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Amin RH, Abdullatif AM. Management of presumed trematode-induced granulomatous intermediate uveitis. Eye (Lond) 2023; 37:2299-2304. [PMID: 36477731 PMCID: PMC10366116 DOI: 10.1038/s41433-022-02336-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/16/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To describe the surgical management of presumed trematode-induced granulomatous intermediate uveitis (PTIGIU) not responding to medical treatment in controlling the inflammation. METHODS A prospective, interventional, single-center study in which patients with a history of fresh canal water contact and PTIGIU were enrolled. All patients underwent lensectomy-pars plana vitrectomy (PPV) and post-operative control of inflammation, functional and anatomical outcomes were assessed. RESULTS Fifteen eyes of 12 patients were included in the study with median age of 11.6 ± 4 yrs. Six months following lensectomy-PPV, inflammation was well controlled in all patients. The eyes were divided into two groups: Group A: 10 patients with an attached retina while Group B: 5 patients who were in the cicatricial stage with tractional retinal detachment. All patients in group A had CDVA of 20/40 or better, unlike patients in group B who failed to achieve a CDVA better than 20/70 throughout their follow-up. In group B, final anatomical success was achieved in only 40% with hypotony occurring in 20%. CONCLUSION PTIGIU is associated with the presence of ciliary body granuloma which, if left untreated, can lead to drastic outcomes. Early lensectomy-PPV represents a viable management option in cases resistant to medical treatment, with a favorable outcome.
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El Hefny E, Sabry D, Sewelam A, El Nokrashy A. Characteristics of Childhood Presumed Trematode-Induced Granulomatous Anterior Uveitis Using Ultrasound Biomicroscopy. Ocul Immunol Inflamm 2022; 30:1604-1608. [PMID: 34014799 DOI: 10.1080/09273948.2021.1922709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the UBM characteristics of presumed trematode-induced granulomatous uveitis. DESIGN Prospective case series. METHODS Thirty patients who presented with anterior chamber (AC) granuloma were included. UBM Imaging included Cornea, iris, AC angle, posterior chamber, ciliary body, and vitreous base. RESULTS Thirty eyes were included with a mean age of 12.4 ± 2.5 years. UBM findings were retrocrneal membrane (33%), sub conjunctival nodule (10%), AC granuloma (100%); peripheral anterior synechia, granuloma-like lesion in posterior chamber; ciliary body edema with localized granuloma at specific site (100%), cataract in 30% either localized or generalized, and dot or thread-like high reflection on vitreous base in (20%). CONCLUSION Presumed trematode-induced AC granuloma is common among children living in the rural areas of Egypt. UBM examinations can demonstrate various pathologic changes of anterior segment of the eye and provide objective evidence for the exact origin of those granulomas.
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Affiliation(s)
- Eman El Hefny
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dalia Sabry
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf Sewelam
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amgad El Nokrashy
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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3
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Li J, Drechsler J, Lin A, Widlus M, Qureshi A, Stoleru G, Saeedi O, Levin MR, Kaleem M, Jaafar M, Madigan WP, Alexander JL. Repeatability and Reliability of Quantified Ultrasound Biomicroscopy Image Analysis of the Ciliary Body at the Pars Plicata. Ultrasound Med Biol 2021; 47:1949-1956. [PMID: 33858721 PMCID: PMC8169634 DOI: 10.1016/j.ultrasmedbio.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
Most of the ciliary body and ciliary processes of the eye cannot be directly visualized in vivo because of the posterior location of the pars plicata to the posterior chamber and iris. However, ciliary anatomy can be effectively imaged using ultrasound biomicroscopy (UBM) by placing the probe close to the limbus, perpendicular to this structure. Previous studies measuring ciliary body parameters in meridian UBM images found that these parameters were measured with poor reliability and repeatability. This study evaluates the intra-observer reliability and inter-observer agreement of a standardized protocol for measuring six ciliary parameters in transverse or quadrant UBM images that capture an entire row of ciliary processes. All six ciliary parameters have high intra-observer reliability, with ciliary body thickness, ciliary process length and ciliary process density measurements being the most consistent for each observer. The coefficient of variation for each observer ranged from 1.4%-15%. Inter-observer agreement was also high for all six parameters, with an intra-class correlation coefficient >0.8. Utilizing transverse UBM images of the pars plicata allows for consistent quantitative analysis in control subjects.
