DOCSLIB.ORG

Subretinal Exudative Deposits in Central Serous Chorioretinopathy 351

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Subretinal Exudative Deposits in Central Serous Chorioretinopathy 351 BritishJournal ofOphthalmology 1993; 77: 349-353 3349 Subretinal exudative deposits in central serous chorioretinopathy Br J Ophthalmol: first published as 10.1136/bjo.77.6.349 on 1 June 1993. Downloaded from Darmakusuma Ie, Lawrence A Yannuzzi, Richard F Spaide, Maurice F Rabb, Norman P Blair, Mark J Daily Abstract ments,' are generally not associated with sub- The presence of subretinal exudation in a retinal exudative deposits. patient with neurosensory detachment of the We evaluated a group of 11 patients with macula frequently suggests the diagnosis of central serous chorioretinopathy who had sub- choroidal neovascularisation. A retrospective retinal exudative deposits for the following chart review of newly diagnosed cases of purposes: firstly, to identify non-pregnant central serous chorioretinopathy revealed 11 women as another subgroup of central serous patients, seven men and four non-pregnant chorioretinopathy patients who develop sub- women, who had plaques of subretinal retinal exudative deposits; secondly, to describe exudate, which presumably were fibrin. the findings and clinical course of these patients Department of Ophthalmology, Each of these patients had a solitary plaque more completely than in previous papers; Manhattan Eye, Ear and that ranged in size from 300 to 1500 tim in thirdly, to define characteristics of subretinal Throat Hospital, New diameter. These patients had no signs or a exudative deposits that differentiate them from York DIe clinical course suggestive of choroidal neo- the typical exudate seen in choroidal neovascu- L A Yannuzzi vascularisation. In each case the subretinal larisation; fourthly, to hypothesise a mechanism R F Spaide plaque was overlying an exuberant leak in the integrating results from previous studies by pigment was Department of retinal epithelium. The exudate which subretinal exudative deposits form. Ophthalmology and generally present at the initial examination, Patients were selected retrospectively from the Visual Sciences, UIC Eye and usually showed dissolution before or files of the contributing authors. Central serous Center, University of coincident with the resolution of the neuro- chorioretinopathy was defined as an idiopathic Illinois at Chicago College ofMedicine and sensory detachment. After resolution of the detachment of the neurosensory retina, associ- Mercy Hospital and central serous chorioretinopathy, patients ated with focal or multifocal leaks at the level of Medical Center, Chicago, were left with subtle alterations in the retinal the retinal epithelium demonstrable on Illinois pigment M F Rabb pigment epithelium in the areas of the sub- fluorescein angiography. The patients had com- retinal plaque. These findings are important plete ophthalmic examinations, fundus colour Laboratory ofRetinal for two reasons. Firstly, the presence of sub- photography, and fluorescein angiography. All Circulation and Metabolism, Department retinal exudation does not necessarily rule out patients were followed at least until the resolu- ofOphthalmology and the diagnosis of central serous chorioretino- tion oftheir primary detachments. http://bjo.bmj.com/ Visual Sciences, UIC Eye pathy. Secondly, pathophysiological theories Center, University of serous must Illinois at Chicago of central chorioretinopathy College of Medicine, explain how the plaques are deposited behind Results Chicago, Illinois the retina. The 11 patients included seven men and four N P Blair (BrJ Ophthalmol 1993; 77: 349-353) women (Table 1). All were newly diagnosed and Department of all were in good health and none of the women Ophthalmology, Loyola were pregnant. The mean age ofthe patients was on September 28, 2021 by guest. Protected copyright. University Medical Neurosensory detachment of the macula can 41 (SD 6) years with a range from 29 to 48 years. School, Maywood, Illinois occur in adults for a variety of reasons; some The mean age of the four women was 40 years, M J Daily conditions require prompt treatment while considerably older than the mean of age of 31 Correspondence to: others can be expected to resolve spontaneously. reported by Gass in his series of pregnant Dr L A Yannuzzi, were Manhattan Eye, Ear and The presence of subretinal exudative deposits patients.' Six were Caucasian, three