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[Increased episcleral venous pressure in uveal effusion].

This paper reports on two patients with bilateral, spontaneous choroidal and retinal detachment. One patient had scleritis, while in the other no underlying eye disease was found. No signs of orbital venous congestion were detected. Although the pathogenesis of this disease is not fully known, the findings of (1) dilated episcleral veins and (2) elevated episcleral venous pressure suggest an obstruction of venous outflow from the uveal tract. The authors believe that these two findings may have been caused by shunting of venous blood anteriorly from the uveal tract into the episcleral veins due to partial obstruction of the vortex veins.

Aged↗

[Familial nanophthalmos].

Microphthalmos is a rare, potentially devastating condition. Catsch found 30 cases of microphthalmos in a population of 26,735 (0.11%); Scouras et al. among 120,000 ophthalmic out-patients found 70 cases of microphthalmos (0.058%); among 3,557 blind adults Lindstedt found 63 cases (1.77%) and Kissel et al. among 210,000 ophthalmic out-patients found 97 cases (0.046%). Congenital microphthalmos may be: colobomatous, complicated, pure. Pure microphthalmos or nanophthalmos is a rare condition in which the eye is reduced in size with a notably high ratio of the lens volume to eye volume, but no other congenital anomalies are present. The sclera is abnormally thick. Nanophthalmos may be sporadic or hereditary: hereditary transmission may be either recessive or dominant. These eyes are anatomically predisposition to angle-closure glaucoma and occasionally associated with uveal effusion. Angle-closure glaucoma probably is the result of the natural increase in the size of the lens with age; in addition, spontaneous choroidal detachment probably may cause elevation and forward rotation of the ciliary body pushing the lens-iris diaphragm forward, with increasing of the relative pupillary block. The uveal effusion probably is the result of choroidal congestion secondary to obstruction of vortex veins by abnormally thickened sclera. Uveal effusion may also occurs spontaneously in patients with nanophthalmos between the ages of 40 to 60 years. Surgical intervention with sudden decompression of the globe, appears to aggravate the degree of uveal effusion. Three cases of familial nanophthalmos associated with angle-closure glaucoma without uveal effusion not microcornea are reported. The occurrence of nanophthalmos in the same family suggests an autosomal recessive inheritance.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

[Choroid plexus papilloma of the third ventricle in infancy: a case report].

The incidence of choroid plexus papilloma is about 0.5% of all intracranial tumors, but they are only infrequently found in the third ventricle. This is a case report of choroid plexus papilloma of the third ventricle in an infant. A make child in his 7th month of age was admitted because of large head circumference, on the 28th February, 1989. CT scan demonstrated hydrocephalus caused by a tumor in the third ventricle. Total removal of the tumor was performed on the 8th of March. Histologically the tumor was found to be choroid plexus papilloma. The patient suffered from postoperative subdural effusion and convulsions, so we performed ventriculoperitoneal shunt on the 14th April, and convulsions were controlled by zonisamid.

Age Factors↗

[Uveal effusion syndrome and scleral thickening].

The uveal effusion syndrome associates bullous no rhegmatognous retinal detachment with shifting subretinal fluid, choroidal detachment and elevated spinal fluid protein. This syndrome could result of nonophthalmos, scleral thickening and/or vortex vein attenuation. The author describes a case of uveal effusion syndrome with isolated scleral thickening. Theoretical explanations of this syndrome are emphasized on the basis of literature and clinical and surgical guidelines are given.

Choroid↗

Nanophthalmic uveal effusion.

A nanophthalmic patient with hypermetropia, shortened anterior-posterior axial length, and thickened choroid presented with a choroidal detachment and nonrhegmatogenous retinal detachment (NRRD). He underwent partial thickness, 5 x 7 mm, sclerectomies and 1-2 mm central sclerostomies 9.5 mm posterior to the limbus, specifically avoiding vortex veins. Complete resolution of the retinal and choroidal detachments occurred in spite of postoperative ultrasonograms demonstrating residual choroidal-scleral thickening. The effectiveness of this technique in our patient, in light of recent studies demonstrating histochemical and microscopic abnormalities in nanophthalmic sclera, suggests impairment of trans-scleral protein transport as the primary pathophysiologic mechanism in nanophthalmic uveal effusion.

