Biomedical subjects
Publications and source records attributed to M Havlíková.
Masquerade syndromes comprise a number of diseases imitating as to their clinical picture inflammation of the eye. These diseases comprise also malignant tumours. The authors present three patients where intraocular tumours (lymphoma, leukaemia, melanoma of the choroid) reminded of chronic uveitis.
The author investigated the rate of phenotype HLA-B27 and systemic diseases in patients with acute anterior uveitis (AAU) in our geographical area. The evaluated clinical differences of AAU manifestations in HLA-B27 positive and HLA-B27 negative patients in a group of 104 subjects followed up for a 10-year period. The patients were under 40 years of age. Men were affected twice as frequently as women. HLA B27 positive AAU is manifested above all by serofibrous exsudation into the anterior chamber and by more frequent relapses. In patients with early treatment there were fewer complications and the prognosis was favourable. AAU in HLA-B27 positive patients is associated in 65% with rheumatic disease. In our population it is above all ankylosing spondylitis and Reiter's disease. In 71% rheumatic diseases were manifested in men. Despite the different clinical course of AAU HLA-B27 positive and negative patients, during long-term follow up the visual acuity is not markedly altered in any of the investigated groups.
The authors draw attention to the different ophthalmological manifestations of Wegener's granulomatosis in two patients examined at the First Ophthalmological Clinic of the First Medical Faculty, Charles University, Prague. The patients complaints led later to establishment of the diagnosis of WG or its relapse. Combined immunosuppressive treatment with steroids and cyclophosphamide relieved the ocular as well as general manifestations of WG.
The author evaluates diagnostic and therapeutic results in nine patients with Behcet's disease investigated at the uveological ambulance of the First Ophthalmological Clinic, Medical Faculty Charles University in Prague during 1987-1996. Anterior uveitis with hypopyon was recorded twice as frequently as retinal vasculitis. Chronic CME, secondary glaucoma and occlusive vasculitis were the most serious complications of ophthalmological manifestations of BD. Ulcerations of connective tissue and skin manifestations of BD were found most frequently in the authors patients. In two thirds of the patients also the risk phenotype HLA B5 was recorded.
Sixteen patients with relapsing or chronic HSV keratouveitis were treated during a new attack by acyclovir 15 mg/kg/day by the i.v. route for 5 days with local combination of acyclovir 3% ung. and steroids. In all 16 patients improvement of signs of keratouveitis occurred on the fourth day of therapy, in 10 patients with improvement of visual acuity. In 5 patients perforating keratoplasty was performed on account of turbidity of the cornea. The authors observed four relapses of the disease in the course of 12 months after termination of treatment.
The authors present an account of surgery of complicated cataract in 20 patients with anterior and intermediate uveitis. During a one-year follow-up period they evaluate the difference of postoperative development and visual acuity in extracapsular extraction without or with implantation of an intraocular lens. In 10 patients (5x m. Fuchs, 3x anterior uveitis, 2x intermediate uveitis) they performed only ECCE. In 10 patients with the same diagnosis an intraocular lens was implemented. The authors did not find marked differences between the ECCE operation and ECCE operation with an intraocular lens in patients with uveitis. The visual acuity improved in all 20 patients, a marked inflammatory reaction in the anterior chamber was observed in both groups only during the first days after surgery. The two groups did not differ markedly as regards late complications. From the investigation ensues that implantation of an intraocular lens is well tolerated in patients with anterior and intermediate uveitis assuming a minimum 12-week remission of the disease.
Mycotic inflammations of the anterior segment of the eye are relatively rare in our geographical zone. The clinical picture, isolation of the pathogenic organism and possible treatment are discussed with reference to three patients with keratomycosis treated at the First Ophthalmological Clinic of the First Medical Faculty, Charles University Prague. Microscopic examination of the affected tissue revealed Fusarium 1x and Candida alb. also on cultivation. Natamycin 5.0% suspension cured Fusarium keratitis and improved the symptoms of Candida infection. In two patients perforating keratoplasty was necessary in one instance because of imminent perforation of a posterior mycotic corneal abscess and in the second patient because of subsequent bacterial reinfection.
Toxoplasmosis chorioretinitis is the most frequent posterior uveitis. Different treatment modes are used for its therapy. Classical is the combination of 50 mg of pyrimethamine with 4 g of sulphadiazine and corticosteroids. In this study the results of treatment with lower doses of pyrimethamine together with long-acting sulphonamide are reported. Twelve patients were treated with Fansidar, combination of 25 mg of pyrimethamine and 500 mg sulphadoxine. The treatment consisted of a loading dose of two tablets of Fansidar, followed by one tablet a day. Prednisone 0.5 mg/kg/day was added and gradually tapered off. Patients were treated for 28 days on average (range 21-50 days). In 83% of patients the scar was considerably smaller than original lesion (on average the scar represented 25% of original lesion). Three months after the treatment the visual acuity was 6/9 or better in 83% of patients. No side-effects of the treatment were observed. Lower doses of pyrimethamine with suphadoxine in an easy once a day treatment regime could be an alternative and cost-effective therapy for ocular toxoplasmosis.