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Affiliation(s)
- Joy Li
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Drechsler
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anna Lin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Widlus
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Azam Qureshi
- Department of Dermatology, George Washington School of Medicine & Health Sciences, Washington, DC, USA
| | - Gianna Stoleru
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Roni Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mona Kaleem
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Jaafar
- Department of Ophthalmology, Children's National Hospital, Washington, DC, USA
| | - William P Madigan
- Department of Ophthalmology, Children's National Hospital, Washington, DC, USA
| | - Janet Leath Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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4
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Tereshchenko AV, Erokhina EV, Volodin DP. Ultrasound biomicroscopy in ophthalmology. Ophthalm J 2021; 14:63-73. [DOI: 10.17816/ov41999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This review presents data on the use of the method of ultrasonic biomicroscopy (UBM) of the anterior segment of the eye in ophthalmological practice in adults and children. Ultrasound biomicroscopy (UBM) is a contact non-invasive method for visualizing structures of the anterior segment of the eye using high-frequency ultrasound in the range from 35 to 100 MHz. Literature data indicate that UBM can be used to visualize almost all structures of the anterior segment, including the cornea, iridocorneal angle, anterior chamber, iris, ciliary body and lens, as well as the peripheral parts of the retina, vasculature and vitreous. There is data on the use of this method in the study of pathogenetic aspects of glaucoma, pseudoecfoliative syndrome, various types of cataracts, post-traumatic injuries of the anterior segment of the eye, meimobium gland dysfunction and other ophthalmopathologies. The use of UBM in children, due to the peculiarities of its implementation, is not widespread, but due to the specificity of the data obtained using it, it is promising. The limited information about the use of UBM in retinopathy of prematurity and the diagnostic capabilities of the method makes its use especially relevant in this severe retinal disease of premature newborns.
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5
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Wintergerst MWM, Liu X, Terheyden JH, Pohlmann D, Li JQ, Montesano G, Ometto G, Holz FG, Crabb DP, Pleyer U, Heinz C, Denniston AK, Finger RP. Structural Endpoints and Outcome Measures in Uveitis. Ophthalmologica 2021; 244:465-479. [PMID: 34062542 DOI: 10.1159/000517521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
Most uveitis entities are rare diseases but, taken together, are responsible for 5-10% of worldwide visual impairment which largely affects persons of working age. As with many rare diseases, there is a lack of high-level evidence regarding its clinical management, partly due to a dearth of reliable and objective quantitative endpoints for clinical trials. This review provides an overview of available structural outcome measures for uveitis disease activity and damage in an anatomical order from the anterior to the posterior segment of the eye. While there is a multitude of available structural outcome measures, not all might qualify as endpoints for clinical uveitis trials, and thorough testing of applicability is warranted. Furthermore, a consensus on endpoint definition, standardization, and "core outcomes" is required. As stipulated by regulatory agencies, endpoints should be precisely defined, clinically important, internally consistent, reliable, responsive to treatment, and relevant for the respective subtype of uveitis. Out of all modalities used for assessment of the reviewed structural outcome measures, optical coherence tomography, color fundus photography, fundus autofluorescence, and fluorescein/indocyanine green angiography represent current "core modalities" for reliable and objective quantification of uveitis outcome measures, based on their practical availability and the evidence provided so far.