Asian, Throat Hospital, 210 East 64th may suggest the presence of choroidal neo- and two were Hispanic. Refractive errors were Street, New York, NY 10021, USA. vascularisation. On the other hand, central plano to + 1 00 in all patients following resolu- Accepted for publication serous chorioretinopathy, except in pregnant tion of the macular detachment except for one 26 January 1993 women' or cases ofatypical large bullous detach- patient who was -2-25. None ofthe patients had angioid streaks, peripheral punched out chorio- Table I Patient characteristics retinal atrophic spots, peripapillary atrophy, chorioretinitis, or soft drusen. Agelsexl Initial visual Final visual Presence of Laser In each case there was a neurosensory detach- Patient race* acuity acuity RPEDt treatment ment associated with a solitary, focal, feather- 1 44/WA 20/400 20/70 Yes No edged plaque on the undersurface of the retina 2 35/F/W 20/25 20/25 Yes No 3 43/M/W 20/70 20/200 Yes No (Fig 1). The placoid deposits were generally 4 38/M/W 20/100 20/20 Yes No greyish-white to white, but were occasionally 5 48/F/W 20/25 20/25 Yes No 6 47/M/W 20/60 20/100 Yes Yes cream-coloured. These deposits were trans- 7 29/F/W 20/70 20/20 Yes No lucent to retroillumination. No patient had 8 44/M/H 20/200 20/25 No Yes 9 37/WA 20/200 20/40 Yes Yes haemorrhage or cystoid macular oedema, which 10 40/WA 20/80 20/20 Yes Yes can be signs suggestive of choroidal neovascu- 11 48/F/H 20/200 20/30 Yes Yes larisation. No patient had the bright, yellow *A=Asian; W=Caucasian; H=Hispanic. white deposits under the retina characteristic of tRPED=retinal pigment epithelial detachment. lipid. Confusion initially caused by the greyish- 350 Ie, Yannuzzi, Spaide, Rabb, Blair, Daily Figure 1(A) A 48-year-old woman with a history of reduced vision in the right eye ofseveral days' duration. There is a neurosensory Br J Ophthalmol: first published as 10.1136/bjo.77.6.349 on 1 June 1993. Downloaded from retinal detachment in the temporal macula overlying a yellowish deposit ofexudate. In the inferonasal macula, there is another serous detachment ofthe retinal pigment epithelium. Figure (B) The early venousphasefluorescein angiogram reveals hyperfluorescencefrompooling beneath the serous detachments ofthe retinalpigment epithelium. The superior white appearance of the plaques led to mistaken pigmentepithelialdetachment is associatedwith afocal leak at diagnoses of choroidal neovascularisation, its temporal margin. retinitis, and, in one patient, an infiltrative metastatic process to the choroid. The subretinal exudative deposit was found between the arcades decline to 20/100. The other two patients, one in 10 of the 11 patients; in one patient it was followed for 8 and one for 9 years, demonstrated found nasal to the disc. no recurrences and visual acuity recovery to The exudate varied in size from 300 pm to 20/20. Nopatientintheseriesdevelopedchoroidal 1500 ,um in diameter. The size ofthe exudate did neovascularisation. not seem to correlate with size of the detach- The dissolution of the exudate did not neces- ment. In our cases, the subretinal exudative sarily parallel the course of the macular detach- deposit often had a partial or complete ring ment. It was usually present at the time of appearance where the centre was thinner and diagnosis. In some cases, the exudate dis- more pellucid than the edges. The inferior appeared long before the sensory retinal detach- portion of the exudate was usually thicker than ment resolved. In a few patients, the ring of the superior portion. exudate persisted surrounding a serous pigment On fluorescein angiography the subretinal epithelial detachment for a variable period after exudative deposit was consistently found the resolution ofthe sensory retinal detachment. directly above or adjacent to a robust leak from In others, the disappearance of the exudate the level of the retinal pigment epithelium (Fig coincided with the resolution of the sensory 2). The exudate did not block the underlying retinal detachment. Some patients were left with detach- a subtle discoloration in the area of the fluorescence. A retinal pigment epithelial greyish http://bjo.bmj.com/ ment was found in 10 of the 11 patients, and the subretinal exudative deposit. leak was almost always at or very near the edge of the retinal pigment epithelial detachment. In a few patients the ring of subretinal exudation Discussion encircled the retinal pigment epithelial detach- The subretinal deposition