The authors evaluated the importance of a large scale of laboratory examinations and specialized examinations in a group of 174 patients with endogenous uveitis examined at the uveological ambulance of the First Ophthalmological Clinic of the First Faculty, Charles University Prague. Laboratory examinations which are part of screening examinations are of little value for the diagnosis of uveitis. Alone they are unable to assess its type or prognosis. They cannot be recommended for routine work in the field. Only the incidence of phenotype HLA B27 in patients with anterior uveitis is, as compared with the healthy population, statistically significant (p < 0.005). Aimed collaboration with specialists from other disciplines is more important. The latter can on the basis of aimed examinations confirm or rule out systemic disease of a patient with uveitis suspected by the ophthalmologist.
Necrotizing herpetic retinopathies are serious, usually rapidly progressive diseases of retina. Three well defined syndromes can be outlined: acute retinal necrosis, progressive outer retinal necrosis and CMV retinitis. Two cases of acute retinal necrosis, where the clinical picture was probably influenced by the corticosteroid use are described. The overview of clinical manifestation and therapy of these syndromes is given.
OBJECTIVE: Evaluation of experience with the diagnosis and treatment of intermediate uveitis in the Czech population. METHODS: The retrospective study summarizes the results assembled in 21 patients (37 eyes) investigated at the First Ophthalmological Clinic in 1988-1995. RESULTS: A diffuse type of inflammation was revealed in 15 patients (26 eyes), exsudative type in 6 patients (11 eyes). In three patients the inflammation did not call for treatment. Long-term remission was achieved in 3 patients by periocular injections of steroids, in 11 patients by systemic Prednisone treatment, in 4 patients by combined immunosuppression. In one patient cryotherapy was performed, in two patients PPV. In 31 eyes (84%) vision was the end of the observation period 6/12 better. CONCLUSION: From the results of the investigation ensues that intermediate uveitis occurs in our geographical zone more frequently in younger age groups and is manifested as a rule by a milder, diffuse type of inflammation. The prerequisite of successful patient care is early diagnosis and correct indication of treatment.
The authors treated as part of a controlled trial, five patients with Consupren, Galen a Co, i.e. the Czech preparation of cyclosporin A. All patients suffered from endogenous uveitis which was refractory to treatment with a combination of prednisone and cyclophosphamide or prednisone and azathioprin. Mitigation of the disease was achieved already during the first three weeks of treatment. In two patients during treatment a slight relapse of the inflammation was observed. As to side effects of this treatment, the authors observed only once readily controllable hypertension and a rise of some indicators of liver metabolism which returned to normal already during treatment. Side-effect in conjunction with renal affection were not observed in any of the patients. Based on these preliminary results the authors assume that Consupren is in the given indication, and when the described pattern of administration is used, effective and justifies the authors to continue with their investigation.
The authors describe two patients with endogenous uveitis. When investigating the aetiology of the inflammation systemic sarcoidosis was diagnosed. The authors emphasize the necessity of interdisciplinary collaboration during care of patients suffering from this disease.
The authors present the case of a female patient who, following complicated surgery, developed endogenous endophthalmitis. Based on the clinical picture and microscopic finding in the punctuate of the affected vitreous body the diagnosis of endogenous mycotic endophthalmitis was established. The treatment of the condition is based on a combination of local and systemic administration of antimycotics. If medicamentous treatment is not effective, pars plana vitrectomy must be performed. In severe cases surgical treatment is selected as soon as the diagnosis is confirmed.
After review of literature about diagnosis and treatment of diabetic macular edema own results with mean observation time of 5 months are presented. After photocoagulation the visual acuity improved in eyes with focal maculopathy in 28.9%, stabilized in 62.2% and in 8.9% it was worse. In eyes with diffuse maculopathy improvement was observed in 29.6%, stabilisation only in 37%, deterioration in 33.3%. In ischemic maculopathy the visual acuity improved in 23%, stabilised in 76.9% and in none case deterioration was stated. We plan to reevaluate our results during longer observation time.
In a brief historical review of views on inflammatory affections of the uveal tissue the authors focused attention also on distinguished personalities in Czech ophthalmology who worked at the Czech Ophthalmological Clinic and participated in the development of uveology. Based on their own observations, they give an account on of their experience with the diagnosis of endogenous uveitis. Consistent with the world literature, they were able to reveal in a group of 174 patients with endogenous uveitis that the condition was associated with a systemic disease in 30%, in 9% they found an infectious aetiology and the remaining 61% were described as idiopathic endogenous uveitis. From the group of idiopathic uveitis they separated clinical entities diagnosed in 29%.
The authors investigated 43 patients with the original diagnosis of endogenous idiopathic uveitis for a period of one year. Comprehensive ophthalmological, immunological and rheumatological examination revealed that in all investigated cases either systemic disease was involved or diseases associated with impaired immunity or endogenous idiopathic uveitis. The patients were treated by immunosuppressive therapy either by Prednisone alone or by a combination of Prednisone and Cyclophosphamide. In all instances remission was achieved, contrary to previous therapy employed in these patients. In the majority of patients/21 of 23 and 12 of 18 resp./remission persisted for at least one year. The authors discuss indications and pitfalls of immunosuppressive therapy based on recommendations found in the literature.