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Affiliation(s)
| | - Xiaoxuan Liu
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Dominika Pohlmann
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jeany Q Li
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Giovanni Montesano
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Giovanni Ometto
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Uwe Pleyer
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Diala FGI, McCarthy K, Chen JL, Tsui E. Multimodal imaging in pediatric uveitis. Ther Adv Ophthalmol 2021; 13:25158414211059244. [PMID: 34901748 PMCID: PMC8655435 DOI: 10.1177/25158414211059244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Pediatric uveitis accounts for up to 10% of all uveitis cases, so special attention must be paid to ensure early diagnosis as well as treatment and follow-up of these young patients in order to decrease the risk of possible ocular complications and consequently vision loss. Multimodal imaging has been an effective and important adjunct in the diagnoses and management of uveitis, especially in children. Reviewed here are the currently utilized modalities, advances, as well as their applications in juvenile idiopathic arthritis-associated uveitis, pars planitis, retinal vasculitis, tubulointerstitial nephritis and uveitis syndrome, Behçet disease, Blau syndrome, and Vogt-Koyanagi-Harada syndrome.
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Affiliation(s)
- Fitz Gerald I. Diala
- UCLA Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kayne McCarthy
- John A. Burns School of Medicine, University of Hawai’i at Ma¯noa, Honolulu, HI, USA
| | - Judy L. Chen
- UCLA Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Edmund Tsui
- UCLA Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, 200 Stein Plaza, Los Angeles, CA 90095-7003, USA
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Mahendradas P, Sridharan A, Kawali A, Sanjay S, Venkatesh R. Role of Ocular Imaging in Diagnosis and Determining Response to Therapeutic Interventions in Posterior and Panuveitis. Asia Pac J Ophthalmol (Phila) 2021; 10:74-86. [PMID: 33512829 DOI: 10.1097/apo.0000000000000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT This review provides a comprehensive description and careful interpretation of various ocular imaging techniques to visualize the different ocular structures in posterior and panuveitis. This can help in the diagnosis, follow-up, and monitoring the response to treatment in patients with different posterior and panuveitic entities.
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Affiliation(s)
| | - Akhila Sridharan
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramesh Venkatesh
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
- Department of Vitreoretinal Services, Narayana Nethralaya, Bangalore, India
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8
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Concha Del Río LE, Duarte González GA, Mayorquín Ruiz M, Arellanes-García L. Characterization of cyclitic membranes by ultrabiomicroscopy in patients with pars planitis. J Ophthalmic Inflamm Infect 2020; 10:7. [PMID: 31997032 PMCID: PMC6989698 DOI: 10.1186/s12348-020-0194-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background In previous studies, authors use ultrasound biomicroscopy (UBM) to analyze the characteristics of cyclitic membranes and the associated complications in patients with pars planitis. However, there are no reports regarding the prevalence of cyclitic membranes or complications at diagnosis and during follow-up. Purpose To describe the characteristics and complications of cyclitic membranes, as determined by UBM in patients with pars planitis using AVISO-S™ (Quantel Medical) equipment with a 50-MHz linear probe with a focus at the pars plana. Design This retrospective study reviewed UBM images of patients diagnosed with pars planitis, from the Inflammatory Eye Disease Clinic in Mexico City from January 2010 to June 2016. Results Cyclitic membranes were observed in the first UBM image in 67 eyes (56.7%) and during follow-up in 81 eyes (68.62%). In 67 eyes (82.71%), the cyclitic membranes extended through one or two quadrants. Extension toward the posterior lens capsule was recognized in 15 eyes (18.52%) and extension toward the peripheral retina in 12 eyes (14.81%). Complications included ciliary body detachments in 10 eyes (12.35%) and peripheral retinal traction in 8 eyes (9.88%). Conclusions UBM is a valuable tool for the diagnosis of cyclitic membranes at admittance and during follow-up of patients with pars planitis; it helps the clinician to detect this complication early.
