens(M. nonliquefaciens) has the worst prognosis. Only three cases of corneal infections due to M. nonliquefaciens have been published. The case is presented of a 79-year-old man with bullous keratopathy, recently affected with severe infectious keratitis. Dense, deep, and central stromal infiltrates and hyphaema were detected. After the identification of M. nonliquefaciens in the culture, and given the progression of the condition, the initial empirical treatment was modified to topical ciprofloxacin and ceftazidime in accordance with the antibiogram, combining oral ciprofloxacin and amoxicillin-clavulanate. After 27 days, there was total resolution of the lesion, with central residual leucoma. Keratitis caused by M. nonliquefaciens is rare and must be suspected in elderly patients with local predisposing factors, such as corneal damage or previous eye surgery. Early antibiogram-guided treatment and close monitoring are important to avoid complications and poor compliance.

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A 54-year-old woman presented with recurrent redness and blurred vision of the left eye with elevated intraocular pressure (IOP) for one year. She was treated as "iridocyclitis" and ``Posner-Schlossman syndrome'' at the local hospitals. However, the patient developed intermittent ocular inflammation and hyphema. Patient had a cataract surgery and intraocular lens (IOL) implantation in the left eye one year before at the local hospital. A diagnostic procedure was performed and the possible pathogenesis was discussed.

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PURPOSE: To examine the clinical outcomes of intraocular lens (IOL) scleral fixation with the friction knot technique. METHODS: Retrospective case series of 152 eyes of 152 patients with inadequate capsular bag support operated with the friction knot IOL scleral fixation technique by a single surgeon. The fixated IOLs were one-piece or three-piece models all with open loop haptics. Main outcome measures were change in corrected distance visual acuity (CDVA) and postoperative complications. RESULTS: The mean follow-up time was 11.7 months (median 4.9, range 0.7-64.8). The mean logarithm of the minimum angle of resolution CDVA improved from preoperative 0.77 ± 0.73 (Snellen 20/118 ± 7.3 lines) to 0.44 ± 0.56 (Snellen 20/55 ± 5.6 lines) at the final visit (p < 0.001). The main postoperative complications were ocular hypertension (30.3%), uveitis-glaucoma-hyphaema syndrome (12.5%; UGHS), vitreous haemorrhage (11.2%) and retinal detachment (8.6%). Two (1.3%) cases of suture breakage were seen. In multivariate Cox regression analysis, age under 60 years [hazard ratio (HR) = 5.41; 95% confidence interval (CI) 1.95-15.01] and scleral fixated one-piece IOL (HR = 4.23; 95% CI 1.44-12.44) were found as significant independent risk factors for developing new UGHS. CONCLUSION: The friction knot technique provides a firm scleral fixation. Scleral fixation may successfully be utilized in dislocated three-piece IOLs with loop haptics. We recommend avoiding scleral fixation of one-piece IOLs in young patients due to a high risk of UGHS.

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AIM: The aim was to analyze general incidence, age incidence, laterality, common mode of presentation, staging of the tumor, radiological evidence, histopathological confirmation, management and follow-up of cases, which were diagnosed as retinoblastoma. DESIGN: Interventional case series study from April 1997 to March 2000. MATERIALS AND METHODS: Detailed history regarding the symptoms such as white reflex, watering, pain, redness, protrusion of eyeball, squint, hyphema, and defective vision were obtained. Family history regarding consanguinity between parents, health of the siblings and other relatives were recorded. Ocular examination included vision, pupillary reaction, detailed fundus examination, ocular tension, and corneal diameter. Investigations included X-ray orbit and skull, computed tomography scan orbit and brain, B-scan orbit, serum and aqueous lactate dehydrogenase; enucleated eyes were subjected to holoprosencephaly (HPE). Enucleation, radiotherapy, cryotherapy and chemotherapy were modalities of treatment. The empty socket and the other apparently normal eye were examined carefully at each visit. RESULTS: The incidence of retinoblastoma is less when compared to other diseases of the eye. There was no sex predilection. Most of the cases diagnosed were sporadic and unilateral. Age of onset is earlier for bilateral cases than unilateral cases. Consanguinity bears close relationship with bilateral involvement. Predominant clinical sign is white reflex in the pupillary area. Majority of cases presented in the second stage of the disease. Enucleation plays a greater role in the management of retinoblastoma. HPE should include several sections of the optic nerve to find out skip lesions.

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CASE REPORT: A 74 year-old woman present with blurry vision of 12 hour duration in her right eye, and with no other symptoms. Biomicroscopic examination revealed a 3 mm hyphaema in her right eye and multiple nodular structures in the pupillary margin of both eyes. DISCUSSION: Iris tufts are vascular anomalies unrelated to ischaemia that must be included in the differential diagnosis of spontaneous hyphaema.

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INTRODUCTION: Various aspects of management of traumatic hyphaema are enmeshed in controversy. Surgery is done to prevent complications: optic atrophy and corneal blood staining occurring if a high risk exists of either or both occurring. Circumstances considered high risk do not enjoy universal consensus. OBJECTIVES: To determine what Nigerian ophthalmologists consider absolute indications for surgical intervention by means of anterior chamber paracentesis and hyphaema washout in closed globe traumatic hyphaema, evaluate these absolute indications, and attempt to evolve a guideline for surgical intervention based on areas of consensus and disagreement. METHOD: A semi-structured, pre-tested questionnaire with responses analyzed with SPSS 11 software. RESULT: Near universal agreement on indication exist on early corneal blood staining and sickle cell haemoglobinopathy. Differing views concern blackball, volume and duration of hyphaema and secondary hypertension-associated hyphaema. However, it appears surgery is embarked on earlier than other practitioners elsewhere may consider necessary. CONCLUSION: Risk level for non-surgical management against risk and benefit of surgery should be evaluated for each individual before surgery.