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PubMed1993

Classification of 750 consecutive uveitis patients in the Rotterdam Eye Hospital.

The data of 750 consecutive uveitis patients who visited the uveitis department of the Rotterdam Eye Hospital were analysed by computer. Anterior uveitis was diagnosed most frequently (52%), mostly the acute form. We found a high percentage of Fuchs' heterochromic iridocyclitis and HLA-B27+ iridocyclitis. In the posterior uveitis group appeared the more recent clinical entities such as acute retinal necrosis, Birdshot retinochoroidopathy, CMV-retinitis, AMPPE and ocular candidiasis. Ocular Toxoplasmosis was still the leading cause in this group. These data will be compared with other studies of similar populations. Factors influencing frequency of subtypes of uveitis and bias of this study will be discussed.

Adolescent↗
PubMed1976

Traumatic rupture of healed cataract wounds.

Three patients suffered blunt trauma that caused rupture of the site of cataract incision three to 12 years after surgery. Epithelial cells were noted in the old cataract would of a 79-year-old white man. The second patient, a 25-year-old black women, had bilateral ocular toxoplasmosis and loss of vitreous humor at the time of lens extraction. The third patient, a 63-year-old white woman, had open-angle glaucoma treated previously with filtering procedures and cyclocryotherapy. The ultimate outcome was poor in each case.

Adult↗
PubMed2006

Rubella virus is associated with fuchs heterochromic iridocyclitis.

PURPOSE: To determine whether rubella virus (RV) is involved in the pathogenesis of Fuchs heterochromic iridocyclitis (FHI). DESIGN: Retrospective patient-controlled study. METHODS: Intraocular immunoglobulin G production against RV, herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii was determined in the aqueous humor of 14 patients with FHI, 13 control subjects with herpetic uveitis anterior, and 19 control subjects with ocular toxoplasmosis by calculation of the Goldmann-Witmer coefficient (GWC). RESULTS: All patients and control subjects were seropositive for RV. Intraocular antibody production (GWC >3) against RV was found in 13 of 14 patients (93%) with FHI. Intraocular antibody production against HSV, VZV, or T gondii was not detected. None of the control subjects with herpetic uveitis anterior or with toxoplasma chorioretinitis had a positive GWC for rubella virus (P < .0001, Fisher exact test). CONCLUSION: Rubella virus, but not HSV, VZV, or T gondii, is associated with FHI.

Adult↗
PubMed2006

Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis.

PURPOSE: To determine the relative contribution of the analysis of intraocular antibody production and the polymerase chain reaction (PCR) in aqueous humor (AH) to the diagnosis of infectious uveitis. DESIGN: Retrospective case-control study. METHODS: Paired AH and serum samples from 230 patients suspected of infectious uveitis were examined for intraocular antibody production against herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii by calculating the Goldmann-Witmer coefficient (GWC). In addition, AH samples were investigated by real-time PCR to determine the presence of microbial DNA. RESULTS: Positive results were obtained in 54 cases (23%): 13 HSV (24%), 16 VZV (30%), and 25 T gondii (46%). Of these, 23 (43%) were positive for both GWC and PCR, 26 (48%) only for GWC, and 5 (9%) only for PCR. With PCR as the sole diagnostic approach, a correct diagnosis of the infectious etiology would have been missed in 34% of cases for the herpes viruses and in 64% for T gondii. Analysis of the relationship between a positive laboratory diagnosis and the time of sampling after onset of ocular disease demonstrated that intraocular antibody production was found throughout the course of the diseases. Viral DNA was more readily detected early in infection. In contrast, T gondii nucleic acid was not detected until 3 weeks after onset of ocular disease. CONCLUSIONS: Analysis of intraocular antibody production contributed considerably to the etiological diagnosis of infectious uveitis, most notably of ocular toxoplasmosis early after onset of disease. Therefore, both PCR and GWC determination might be performed for comprehensive diagnosis of intraocular infections.

Animals↗
PubMed1994

Detection of intraocular antibody production to herpesviruses in acute retinal necrosis syndrome.

In order to improve the determination of the causative agent in acute retinal necrosis syndrome, we evaluated the detection of intraocular antibody production to herpesviruses in 28 patients with this disease. Intraocular antibody production was determined by calculation of the Goldmann-Witmer coefficient whereby specific antibody titers in the inflamed eye and circulation are related to the total IgG content in ocular fluid and serum. Specific antibody titers to herpesviruses and Toxoplasma were determined by the indirect immunofluorescence technique. Thirty-five patients with ocular toxoplasmosis, cataract, or proliferative vitreoretinal disorders were tested as controls. By this technique, intraocular antibody production to varicella zoster virus or herpes simplex virus could be established in 16 (57%) of the patients with the typical clinical features of acute retinal necrosis, compared to none of the controls. Of the 33 affected eyes, 21 (64%) had a visual outcome of less than 20/200. We concluded that detection of intraocular antibody production to herpesviruses may be a useful diagnostic tool in establishing the causative agents in acute retinal necrosis.