described in this ment like a halo. No patient had evidence of report appears to be a primary manifestation of retinal vascular leakage. central serous chorioretinopathy. Recognised on September 28, 2021 by guest. Protected copyright. A majority of our cases had spontaneous secondary alterations in central serous chorio- resolution of their detachments in 3-6 months. Five patients were treated by laser photocoagula- tion (Fig 3). One author (LAY) followed three patients for more than 7 years. One of these patients experienced chronic and recurrent acute detachments with progressive perifoveal atrophy, cystic macular degeneration, and visual Figure 1(D) A photograph ofthe same patientfollowing 'Figure I1(C) A late venous laserphotocoagulation treatment to the pigment
Load more

Recommended publications
  • Unusual Ocular Presentation Ofacute Toxoplasmosis 697
    Br J Ophthalmol: first published as 10.1136/bjo.61.11.693 on 1 November 1977. Downloaded from British Journal of Ophthalmology, 1977, 61, 693-698 Unusual ocular presentation of acute toxoplasmosis DARRELL WILLERSON, JR., THOMAS M. AABERG, FREDERICK REESER, AND TRAVIS A. MEREDITH From the Medical College of Wisconsin, Eye Institute, Milwaukee, USA SUMMARY Four patients with toxoplasmosis are reported with unusual presenting ocular lesions. One patient had an active lesion that appeared to involve the optic nerve as well as focal toxoplas- mosis chorioretinitis at the macula. A second patient had a pale optic nerve in association with the classical chorioretinal scars of toxoplasmosis. The third patient had toxoplasmosis chorioretinitis of the macula with subretinal neovascularisation. The fourth patient had a branch artery occlusion complicating acute retinitis. Our report includes 4 patients with unusual mani- mutton-fat keratic precipitates (kp) OD, but not OS. festations of toxoplasmosis. Optic neuritis and/or The anterior chamber had 2+ cells OD and 1+ optic atrophy was present in 2 patients. A sub- flare. The vitreous had 1 to 2+ cells anteriorly and retinal neovascular frond was present in a third 3 to 4+ posteriorly. An elevated, one disc diameter, patient. The fourth individual had a branch artery intraretinal exudative lesion of the macula was occlusion involving a vessel which passed through an present with overlying vitreous cells (Fig. 1). The area of acute toxoplasmosis chorioretinitis. disc was oedematous; at the temporal margin there Although retinitis occurring at the macula, the copyright. retinal periphery, or even in a juxtapapillary position occurs commonly, optic nerve involvement in toxo- plasmosis is rare (Hogan et al., 1964).
    [Show full text]
  • Onchocerciasis
    11 ONCHOCERCIASIS ADRIAN HOPKINS AND BOAKYE A. BOATIN 11.1 INTRODUCTION the infection is actually much reduced and elimination of transmission in some areas has been achieved. Differences Onchocerciasis (or river blindness) is a parasitic disease in the vectors in different regions of Africa, and differences in cause by the filarial worm, Onchocerca volvulus. Man is the the parasite between its savannah and forest forms led to only known animal reservoir. The vector is a small black fly different presentations of the disease in different areas. of the Simulium species. The black fly breeds in well- It is probable that the disease in the Americas was brought oxygenated water and is therefore mostly associated with across from Africa by infected people during the slave trade rivers where there is fast-flowing water, broken up by catar- and found different Simulium flies, but ones still able to acts or vegetation. All populations are exposed if they live transmit the disease (3). Around 500,000 people were at risk near the breeding sites and the clinical signs of the disease in the Americas in 13 different foci, although the disease has are related to the amount of exposure and the length of time recently been eliminated from some of these foci, and there is the population is exposed. In areas of high prevalence first an ambitious target of eliminating the transmission of the signs are in the skin, with chronic itching leading to infection disease in the Americas by 2012. and chronic skin changes. Blindness begins slowly with Host factors may also play a major role in the severe skin increasingly impaired vision often leading to total loss of form of the disease called Sowda, which is found mostly in vision in young adults, in their early thirties, when they northern Sudan and in Yemen.