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Affiliation(s)
- Luz Elena Concha Del Río
- Inflammatory Eye Diseases Clinic, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera en México (APEC), Vicente García Torres 46, Col. Barrio San Lucas, Coyoacán, Mexico City, Mexico.
| | - Gonzalo Alejandro Duarte González
- Inflammatory Eye Diseases Clinic, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera en México (APEC), Vicente García Torres 46, Col. Barrio San Lucas, Coyoacán, Mexico City, Mexico
| | - Mariana Mayorquín Ruiz
- Ultrasound Service, Hospital Dr. Luis Sánchez Bulnes. Asociación para Evitar la Ceguera en México (APEC), Vicente García Torres 46, Col. Barrio San Lucas, Coyoacán, Mexico City, Mexico
| | - Lourdes Arellanes-García
- Inflammatory Eye Diseases Clinic, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera en México (APEC), Vicente García Torres 46, Col. Barrio San Lucas, Coyoacán, Mexico City, Mexico
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Abstract
Ocular hypotony is an infrequent, yet potentially vision-threatening, entity. The list of differential causes is extensive, involving any condition that may compromise aqueous humor dynamics or the integrity of the globe and sometimes following medical treatments or procedures. Depending on the cause and the clinical impact, treatment options aim to correct the underlying pathology and to reestablish anatomical integrity, as well as visual function. We review the pathophysiology, clinical presentation, different causes, and associated therapeutic options of ocular hypotony.
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Affiliation(s)
- Qianqian Wang
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, University of Montreal Hospital Center, Montreal Quebec, Canada
| | - Avrey Thau
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alex V Levin
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Lee
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Abstract
Purpose To describe the morphologic alterations in ultrasound biomicroscopy (UBM) present in peripheral vitreoretinal toxocariasis. METHODS An observational prospective study of case series. Fifteen eyes of 15 patients with clinical and laboratory diagnosis of peripheral vitreoretinal toxocariasis were enrolled. The patients were submitted to UBM examination of the region corresponding to the pars plana of the affected eye. Results The most common morphologic alterations found by UBM in patients with peripheral vitreoretinal toxocariasis were as follows: vitreal membranes (13 cases), toxocara granuloma (11 cases), and pseudocysts (8 cases). Other less frequent findings were thickening of the ciliary body (6 cases), cystic formation (2 cases), peripheral retinal detachment (2 cases), rectification of the iris root (1 case), and posterior synechiae (1 case). CONCLUSIONS UBM allows detection of well-defined morphologic alterations associated with peripheral vitreoretinal toxocariasis, being useful to reinforce the clinical diagnosis
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Affiliation(s)
- W Cella
- Retina Service, Department of Ophthalmology, State University of Campinas-UNICAMP, Campinas, Brazil.
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Abstract
The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.
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Affiliation(s)
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore 168751, Singapore
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Chen Q, Gu J, Jiang R, Zhou M, Chang Q. Role of ultrasound biomicroscopy in diagnosis of ocular toxocariasis. Br J Ophthalmol 2017; 102:642-646. [DOI: 10.1136/bjophthalmol-2017-310583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/27/2017] [Accepted: 08/13/2017] [Indexed: 11/03/2022]
Abstract
PurposeTo investigate ultrasound biomicroscopy (UBM) characteristics of patients with ocular toxocariasis (OT) and to explore the role of UBM in the diagnosis and differential diagnosis of OT.DesignCross-sectional study.Methods78 eyes of 77 patients clinically consistent with OT and confirmed by serum and/or intraocular antibodies in a single tertiary centre (Fudan University Eye and ENT Hospital, Shanghai) between July 2009 and July 2016 were included in the study. UBM was performed, and the outcomes were analysed.ResultsMean age of the patients included was 12.8±10.3 years. Positive UBM findings were observed in 72 of 78 eyes (92.3%). The primary imaging feature was peripheral granulomas (66 eyes; 84.6%), of which 78.5% were adjacent to the nasal or temporal side of horizontal meridian and 79.7% located on the surface of the ciliary body, presenting as olivary foci on radical section and botuliform foci on coronal section. Moreover, 12 of the peripherally involved eyes were accompanied with posterior pole granulomas, which could be termed ‘combined type’. Other UBM findings included vitreous strands (53 eyes; 67.9%), peripheral tractional retinal detachment (41 eyes; 52.6%) and tractional cyclodialysis (32 eyes; 41.0%).ConclusionsThe utilisation of UBM verifies the existence of the combined subtype (with both peripheral and posterior pole granulomas) and improves the detection rate of peripheral granulomas, which is of great importance to the diagnosis and differential diagnosis of OT.