Adult↗
PubMed1991

Analysis of local antibody production in the vitreous humor of patients with severe uveitis.

We analyzed the local antibody production in vitreous humor samples collected during vitrectomy in patients with severe vision-threatening uveitis. In 24 patients, paired serum and undiluted vitreous humor samples were collected and tested for antibodies against Toxoplasma gondii, herpes simplex virus, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, and Toxocara canis. Total IgG and the Goldmann-Witmer coefficient were determined. The initial diagnosis of ocular toxoplasmosis could be confirmed in six of the seven patients. The seventh patient showed a local antibody production against herpes simplex virus. One of the three patients with chronic panuveitis at initial diagnosis showed a local antibody production against T. gondii. These last two findings resulted in a change in medical treatment. Analysis of local antibody production in vitreous humor samples is a valuable diagnostic tool.

Animals↗
PubMedDate not supplied

Fuchs' heterochromic cyclitis.

Fuchs' heterochromic cyclitis (FHC) is a chronic anterior segment inflammatory syndrome that accounts for 2 to 3% of all uveitis cases. The etiology is unknown, but Herpes simplex, ocular toxoplasmosis and rubella infection have been implicated in the pathogenesis of the disease. It occurs more commonly in the third and fourth decades of life with an equal gender distribution. Patients are usually asymptomatic but may present with floaters and blurry vision. There is a mild but persistent anterior chamber reaction with diffuse and characteristic white stellate keratic precipitates. Iris and trabecular meshwork show abnormal vessels that may sometimes lead to a hyphema. Synechia formation is uncommon. Heterochromia is considered an important feature and accounts for the name, but it is variable depending on the intensity of the anterior stromal atrophy, initial iris color and amount of pigment in the iris pigmented epithelium. Progression of the disease is associated with cataract formation and glaucoma. Anti-inflammatory treatment is not indicated for the low-grade anterior chamber reaction seen in Fuchs' patients. Occasionally, a short course of corticosteroids is indicated if a symptomatic exacerbation occurs. The long-term prognosis is good, and patients usually maintain a visual acuity of 20/40 or better.

Humans↗
PubMed2000

Infectious causes of uveitis in the developing world.

Infectious causes of uveitis are common in the developing world and include some causes that are rarely encountered in industrialized nations, such as tuberculosis, leptospirosis, leprosy, onchocerciasis, and cystercicosis. Ocular toxoplasmosis occurs in all countries but is more common in Central and South America, the South Pacific, and western Europe. AIDS-related opportunistic infections occur wherever HIV infection is prevalent, including North and South America, western and eastern Europe, the former Soviet Union, sub-Saharan Africa, and South and Southeast Asia. Physicians who care for patients in the developing world should consider these infectious possibilities whenever their patients develop uveitis.

Developing Countries↗
PubMed1986

Bilateral toxoplasma retinochoroiditis in a patient with acquired immune deficiency syndrome.

A 32-year-old patient with acquired immune deficiency syndrome (AIDS) was evaluated for bilateral visual loss accompanied by uveitis, vitritis and retinochoroiditis. Diagnostic vitrectomy was performed on the right eye, and the diagnosis of ocular toxoplasmosis made. Central nervous system involvement was suggested by ring enhancing lesions on CT scan. The patient improved on a pyrimethamine, sulfadiazine and clindamycin, but succumbed to disseminated toxoplasmosis when treatment was discontinued.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Development of an in vitro model of Toxoplasma gondii cyst formation.

Toxoplasma gondii tissue cyst reactivation is a major pathogenic mechanism in ocular toxoplasmosis, disease associated with AIDS and organ transplantation. The mechanisms associated with cyst formation and reactivation have not been elucidated. The complexity of studying these issues in animal models has led to the development of in vitro tissue culture strategies for cyst formation. In the present study we have adopted the human embryonic lung fibroblast (HEL) as the host cell and have compared the cyst forming abilities of eight clinical isolates. We describe by transmission electron microscopy and quantitative light microscopy the development of cysts in vitro. The numbers of in vitro cysts increased with time for all isolates. Cyst cultures were stabilised by manipulation of the free parasite load, an observation not previously recorded. Thus, in this paper we describe a viable model for the analysis of the mechanisms of Toxoplasma cyst development.