    [Show full text]
  • Vitreitis and Movement Disorder Associated with Neurosyphilis and Human Immunodeficiency Virus (HIV) Infection: Case Report
    RELATOS DE CASOS Vitreitis and movement disorder associated with neurosyphilis and human immunodeficiency virus (HIV) infection: case report Vitreíte e distúrbio motor associados à neurosífilis e infecção pelo vírus da imunodeficiência humana (HIV): relato de caso Luciano Sousa Pereira1 ABSTRACT Amy P Wu2 Ganesha Kandavel3 In this report, we describe an unusual patient with a choreiform movement Farnaz Memarzadeh4 disorder, misdiagnosed as Huntington disease, who later developed Timothy James McCulley5 dense vitreitis leading to the identification of Treponema pallidum as the underlying pathogen of both abnormalities. Keywords: Vitreous body/pathology; Neurosyphilis; Treponema pallidum; HIV infections/ complications; Oftalmopatias/etiologia INTRODUCTION Syphilis, Treponema pallidum infection, with its numerous presenta- tions has been nicknamed “the great imitator”. Potential ophthalmic mani- festations are many and can aid in pathogen identification; however, isola- ted vitreitis has rarely been described(1-3). Although not infrequent, move- ment disorders are rarely the predominating abnormality in patients with neurosyphilis(4). In this report we describe a unique patient with severe choreiform movement disorder, misdiagnosed as Huntington’s disease (HD), who later developed a dense vitreitis leading to the identification of Trabalho realizado na University of California, San T. pallidum as the underlying pathogen. Francisco - UCSF - USA. 1 Department of Ophthalmology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo (SP) - Brasil. Department of Ophthalmology, University of Cali- CASE REPORT fórnia, San Francisco, San Francisco - California (CA) - USA. 2 Department of Ophthalmology, Stanford University A 35-year-old male presented with unilateral decreased vision, photo- School of Medicine, Stanford - California (CA) - USA. phobia and conjunctival injection.
    [Show full text]
  • The Core Neglected Tropical Diseases
    s 30 COMMUNITY EY At a glance: the core E H E ALT H JOURNAL neglected tropical diseases (NTDs) Trachoma Onchocerciasis Soil-transmitted Lymphatic Schistosomiasis | VOL helminths filariasis UM E 26 CDC CDC CBM WHO I SS U E 82 | 2013 Swiss Tropical Institute courtesy M Tanner Swiss Tropical Trachomatous trichiasis A woman blinded by Adult female Ascaris lumbricoides Elephantiasis due to lymphatic Dipstick testing to detect onchocerciasis worm filariasis haematuria. The sample on the left is negative for haematuria – the other two are both positive Where • Africa • Africa • Worldwide • Africa, • Africa • Latin America • Latin America (see www.thiswormyworld.org) • Asia • Asia • Yemen • Yemen • Latin America • Latin America • China • Pacific Islands (see www.thiswormyworld.org) • India (see www.thiswormyworld.org) • Australia • South-East Asia • Pacific Islands (see www.trachomaatlas.org) How • Discharge from • Acquired by the bite of • Eggs are passed out in • Acquired by the bite of • Acquired by contact infected eyes spreads an infected blackfly faeces and then infected mosquitoes with standing fresh via fingers, fomites (Simulium sp.) swallowed by another water (e.g. lakes) in and eye-seeking flies host (Ascaris, Trichuris) which there are (especially Musca or develop into infective infected snails sorbens) larvae and penetrate intact skin (hookworm) Who • Pre-school-age children • People living near • People living in • Children aquire the • Children and adults have the highest rivers where blackflies communities with infection, but who
    [Show full text]
  • Screening for Retinopathy of Prematurity L Andruscavage, D J Weissgold