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Affiliation(s)
- Jay Siak
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore
- Ocular Inflammation and Immunology Research Group, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Soon-Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore
- Ocular Inflammation and Immunology Research Group, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Zur D, Neudorfer M, Shulman S, Rosenblatt A, Habot-Wilner Z. High-resolution ultrasound biomicroscopy as an adjunctive diagnostic tool for anterior scleral inflammatory disease. Acta Ophthalmol 2016; 94:e384-9. [PMID: 26892270 DOI: 10.1111/aos.12995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/24/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To study high-resolution ultrasound biomicroscopy (UBM) findings in anterior scleral inflammatory disease and evaluate the efficacy of high-resolution UBM as an adjunctive diagnostic tool. METHODS A cross-sectional study. The medical records of 30 patients (33 eyes) with episcleritis or anterior scleritis were reviewed for clinical features and high-resolution UBM findings. Ultrasound biomicroscopy (UBM) examination was performed using 50 MHz Aviso S (Quantel Medical, Clermont-Ferrand, France). RESULTS Seventeen eyes had episcleritis [nodular (12), simple (five)], and 16 eyes had anterior scleritis [nodular (14), diffuse (two)] as classified by UBM. The use of high-resolution UBM allowed high-resolution imaging of the sclera and episclera and showed characteristic patterns of episcleritis and anterior scleritis. The clinical classification matched UBM findings in 25 (76%) eyes. In the other eight eyes (24%), UBM analysis led to a change in the final classification: four eyes with suspected episcleritis were classified with scleritis, and four eyes with suspected scleritis were classified with episcleritis. Eleven patients (36.7%) had an associated systemic disease. CONCLUSION High-resolution UBM enabled visualization of distinct imaging findings of episcleritis and anterior scleritis, indicating its usefulness in the classification of challenging cases of anterior scleral inflammatory disease.
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Affiliation(s)
- Dinah Zur
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Meira Neudorfer
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shiri Shulman
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Amir Rosenblatt
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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15
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Zeghidi H, Saadoun D, Bodaghi B. Les manifestations oculaires de la maladie de Behçet. Rev Med Interne 2014; 35:97-102. [DOI: 10.1016/j.revmed.2013.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 01/01/2023]
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17
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18
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Abstract
Ancillary investigations are the backbone of uveitis work-up both for anterior and posterior segment diseases. They help in making the diagnosis, ruling out certain differential diagnosis and monitoring inflammation during the follow-up. This review aims to be an overview describing the role of commonly used investigations for uveitis.
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Affiliation(s)
- Vishali Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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19
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Agrawal R, Murthy S, Ganesh SK, Phaik CS, Sangwan V, Biswas J. Cataract surgery in uveitis. Int J Inflam 2012; 2012:548453. [PMID: 22518338 DOI: 10.1155/2012/548453] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/28/2011] [Indexed: 11/17/2022] Open
Abstract
Cataract surgery in uveitic eyes is often challenging and can result in intraoperative and postoperative complications. Most uveitic patients enjoy good vision despite potentially sight-threatening complications, including cataract development. In those patients who develop cataracts, successful surgery stems from educated patient selection, careful surgical technique, and aggressive preoperative and postoperative control of inflammation. With improved understanding of the disease processes, pre- and perioperative control of inflammation, modern surgical techniques, availability of biocompatible intraocular lens material and design, surgical experience in performing complicated cataract surgeries, and efficient management of postoperative complications have led to much better outcome. Preoperative factors include proper patient selection and counseling and preoperative control of inflammation. Meticulous and careful cataract surgery in uveitic cataract is essential in optimizing the postoperative outcome. Management of postoperative complications, especially inflammation and glaucoma, earlier rather than later, has also contributed to improved outcomes. This manuscript is review of the existing literature and highlights the management pearls in tackling complicated cataract based on medline search of literature and experience of the authors.