Exudates and Transudates↗

[Secondary angle-block glaucoma in posterior scleritis].

Posterior scleritis is an often misdiagnosed disease of the eye. Mainly it appears in elderly women and tends to be recurrent. Symptoms leading to diagnosis are swelling of the eye lids, a red eye, disturbances of the motility and protrusio bulbi. In rare cases you find exudative choroidal or retinal detachment, edema of the macula, or the optic nerve head, and secondary angle closure glaucoma. Often posterior scleritis is associated with general illness as herpes zoster, mixed connective tissue diseases, or Boeck's disease. Differential diagnosis are choroidal tumors as for example, melanoma, hemangioma, and metastases. The typical uveal effusion can also be caused by an arterio-venous fistula, panretinal photocoagulation, buckling procedure for retinal detachment, and by intraocular surgery in general. Especially cyclitis anularis pseudotumorosa has to be considered and shut out. Most important diagnostical means are ultrasound, and CT-scan. The underlying case describes an 81 years old woman that presented with acute angle closure glaucoma, and exudative choroidal detachment of the right eye. The ultrasound and CT-scan investigations confirmed the diagnosis of scleritis posterior. The acute angle closure glaucoma, and the choroidal detachment regressed immediately under the treatment with steroids given locally and systemically. There was no impact of miotics and peripheral iridectomy which both could not avoid recurrence of angle closure glaucoma.

Aged↗

Laser and unsutured sclerotomy in nanophthalmos.

Among 30 eyes with nanophthalmos, 21 had angle-closure glaucoma and two had open-angle glaucoma associated with pseudoexfoliation of the lens capsule. Laser iridotomies, sometimes combined with laser iridoplasty, were sufficient to control, or to allow medical control of, the glaucoma in 15 of 18 eyes. Four eyes with uveal effusion underwent an unsutured sclerotomy or sclerectomy, and all had resolution of the choroidal detachment within two weeks. Cataract extraction improved the vision in seven of nine eyes. Previous or simultaneous sclerotomy or sclerectomy was performed on all nine eyes that underwent cataract extraction and in two eyes at the time of glaucoma surgery; no eye had postoperative uveal effusion or other major complications. Laser iridotomy and iridoplasty, sometimes with supplemental medical therapy, are often sufficient in the treatment of angle-closure glaucoma in nanophthalmos and are safer than surgery. Nanophthalmic uveal effusion can be prevented or treated with an unsutured sclerotomy or sclerectomy.

Adolescent↗

[Uveal effusion syndrome--case report].

The history and clinical findings of 60-year old man with effusion syndrome are presented. The uveal effusion syndrome typically affects healthy middle age men and causes recurrent, spontaneous, serous retinal and cilio-choroidal detachments which, often results in significant visual impairment. In addition, to the general clinical examinations, indirect ophthalnoscopy, fundus fluorescein angiography, ultrasonography and MRI are used to make definitive diagnosis. Annular cilio-choroidal detachment, shifting non-rheumatogenous retinal detachment, unremarkable inflammation in the anterior segment and normal intraocular pressure are the key features of the idiopathic uveal effusion syndrome. The fundus change is characterized by the "leopard-spot".

Exudates and Transudates↗

Uveitis in rabbits with pleural effusion disease. Clinical and histopathological observations.

Pleural effusion disease (PED) is a generalized infection of laboratory rabbits caused by a virus-like agent. The disease was first described in the late sixties as a mortality problem among rabbits used for the propagation of Nichols' pathogenic Treponema pallidum in Scandinavian laboratories using the T. pallidum immobilization (TPI) test for the serological diagnosis of syphilis. The iridocyclitis, described as a manifestation of PED, has been studied in detail in rabbits experimentally infected with the PED agent. All rabbits surviving the acute phase of infection developed a non-pyogenic, non-granulomatous anterior uveitis during the "viraemic" stage of infection. The ocular signs of disease culminated between days 3 and 6 and disappeared within 2 to 3 weeks. No recurrence of uveitis was observed during a 6-months observation period, nor by subsequent subcutaneous re-inoculation of the PED agent. Histologically, the uveal reaction was mild and regressed almost completely within 4 weeks. Discrete choroidal inflammatory foci occurred in some of the re-inoculated rabbits, but without changes in the anterior eye segment. The uveitis of pleural effusion disease in rabbits seems to be caused directly by the virus-like agent. It might possibly serve as a simple and reproducible model in further uveitis research.