    1127 CLINICAL SCIENCE Br J Ophthalmol: first published as 10.1136/bjo.86.10.1127 on 1 October 2002. Downloaded from Screening for retinopathy of prematurity L Andruscavage, D J Weissgold ............................................................................................................................. Br J Ophthalmol 2002;86:1127–1130 Aim: A cross sectional (prevalence) study was performed to assess the usefulness and sensitivity of See end of article for commonly employed criteria to identify infants for routine ophthalmoscopic screening for retinopathy of authors’ affiliations prematurity (ROP). ....................... Methods: At a tertiary care centre between 1 January 1992 and 30 June 1998, experienced Correspondence to: vitreoretinal specialists screened 438 premature infants for ROP. Retinal maturity and the presence of David Weissgold, MD, ROP were determined by indirect ophthalmoscopic examinations. UVM/FAHC, Results: Of the eligible infants surviving 28 days, 276 (91.7%) of 301 infants with birth weights Ophthalmology, <1500 g and 162 (52.3%) of 310 infants with birth weights between 1501 and 2500 g were 1 S Prospect Street, Burlington, VT 05401, screened for ROP. 10 (3.9%) of the 310 infants with larger birth weights developed stage 1 or 2 ROP. USA; david.weissgold@ Two (0.6%) of the 310 infants with larger birth weights developed stage 3 ROP. These two infants pro- vtmednet.org gressed to threshold ROP and required treatment. Accepted for publication Conclusions: Relatively restrictive criteria to identify premature infants eligible for routine ophthalmo- 29 April 2002 scopic screening for ROP may be the cause for some infants going unexamined and their ROP unde- ....................... tected. lindness and poor visual acuity due to retinopathy of 1997 and again in 2001, the AAP,the American Association for prematurity (ROP) are serious morbidities of premature Pediatric Ophthalmology and Strabismus, and the American birth.
    [Show full text]
  • The Adverse Effects of Corticosteroids in Central Serous Chorioretinopathy
    THE ADVERSE EFFECTS OF CORTICOSTEROIDS IN CENTRAL SEROUS CHORIORETINOPATHY DE NIJS E.*, BRABANT P.*, DE LAEY J.J.* SUMMARY (CRSC). Drie patiënten worden voorgesteld waarbij CRSC geïnduceerd of verergerd werd na corticothe- The purpose of this paper is to report on the possi- rapie. Ondanks veelvuldige publicaties die deze bij- ble deleterious effect of corticosteroids in central se- werking van corticoïden aantoonden bij patiënten rous chorioretinopathy (CSCR). We will describe three met CRSC, gebruiken sommige oogartsen nog steeds patients in whom CSCR was induced or aggravated steroïden bij CRSC. Steroïden zijn vaak nodig bij de by corticosteroids. Despite multiple reports describ- behandeling van uiteenlopende aandoeningen. Oog- ing the onset of CSCR or aggravation of existing le- artsen moeten op de hoogte zijn van deze schade- sions with corticosteroids, they are still used by some lijke effecten van corticoïden in al hun toedienings- ophthalmologists for the treatment of CSCR. Corti- vormen. costeroids are also widely used for the treatment of a variety of diseases. Ophthalmologists should be KEY-WORDS aware that corticosteroids independently of the way of administration may cause this type of complica- Central serous chorioretinopathy - side effect tion. - corticosteroid RÉSUMÉ MOTS-CLÉS Le but de notre rapport est de souligner l’effet né- Choriorétinite séreuse centrale - complication faste des stéroïdes sur la choriorétinite séreuse cen- - corticoïdes trale (CRSC). Nous décrivons trois patients chez qui la CRSC est provoquée ou aggravée par les corticoï- des. Malgré les nombreuses publications, certains oph- talmologues ignorent les effets défavorables des cor- ticoïdes dans toutes ses formes sur la CRSC. Cer- tains les utilisent même dans le traitement de ces lésions.