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Hooper C, Pavesio C. Investigations in the diagnosis of uveitis. Expert Review of Ophthalmology 2011. [DOI: 10.1586/eop.11.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.
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Affiliation(s)
- Rupesh V Agrawal
- L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Somasheila Murthy
- L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Virender Sangwan
- L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Abstract
PURPOSE To describe the clinical response to cyclitic membrane excision of eyes with juvenile idiopathic arthritis (JIA)-associated uveitis and hypotony. METHODS The clinical records of patients with JIA-associated uveitis in a tertiary referral center were reviewed. Those patients with JIA-associated uveitis and hypotony who underwent cyclitic membrane excision were included in the study. Patients with hypotony secondary to active inflammation, retinal detachment, and surgical intervention (filtering, cyclo-destructive procedures, and glaucoma valve implantation) were excluded. RESULTS Two pediatric and two adult patients (4 eyes) were identified. The range of pre-operative intraocular pressure (IOP) was 0-5 mmHg. The two adult patients were noted to have atrophic ciliary processes intra-operatively, while the two pediatric patients had normal ciliary processes. At six months follow-up, the adult patients had IOPs of 5 mmHg, while the two pediatric patients had IOPs of 16 mmHg. At last consultation (mean duration of follow-up: 3.6 years), IOP was normal in all eyes. None of the eyes had a decrease in vision. CONCLUSIONS Release of traction on the ciliary body by inflammatory membranes may play a role in the management of hypotony in patients with JIA-associated uveitis. However, even though the IOP was successfully elevated, preventing phthisis, vision remained poor due to the long-standing complications secondary to chronic uveitis. This emphasizes the critical importance of early diagnosis and appropriate treatment of the inflammation before vision-robbing complications occur.
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Affiliation(s)
- Ellen N Yu
- Massachusetts Eye Research & Surgery Institute, Ocular Immunology and Uveitis Foundation, Harvard Medical School, Cambridge, MA 02142, USA
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Abstract
PURPOSE To report outcome of pars plana vitrectomy in patients with chronic hypotony due to uveitis. METHODS Assessment of ciliary body was done preoperatively by ultrasound biomicroscopy and intraoperatively by direct visualization. Surgical procedure included pars plana or limbal lensectomy and vitrectomy with removal of ciliary membranes and traction. Silicone oil tamponade was used in selected eyes. Postoperatively subtenon triamcinolone acetonide was given if intraocular pressure (IOP) remained low. RESULTS Fifteen eyes of nine patients, all woman at mean age of 15.66 +/- 12.57 (4-40) years, were included. In 7 eyes with intact ciliary processes, mean pre- and postoperative IOP was 4.00 +/- 1.6 mmHg and 9.1 +/- 4.1 mmHg, respectively. In 4 eyes with ciliary atrophy that did not receive silicone oil tamponade, mean pre- and postoperative IOP was 4.25 +/- 1.7 and 3.75 +/- 0.9 mmHg, respectively. In 4 eyes with ciliary atrophy that received silicone oil tamponade mean pre- and postoperative IOP was 3.75 +/- 1.7 and 11.5 +/- 2.3 mmHg, respectively. Mean follow-up was 19.9 +/- 14.9 (8-56) months. Postoperative mean logMAR visual acuity improved significantly (P < 0.001) from 2.29 +/- 0.67 to 1.01 +/- 0.89. CONCLUSION In eyes with normal ciliary processes, removal of ciliary membranes alone was sufficient to restore IOP. However, if ciliary atrophy was present, IOP was restored only in those eyes that received silicone oil tamponade.