Animals↗
PubMed1996

Mechanisms of interferon-induced inhibition of Toxoplasma gondii replication in human retinal pigment epithelial cells.

Inflammation associated with retinochoroiditis is a major complication of ocular toxoplasmosis in infants and immunocompetent individuals. Moreover, Toxoplasma gondii-induced retinal disease causes serious complications in patients with AIDS and transplant patients. The retinal pigment epithelial (RPE) cell is an important regulatory cell within the retina and is one of the cells infected with T. gondii in in vivo. We have developed a human RPE (HRPE) cell in vitro model system to evaluate T. gondii replication and the regulation of this replication by cytokines. T. gondii replication was quantitated by counting the foci of infection (plaque formation) and the numbers of tachyzoites released into the supernatant fluids. Pretreatment of cultures with recombinant human tumor necrosis factor alpha, alpha interferon (IFN-alpha), IFN-beta, or IFN-gamma for 24 h prior to inoculation inhibited T. gondii replication in a dose-dependent manner. Of these cytokines, IFN-gamma was the most potent, and T. gondii replication was completely inhibited at a concentration of 100 U/ml. The anti-toxoplasmotic activity of IFN-gamma was significantly blocked by monoclonal antibody to IFN-gamma. Treatment of the cultures with IFN-gamma from day 1 or 2 postinoculation with T. gondii also offered protection against the parasite. The anti-toxoplasmotic activity of tumor necrosis factor alpha or IFN-alpha, -beta, or -gamma in these cultures was found to be independent of the nitric oxide (NO) pathway, since NO production was not found in HRPE cells treated with these cytokines. However, addition of tryptophan to IFN-gamma-treated cells significantly reversed the inhibitory effects of IFN-gamma, suggesting that IFN-gamma acts by depleting cellular tryptophan. This effect was further confirmed by reverse transcription-PCR and Northern (RNA) blot analysis, which indicated induction of indoleamine 2,3-dioxygenase (IDO), an enzyme that converts tryptophan to kynurenine. These results indicated that interferons inhibited T. gondii replication in HRPE by NO-independent but IDO-dependent mechanisms. This in vitro model of T. gondii replication in HRPE may be useful in evaluating the effects of cytokines and drugs on T. gondii replication within the retina.

Animals↗
PubMed1996

Causes and frequency of blindness in patients with intraocular inflammatory disease.

AIMS/BACKGROUND: Uveitis, an intraocular inflammatory disease, is a significant cause of visual impairment. It is not known how many patients with uveitis will retain visual acuity and how many develop visual impairment or even blindness. The aim of this study was to assess the frequency of blindness in patients with uveitis and, more specifically, to identify the clinical profile of patients at risk for visual loss. METHODS: A cross sectional and retrospective study of 582 patients with uveitis who visited the ophthalmology departments of two university hospitals in the Netherlands was performed. RESULTS: Within the group of 582 patients, 203 (35%) exhibited blindness or visual impairment; bilateral legal blindness developed in 22 (4%) patients, 26 (4.5%) had one blind eye with visual impairment of the other, and nine (1.5%) had bilateral visual impairment. Unilateral blindness developed in 82 (14%) patients, whereas 64 (11%) exhibited unilateral visual impairment. The most important cause of both blindness and visual impairment was cystoid macular oedema (29% and 41%, respectively). Complications of uveitis were encountered in more than half of the patients and 23% underwent one or more surgical procedures. When the patients were subdivided according to anatomical site, those with panuveitis had the worst visual prognosis. The systemic diseases associated with a poor visual prognosis were juvenile chronic arthritis and sarcoidosis. Ocular toxoplasmosis was the most frequent cause of unilateral visual loss. CONCLUSIONS: Cystoid macular oedema is the most frequent complication of uveitis and its occurrence plays a decisive role in the visual outcome of this disease.

Arthritis, Juvenile↗
PubMed2000

Soluble Fas ligand and soluble Fas in ocular fluid of patients with uveitis.