    [Show full text]
  • Optic Neuritis and Chorioretinitis As Ocular Manifestations of Borreliosis
    DOI 10.5935/0034-7280.20170054 RELATO DE CASO259 Optic neuritis and chorioretinitis as ocular manifestations of borreliosis in Brazil: three cases reported Neurite óptica e coriorretinite como manifestações oculares da borreliose no Brasil: três casos relatados Bárbara Emilly Matos Rodrigues1, André Barbosa Castelo Branco2, Bruno Andrade Amaral3, Marciel Dourado Franca4, Túlio Gomes Cathalá Loureiro 4 ABSTRACT Lyme disease is a systemic infection caused by a tick bite and transmission of the Borrelia burgdorferi spirochete. Species of tick vectors of the disease infest mainly wild or rural animals and rodents that may be asymptomatic reservoirs of the bacteria. Characteristic of the northern hemisphere, Lyme disease in Brazil takes on different characteristics, complicating diagnosis. This paper aims to describe three cases of Lyme-like disease in a city in the state of Bahia, Brazil, with ophthalmologic findings. Keywords: Lyme Disease, ticks, Lyme-like Disease, Borrelia burgdorferi RESUMO A doença de Lyme é uma infecção sistêmica causada pela picada do carrapato e transmissão da espiroqueta Borrelia burgdorferi. As espécies de carrapatos vetores da doença infestam, principalmente, animais silvestres, rurais e roedores que podem ser reservatórios assintomáticos da bactéria. Característica do hemisfério norte, a doença de Lyme no Brasil assume características distintas, dificultando seu diagnóstico. Esse trabalho tem por objetivo, descrever três casos da doença Lyme símile do Brasil, com achados oftalmológicos, em município do Estado da Bahia. Descritores: Doença de Lyme , carrapatos, Doença Lyme símile, Borrelia burgdorferi 1 Departamento de Retina, Oftalmodiagnose Irecê, Irecê, BA, Brazil. 2 Universidade Federal da Bahia, Salvador, BA, Brazil. 3 Faculdade Independente do Nordeste LTDA, Vitória da Conquista, BA, Brazil.
    [Show full text]
  • Ocular Chorioretinal Manifestations in Patients with Diabetes Mellitus in a Tertiary Care Hospital
    Quest Journals Journal of Medical and Dental Science Research Volume 3~ Issue 8 (2016) pp: 37-41 ISSN(Online) : 2394-076X ISSN (Print):2394-0751 www.questjournals.org Research Paper Ocular Chorioretinal Manifestations in Patients with Diabetes Mellitus in a Tertiary Care Hospital Dr.Vasuki G1, Dr. Jeyalatha D1, Dr. Ananth C2 1Assistant Professor, Dept Of Physiology, Kanyakumari Govt Medical College, Asaripallam, Dr. MGR Medical University, Chennai/ India 1Assistant Professor, Dept of Ophthalmology, Kanyakumari Govt Medical College, Asaripallam, Dr. MGR Medical University, Chennai/ India 2Associate Professor, Dept Of Pathology, Kanyakumari Govt Medical College, Asaripallam, Dr. MGR Medical University, Chennai/ India) Abstract Background: Retinal disease is one of the risk factor for complications leading to increased mortality in patients with diabetes mellitus. Choroid and vitreoretinal affectios of the eye are varied in diabetes mellitus and is the prime cause for new blindness and visual disability especially in young, working age group individuals. Materials and Methods: The study is a hospital- based , non- interventional,cross-sectional prospective study. The ocular disorder are evaluated in 500 patients attending Ophthalmology out patient department of Kanyakumari govt medical college hospital. Estimation of visual acuity, anterior segment examination, slit lamp examination, intraocular pressure, retinoscopy & fundus examination, visual field analysis , gonioscopy are done to detail the defective vision. Results analysis: The common pathological changes in the posterior segment causing defective vision are diabetic retinopathy- 94 patients (18.8%), Combined retinopathy- 10(2%). Other manifestations include retinal detachment, age related macular degeneration, vitreous hemorrhage, macular hole, branch retinal vein occlusion, branch retinal artery occlusion, chorioretintis, optic atrophy. Conclusion: The ocular manifestation commonly associated with diabetes mellitus is retinopathy which can be modified by preventive measure and screening procedures.