Animals↗

[Acute bilateral glaucoma in an LAV-positive subject].

A bilateral angle-closure glaucoma is described in a homosexual man, with a positive HIV serology. This angle closure is secondary to an anterior rotation of the ciliary body at the scleral spur following development of an inflammatory cilio-choroidal detachment: which is itself connected with a massive uveal-retinal effusion. The cause of this uveal effusion appears to be cytomegalovirus. This unusual syndrome was the initial manifestation of AIDS (Acquired Immune Deficiency Syndrome). A symptomatologic treatment with cycloplegics and prednisolone and a specific one with DHPG (9-1, 3-dihydroxy-2-propoxymethyl guanine), resulted in rapid regression of the local lesions; his overall clinical condition however deteriorated rapidly over two months following onset of syndrome.

Acquired Immunodeficiency Syndrome↗

The uveal effusion syndrome and trans-scleral flow.

Recent studies of the uveal effusion syndrome, a rare condition characterised by idiopathic spontaneous serous detachment of the retina and peripheral choroid, have suggested a primary scleral abnormality as the underlying cause. In particular, abnormal deposition of glycosaminoglycans within the sclera may impair normal trans-scleral flow of fluid and contribute to increased scleral thickness. In four cases of uveal effusion syndrome, we have confirmed the accumulation of glycosaminoglycans in the sclera. Histochemical studies show that most of this material is proteodermatan sulphate with a smaller contribution from proteochondroitin sulphate, while electron microscopy showed an increase in collagen fibril thickness. Secondary changes within the retinal pigment epithelium were also observed, particularly foci of proliferation which corresponded to the characteristic 'leopard-spot' fundal appearances of this disorder. We therefore suggest that the uveal effusion syndrome is due to a primary defect in proteodermatan synthesis and/or degradation by scleral fibroblasts and may represent a form of ocular mucopolysaccharidosis.

Aged↗

Mucosa-associated lymphoid tissue lymphoma with intraocular involvement.

PURPOSE: To report the clinicopathologic features of a patient with mucosa-associated lymphoid tissue (MALT) lymphoma of the conjunctiva and associated intraocular involvement. METHODS: This study is a retrospective clinicopathologic correlative case report summarizing the clinical, radiologic, and histopathologic findings of a patient with conjunctival MALT lymphoma and associated intraocular involvement. RESULTS: Ophthalmic examination and fluorescein angiography demonstrated progressive conjunctival infiltration bilaterally, marked uveal effusions in the left eye, and cellular white infiltrates of the choroid in the right eye. MRI of the orbit revealed a diffusely infiltrating intra- and extraocular lesion extending around the globe and optic nerve in the left eye without evidence of intracranial extension. Conjunctival biopsy showed low-grade tumor cells, consistent with the diagnosis of MALT lymphoma. The patient was successfully treated with external beam radiation with marked clinical improvement. CONCLUSION: Conjunctival MALT lymphomas, typically indolent and localized tumors, may extend into the orbit and invade local tissues such as the choroid with devastating consequences. A conjunctival biopsy can provide an easy diagnosis of this treatable entity.

Choroid Neoplasms↗

Fatal pulmonary embolism in a child undergoing extra-ventricular drainage surgery--a case report.

Thromboembolism is rather common in neurological patients and patients with brain tumor, who are bed-ridden or with partial immobile limb. In serious instances morbidity and mortality are inevitable. We present a case report on a fatal pulmonary embolism in a 2-year-old girl who underwent extra-ventricular drainage procedure under general anesthesia for occipital subdural effusion, a sequela of the former surgery undertaken to remove the choroid plexus papilloma 13 days ago. Sudden cardiac arrest occurred during induction of anesthesia and she finally succumbed in spite of vigorous cardiopulmonary resuscitation. Transthoracic and transesophageal echocardiography performed in the course of resuscitation disclosed thrombi of various sizes scattering in right atrium, the right ventricle, main pulmonary trunk, and the left pulmonary artery. The cause of death was thought to be severe obstruction of right ventricular outflow tract by large thrombi. The etiological factors which possibly led to the thrombosis were discussed, and the methods of diagnosis and treatment were also explored.

Brain Neoplasms↗