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Peizeng Y, Qianli M, Xiangkun H, Hongyan Z, Li W, Kijlstra A. Longitudinal study of anterior segment inflammation by ultrasound biomicroscopy in patients with acute anterior uveitis. Acta Ophthalmol 2009; 87:211-5. [PMID: 18811638 DOI: 10.1111/j.1755-3768.2008.01194.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate dynamic changes in the anterior segment in patients with acute anterior uveitis (AAU) using ultrasound biomicroscopy (UBM). METHODS Acute anterior uveitis was diagnosed in 18 patients according to history and ocular examinations. Ultrasound biomicroscopy was performed and the results at three time-points (within 2 weeks of the uveitis attack, and at 2-4 weeks and 6 weeks after it) were analysed. The relationships between clinical manifestations and UBM findings were also evaluated. RESULTS All investigated AAU patients showed severe ciliary injection, numerous dust keratic precipitates (KPs), aqueous flare and inflammatory cells, and were treated predominantly with corticosteroid and cycloplegic eyedrops. Ultrasound biomicroscopy showed a large number of cells in the anterior and posterior chamber, marked oedema and exudates in and around the iris and ciliary body within 2 weeks of AAU onset. These abnormalities were dramatically improved at 2-4 weeks and almost resolved at 6 weeks and thereafter. CONCLUSIONS Ultrasound biomicroscopy reveals severe inflammatory changes in and around the ciliary body in patients with AAU. These signs rapidly resolve upon treatment.
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Affiliation(s)
- Yang Peizeng
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Yeh S, Faia LJ, Nussenblatt RB. Advances in the diagnosis and immunotherapy for ocular inflammatory disease. Semin Immunopathol 2008; 30:145-64. [PMID: 18320151 DOI: 10.1007/s00281-008-0109-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 02/04/2008] [Indexed: 02/07/2023]
Abstract
Significant advances in the diagnosis and therapy for uveitis have been made to improve the quality of care for patients with ocular inflammatory diseases. While traditional ophthalmic examination techniques, fluorescein angiography, and optical coherence tomography continue to play a major role in the evaluation of patients with uveitis, the advent of spectral domain optical coherence tomography and fundus autofluorescence into clinical practice provides additional information about disease processes. Polymerase chain reaction and cytokine diagnostics have also continued to play a greater role in the evaluation of patients with inflammatory diseases. The biologic agents, a group of medications that targets cytokines and other soluble mediators of inflammation, have demonstrated promise in targeted immunotherapy for specific uveitic entities. Their ophthalmic indications have continued to expand, improving the therapeutic armentarium of uveitis specialists.
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Mantovani A, Resta A, Herbort CP, Abu El Asrar A, Kawaguchi T, Mochizuki M, Okada AA, Rao NA. Work-up, diagnosis and management of acute Vogt-Koyanagi-Harada disease: a case of acute myopization with granulomatous uveitis. Int Ophthalmol 2007; 27:105-15. [PMID: 17484019 DOI: 10.1007/s10792-007-9052-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE In its typical form and when seen at onset, Vogt-Koyanagi-Harada (VKH) is characterized by easily recognizable signs that allow diagnosis without difficulty. In cases that do not have acute onset, that are seen at a later stage or that do not show the complete set of signs, appraisal is more difficult and diagnosis may cause difficulties. We present here a case of bilateral granulomatous uveitis compatible with VKH disease in order to allow several experts to give their opinion on the most appropriate manner to confirm or reject the diagnosis and their approach to the management of the case. CASE PRESENTATION A 17-year-old female patient consulted her ophthalmologist for blurred vision OU following an episode of a flu-like disease with malaise, fever and headaches. A bilateral anterior granulomatous uveitis with a right papillitis was diagnosed and the patient presented with a bilateral acute myopization. Fluorescein angiography showed right disc hyperfluorescence with late leakage and slight left disc hyperfluorescence. The patient was given a course of one week of peroral corticosteroid therapy followed by an intramuscular injection of Bentelan twice weekly. In the absence of significant improvement the patient was sent six weeks later to a specialized center where a complete work-up was performed. EXPERT OPINION The diagnostic work-up, investigational tests, and differential diagnosis to confirm or reject the diagnosis of VKH as well as the management of the case will be described by the experts.