    [Show full text]
  • Infectious Organisms of Ophthalmic Importance
    INFECTIOUS ORGANISMS OF OPHTHALMIC IMPORTANCE Diane VH Hendrix, DVM, DACVO University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996 OCULAR BACTERIOLOGY Bacteria are prokaryotic organisms consisting of a cell membrane, cytoplasm, RNA, DNA, often a cell wall, and sometimes specialized surface structures such as capsules or pili. Bacteria lack a nuclear membrane and mitotic apparatus. The DNA of most bacteria is organized into a single circular chromosome. Additionally, the bacterial cytoplasm may contain smaller molecules of DNA– plasmids –that carry information for drug resistance or code for toxins that can affect host cellular functions. Some physical characteristics of bacteria are variable. Mycoplasma lack a rigid cell wall, and some agents such as Borrelia and Leptospira have flexible, thin walls. Pili are short, hair-like extensions at the cell membrane of some bacteria that mediate adhesion to specific surfaces. While fimbriae or pili aid in initial colonization of the host, they may also increase susceptibility of bacteria to phagocytosis. Bacteria reproduce by asexual binary fission. The bacterial growth cycle in a rate-limiting, closed environment or culture typically consists of four phases: lag phase, logarithmic growth phase, stationary growth phase, and decline phase. Iron is essential; its availability affects bacterial growth and can influence the nature of a bacterial infection. The fact that the eye is iron-deficient may aid in its resistance to bacteria. Bacteria that are considered to be nonpathogenic or weakly pathogenic can cause infection in compromised hosts or present as co-infections. Some examples of opportunistic bacteria include Staphylococcus epidermidis, Bacillus spp., Corynebacterium spp., Escherichia coli, Klebsiella spp., Enterobacter spp., Serratia spp., and Pseudomonas spp.
    [Show full text]
  • Chorioretinitis and Optic Neuritis
    Chorioretinitis and Optic Neuritis Rhea V. Morgan, DVM, DACVIM (Small Animal), DACVO BASIC INFORMATION suspected, blood pressure can be measured. In eyes that are cloudy Description and cannot be examined well, an ultrasound may be performed. Inflammation of the tissues of the back of the eye (choroid, retina) If a brain disorder is suspected, computed tomography (CT scan) is called chorioretinitis . The choroid is part of the uvea of the eye, or magnetic resonance imaging and a spinal tap may be recom- so inflammation of the choroid may be called posterior uveitis . mended. The cause of chorioretinitis and/or optic neuritis can be Involvement of the nerve leading from the eye to the brain is called difficult to find and may require numerous tests. optic neuritis . These conditions may occur alone or together and are inherently serious because they affect vision. TREATMENT AND FOLLOW-UP Causes Treatment Options With the exception of trauma to the eye, these conditions are usu- ally manifestations of a systemic or generalized problem. The Treatment involves administering medications for the eye problem choroid and retina are commonly affected by other diseases within and for any underlying causes. Medications applied to the eye do not the body, and optic neuritis may arise with certain disorders of the reach the retina and choroid but topical anti-inflammatory drugs (usu- brain. Numerous causes must be considered: ally steroids), pupil dilators/pain relievers (such as atropine), and anti- • More than 25 different infections can cause this inflamma- biotics may be used for inflammation in the front part of the eye.