AIMS: To investigate the presence of soluble Fas ligand (sFasL) and soluble Fas (sFas) in ocular fluid of patients with uveitis. METHODS: Samples of aqueous humour (AH, n=17), vitreous fluid (n=9), and serum (n=60) were collected from patients with uveitis which included Behçet's disease, Vogt-Koyanagi-Harada disease, sarcoidosis, human T lymphotropic virus type 1 (HTLV-I) uveitis, sympathetic ophthalmia, HLA-B27 associated acute anterior uveitis, and ocular toxoplasmosis. The AH of patients with age related cataract without uveitis obtained during cataract surgery was used as controls (n=20). The amounts of sFasL and sFas were measured by enzyme linked immunosorbent assay. RESULTS: Significant amounts of sFasL were detected in AH of patients with age related cataract (non-uveitis group). sFasL was also detected in AH of patients with uveitis, though the amounts were slightly lower than those in the non-uveitis group. On the other hand, the levels of sFas in AH of patients with uveitis were significantly higher than those in controls. As for the disease activity, the levels of sFasL and sFas in the vitreous fluid of patients with active uveitis were significantly higher than those in inactive uveitis. sFasL in the serum of healthy donors and patients with uveitis was below detectable levels, except for patients with HTLV-I uveitis who had significant amounts of sFasL in the serum. The levels of sFas in the serum of patients with Behçet's disease, sarcoidosis, and HTLV-I uveitis were significantly higher than those of healthy donors. CONCLUSIONS: sFasL is present in the AH of non-uveitic eyes with age related cataract. Intraocular levels of sFasL and sFas are significantly increased in uveitis, particularly in active uveitis. These data suggest that intraocular sFasL and sFas may have a regulatory role in uveitis.

Adult↗
PubMed1986

Focal chorioretinal atrophic lesions in patients treated with hemodialysis.

Five patients treated with hemodialysis had focal chorioretinal atrophic lesions. These lesions had not been noted before the hemodialysis treatment. Although the lesions resembled those of ocular toxoplasmosis and histoplasmosis, serum titers and skin reactions for those organisms were negative or within the normal range. Focal retinochoroidal lesions in patients receiving hemodialysis may indicate a possible sign of infection.

Adult↗
PubMed1990

Uveitis in northern Portugal.

During the past four years 450 patients (247 female - mean age 36 years and 203 male - mean age 34 years) with intraocular inflammation were evaluated using standard diagnostic criteria, to establish a uveitis survey profile. Patients were divided into four anatomic groups: anterior uveitis (270 cases = 60%), posterior uveitis (108 cases = 24%), panuveitis (54 cases = 12%) and intermediate uveitis (18 cases = 4%). A probable aetiological diagnosis was made in 232 cases (51.5%). Rheumatic diseases were diagnosed most commonly (55 cases = 12.2%), mainly ankylosing spondylitis, as is true for other European countries. Ocular toxoplasmosis was a frequent cause of uveitis, as in Brazil and West Africa, thus requiring a prompt diagnosis and treatment. Behçet's syndrome was associated with HLA B5 (65%) as in Japanese and Mediterranean populations. In our area AIDS retinitis is becoming an important differential diagnosis.

Adolescent↗
PubMed1996

[Retinal manifestations of AIDS].

Cytomegalovirus (CMV) retinitis is the most common retinal opportunistic infection in AIDS patients and is the main cause of blindness. It is generally associated with a CD4+ lymphocyte count below 50/microL. CMV retinitis is often asymptomatic (54% of the cases), frequent ophtalmoscopic screening is very important. Two virostatic drugs (Cymevan and Foscavir) have been approved for the treatment of CMV retinitis. Both are effective in preventing the progression of the lesion within 3 weeks of induction therapy. Long-term use of virostatic maintenance therapy delays the onset of relapses. The differential diagnosis of CMV retinitis are: human immunodeficiency virus retinopathy, varicella-zoster virus retinitis, ocular toxoplasmosis, syphilis, candida endophthalmitis in intravenous drug users, and unfrequently, tuberculosis, choroidal pneumocystosis, intraocular lymphoma.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Ophthalmologic manifestations observed in a pediatric HIV-seropositive population].

PURPOSE: HIV positive children underwent ophthalmologic examination to evaluate prospectively the incidence, and type of ocular involvement in pediatric AIDS. METHOD: Two ophthalmologists examined the children during their pediatric examination, for two years. When possible, a retinography was performed. RESULTS: Among the 33 HIV positive children, 23 children developed AIDS according to CDC classification. The incidence was lower than reported in adult series. Retinal manifestations could be divided into two groups: 1. veinous dilatation and perivasculitis; 2. retinal opportunistic infections: Ocular Toxoplasmosis was the main finding. In addition we report one case of herpetic keratitis. Annexial complications were represented by conjonctivitis and molluscum contagiosum. CONCLUSION: Manifestations of HIV infection in children appears to be different from adults. We recommend ophthalmic screening in all AIDS pediatric patients to diagnose and treat the infectious complications.

AIDS-Related Opportunistic Infections↗