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Doro D, Manfrè A, Deligianni V, Secchi AG. Combined 50- and 20-MHz frequency ultrasound imaging in intermediate uveitis. Am J Ophthalmol 2006; 141:953-5. [PMID: 16678517 DOI: 10.1016/j.ajo.2005.11.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the information provided by multifrequency ultrasound examination in patients with intermediate uveitis. DESIGN Prospective observational case series. METHOD High-resolution ultrasonography with 50- and 20-MHz frequency immersion probes was performed in seven eyes of five young patients with clinical diagnosis of intermediate uveitis. RESULTS Exudative material over the inferior pars plana and peripheral retina (snowbank) was found in all eyes with 50- and 20-MHz probe, although resolution of the latter was poorer. The 50-MHz imaging was superior for visualization of angle structures and details of pars planitis; the anterior vitreous involvement and cyclitic bands were better shown with the 20-MHz probe, which could also evidence cystoid macular edema. CONCLUSIONS Ultrasound examination with both 50- and 20-MHz frequency probes can detect the typical snowbank in intermediate uveitis and be useful in eyes with small pupil, dense vitreitis, or both, especially before pars plana vitrectomy or cataract surgery.
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Affiliation(s)
- Daniele Doro
- Department of Neurosciences-Ophthalmology, University of Padua, Via Giustiniani 2, Padua 35128, Italy.
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Affiliation(s)
- Luciana Peixoto Finamor
- Vision Institute, Federal University of São Paulo, Rua Botucatu 824, São Paulo, Brazil 04023062
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Abstract
PURPOSE OF REVIEW The goal of this review is to describe the more commonly used imaging techniques and their use to identify causes of vision loss, extent of disease, and distinctive patterns associated with various causes of posterior uveitis. RECENT FINDINGS Distinctive patterns seen with new imaging techniques and applications are being described. Ophthalmic CT, fluorescein angiography, indocyanine green angiography, and others are demonstrating inflammation and pathology in posterior uveitis. As our experience grows with these modalities, they are being used increasingly in the diagnosis and management of patients with posterior uveitis. SUMMARY This review familiarizes the ophthalmologist with imaging in patients with inflammatory disorders of the retina and choroid. These modalities can help with the diagnosis, treatment, and monitoring of patients with uveitis.
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Affiliation(s)
- Antonio P Ciardella
- Department of Ophthalmology, Denver Health Medical Center, Denver, Colorado 80204, USA.
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Greiner KH, Kilmartin DJ, Forrester JV, Atta HR. Grading of pars planitis by ultrasound biomicroscopy--echographic and clinical study. Eur J Ultrasound 2002; 15:139-44. [PMID: 12423740 DOI: 10.1016/s0929-8266(02)00035-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the value of high frequency ultrasound biomicroscopy (UBM) in the assessment of pars planitis, and in particular to correlate UBM findings and ophthalmoscopy findings. METHODS All patients with pars planitis were identified from the uveitis database of the Department of Ophthalmology, University of Aberdeen. Fifteen consecutive patients (age 14-52 years) underwent complete ophthalmological examination. UBM was performed at a sound frequency of 50 MHz on 17 eyes of 10 patients to determine the extent of disease. UBM findings were evaluated by two investigators in a blinded fashion and graded from 0 to 3 according to the following grading criteria: 0=no cells, 1=mild cells, 2=marked cells, 3=organization of cells. Opthalmoscopy findings were also graded using the same criteria. UBM and ophthalmoscopy findings were independently graded and compared. RESULTS We found a good inter-observer correlation for the UBM grading of pars planitis (rho=0.86). There was no significant difference in the grading of pars planitis by indirect ophthalmoscopy as compared to grading by UBM (P>0.05). CONCLUSION UBM appears to be a valuable and reliable diagnostic technique for the evaluation of patients with pars planitis and may be useful especially in patients with media opacities to diagnose and/or monitor efficacy of treatment.
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Affiliation(s)
- Kathrin H Greiner
- Department of Ophthalmology, Grampian University Hospitals, Foresterhill, AB25 2ZD, Scotland, Aberdeen, UK
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