    [Show full text]
  • Experimental Ocular Onchocerciasis in Cynomolgus Monkeys
    Investigative Ophthalmology & Visual Science, Vol. 29, No. 11, November 1988 Copyright © Association for Research in Vision and Ophthalmology Experimental Ocular Onchocerciasis in Cynomolgus Monkeys //. Chorioreriniris Elicited by Inrrovirreol Onchocerca lienalis Microfi/ariae Richard D. Semba,* John J. Donnelly,t John H. Rockey.f James B. Lok4 Aref A. Saklat and Hugh R. Taylor* Chorioretinitis due to onchocerciasis is a major cause of blindness, and the pathogenesis is poorly understood. We have developed an experimental model for onchocercal chorioretinitis using cyno- molgus monkeys (Macaca fascicularis). Two normal monkeys and two monkeys which had received prior sensitization with subcutaneous injections of live Onchocerca lienalis microfilariae were given intravitreal injections of either 0,10, 50 or 500 live microfilariae. Posterior segment changes included disc edema, venous engorgement, retinal vasculitis, intraretinal hemorrhage, and progressive retinal pigment epithelial (RPE) disturbances. Histopathological findings included perivascular infiltrates with eosinophils, eosinophilic choroiditis, and RPE hypertrophy, hyperplasia and loss of pigment. Microfilariae in the retina had no surrounding inflammation but were found adjacent to areas of RPE alterations. Overall the inflammatory reaction in the two unsensitized monkeys was more severe than that seen in the sensitized monkeys. The retinal appearance of the monkeys resembled that found in human onchocerciasis, and this model appears to be a promising one for future investigations. Invest Ophthalmol Vis Sci 29:1642-1651,1988 Onchocerciasis, a filarial infection caused by On- Experimental animal models have provided addi- chocerca volvulus, is a major cause of blindness in tional information on the immunopathology and endemic areas of Africa and Central and South pathogenesis of ocular onchocerciasis.3 Chorioretinal America.
    [Show full text]
  • Grand Rounds
    Grand Rounds Jenny Temnogorod SUNY Downstate Medical Center Department of Ophthalmology September 19, 2013 History and Examination HPI: 2 day old SGA (small for gestational age, 37 weeks, BWt. 1760g) with IUGR TORCH infection work-up was ordered to evaluate IUGR and ophthalmology was consulted to rule out chorioretinitis. In addition, there was rupture of membranes at delivery and mother had post-op fever, so baby was empirically started on IV antibiotics for presumed chorioamnionitis. Patient Care, Interpersonal and Communication Skills, Systems based practice History and Examination l Maternal history: 30F, two previous term deliveries, with routine prenatal follow-up prior to the recent delivery. Gestational age determined by LMP, confirmed by ultrasound. Patient Care, Systems-based Practice History and Examination l PLE l LLA: wnl ou l C/S: w/q ou l K: cl ou l AC: f/s ou l IP: pharm dilated ou l L: cl ou Patient Care History and Examination DFE (picture: R eye taken 1 week later) Patient Care History and Examination l Initial DFE l Ridge present between vascularized and small area of nonvascularized retina in temporal periphery near ora serrata ou l Dilation and tortuosity of posterior retinal vessels ou l No chorioretinitis ou l DFE 1 week later l Fully vascularized retina ou l Decreased dilation and tortuosity of posterior retinal vessels ou Patient Care Differential Diagnosis? Medical Knowledge Differential Diagnosis l Retinopathy of prematurity with plus disease l Racemose hemangiomatosis (Wyburn-Mason Syndrome) l Familial exudative vitreoretinopathy (FEVR) l Norrie Disease Medical Knowledge Wyburn-Mason Syndrome l Arteriovenous malformations of the retina, optic nerve, brain, facial structures l Retinal racemose hemangiomas: typically unilateral, nonhereditary, nonfamilial, often asymptomatic Medical Knowledge Familial Exudative Vitreoretinopathy (FEVR) l Failure of temporal retina to vascularize l Inherited via several gene loci; most autosomal dominant (chromosome 11), one X-linked recessive (NDP gene).
    [Show full text]