RESUMO
BACKGROUND: Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells. In contrast to ophthalmic manifestations by non-HL that are well recognized, there is paucity of the literature as it relates to ophthalmic manifestation by HL. We performed a comprehensive review of published studies (case reports and small case series) to characterize the ophthalmic manifestations of HL. SUMMARY: Thirty patients were identified with ophthalmic manifestation of HL. Thirteen (43%) were male, and 14 (46%) were female (in 3 cases, sex was not specified). The median age at ophthalmic presentation was 27 years. Diagnosis of HL was made after ophthalmic manifestation in 10 (33%) cases, whereas 11 (36%) cases had a prior diagnosis of HL. Ophthalmic manifestations can be classified into 3 main groups; direct infiltration, inflammatory reaction, and paraneoplastic process. Seven cases had infiltration of the optic nerve. Uveal inflammatory reaction was reported in 21 cases. The presence of intraocular Reed-Sternberg cells had been confirmed in 1 case with granulomatous uveitis. Conjunctival and corneal reaction was seen in 3 cases. HL was in stage 2 or higher, with only 1 case with stage 1A (12 cases HL stage not specified). Seven cases (22%) died of HD, all were diagnosed with advanced lymphoma, and none was treated with chemotherapy. KEY MESSAGE: Ocular involvement in HL is extremely rare. A few cases of histopathologically confirmed optic nerve/tract infiltration are within the spectrum of CNS involvement by HL. Inflammatory uveitis is the most common ophthalmic association of HL. In the presence of prior known diagnosis of HL, restaging should be considered to exclude recurrence. Toxicity or adverse reaction to drugs used to treat HL may also contribute to ophthalmic involvement.
RESUMO
PURPOSE: To determine the relationship between the length of ciliary processes as measured by ultrasound biomicroscopy and the duration, localization and severity of uveitis. METHODS: We analyzed in this prospective study, 58 individuals including patients with different stages of uveitis and normal patients (112 eyes including 18 normal), between August 2001 and August 2002, at the Cleveland Clinic Foundation, Ohio, USA. All patients were referred to ultrasound biomicroscopy by the Uveitis Department, after a complete ophthalmological examination. A 50 MHz-transducer UBM model 840 (Zeiss-Humphrey) was used under topical anesthesia and immersion technique. RESULTS: The most frequent etiology was idiophatic uveitis (27.8%). Recurrent, aggressive and diffuse uveitis lead to significant damage of the ciliary processes. The most significant loss of the ciliary processes was found in the inferior quadrant and the highest in normal patients and in the temporal quadrant. Hypotonic eyes have their ciliary processes reduced. CONCLUSIONS: Ultrasound biomicroscopy has proved to be useful in evaluating anatomical changes of ciliary processes in uveitis and in ocular hypotony, and provides a basis to, make recommendations regarding baseline screening of uveitis patients. Patients who are found to have atrophy of the ciliary processes may need a more aggressive treatment for any signs of inflammation to prevent further damage and eventual hypotony.
Assuntos
Corpo Ciliar/diagnóstico por imagem , Uveíte/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Doença Crônica , Feminino , Humanos , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
OBJETIVO: Determinar a relação entre o comprimento dos processos ciliares com a duração, localização e gravidade das uveítes. MÉTODOS: Foram analisados em estudo prospectivo, 58 indivíduos, incluindo pacientes com diferentes estágios de uveíte e indivíduos sem a doença (112 olhos, sendo 18 normais), no período de agosto de 2001 a agosto de 2002, no Departamento de Uveítes do Cole Eye Institute da Cleveland Clinic Foundation - Ohio - EUA. Todos os pacientes foram referidos para o exame de biomicroscopia ultra-sônica, pelo Departamento de Uveítes após exame oftalmológico de rotina. O aparelho modelo 840 (Zeiss-Humphrey) com transdutor de 50 MHz foi utilizado para análise dos processos ciliares sob anestesia tópica e técnica de imersão. RESULTADOS: Em relação à etiologia das uveítes, a de maior freqüência foi a idiopática (27,8 por cento). As uveítes recorrentes, agressivas e difusas levaram ao significante dano nos processos ciliares. A maior perda significativa na medida dos processos ciliares foi encontrada no quadrante inferior e as maiores medidas foram encontradas em olhos normais e no quadrante temporal. CONCLUSÃO: A biomicroscopia ultra-sônica mostrou ser método útil para avaliar as alterações anatômicas encontradas nos processos ciliares dos pacientes com uveíte. De acordo com estes achados, podemos criar recomendações para futuros trabalhos, que nos ajudem a avaliar a necessidade destes pacientes vir a receber tratamento mais agressivo em qualquer sinal de inflamação, com o objetivo de prevenir futuro dano e eventual hipotonia.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Corpo Ciliar/ultraestrutura , Uveíte , Estudos de Casos e Controles , Doença Crônica , Microscopia Acústica , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
As uveítes anteriores são caracterizadas pela inflamação preponderante do segmento anterior do olho. Hiperemia conjuntival, reação de câmara anterior com células e "flare", precipitados ceráticos e sinéquias posteriores são sinais que compõem o quadro inflamatório. Aspectos clínicos de algumas doenças sistêmicas envolvidas na etiologia das uveítes anteriores serão abordados neste artigo.
Assuntos
Humanos , Criança , Adolescente , Adulto , Uveíte Anterior/diagnóstico , Uveíte Anterior/etiologia , Uveíte/classificação , /análiseRESUMO
Systemic lupus erythematosus (SLE) is a chronic, immunologic disorder that may affect multiple organ systems. Keratoconjunctivitis sicca is the most common ocular manifestation, but visual morbidity is usually due to retinal and neuro-ophthalmic manifestations of the disease. Ocular manifestations of lupus are a reflection of systemic disease. The presence of ocular manifestations should alert the clinician to the likely presence of disease activity elsewhere. Therefore, all patients with ocular lupus should be carefully evaluated for systemic involvement to detect potentially treatable and preventable complications of the disease. In addition, the ophthalmologist should include SLE in the differential diagnosis of many retinal vascular and neuro-ophthalmic disorders. The ophthalmologist may play an important role in the care of patients with SLE, since ocular inflammatory lesions may precede potentially serious extraocular disease.