Course Book 2018
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Fundus Signs in Temporal Arteritis
Br J Ophthalmol: first published as 10.1136/bjo.62.9.591 on 1 September 1978. Downloaded from British Journal of Ophthalmology, 1978, 62, 591-594 Fundus signs in temporal arteritis D. McLEOD, E. 0. OJI, E. M. KOHNER, AND J. MARSHALL From Moorfields Eye Hospital and Institute of Ophthalmology, London SUMMARY A patient with temporal arteritis developed a variety of ischaemic lesions in the eyes. Infarction of the inner retina and optic nerve head was delineated on presentation by white swelling in the retinal nerve fibre layer. The role of interrupted axoplasmic transport in the production of this sign is discussed. Outer retinal infarction was also noted on presentation and subsequently gave rise to striking pigmented scars. Temporal arteritis often presents with visual loss, the central venous tributaries were of normal and necropsy examination in such cases shows wide- calibre and colour. No abnormality of the inner spread disease of the ophthalmic artery and the retina was noted in the territory of supply of the extraocular course of its ciliary and retinal branches central retinal artery. (Henkind et al., 1970). The medial and lateral At first sight the left eye showed a similar ophthal- posterior ciliary arteries supply the optic nerve head, moscopic picture, with pale swelling of the nasal the outer retina, and, in 20 to 50% of individuals, part of the optic disc and a row of fluffy white by copyright. a variable area of inner retina contiguous with the cotton-wool spots crossing the papillomacular optic disc (Hayreh, 1969); the central retinal artery bundle (Fig. 2). -
The Uveo-Meningeal Syndromes
ORIGINAL ARTICLE The Uveo-Meningeal Syndromes Paul W. Brazis, MD,* Michael Stewart, MD,* and Andrew G. Lee, MD† main clinical features being a meningitis or meningoenceph- Background: The uveo-meningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. alitis associated with uveitis. The meningeal involvement is Review Summary: We review the clinical manifestations of uveitis often chronic and may cause cranial neuropathies, polyra- and describe the infectious, inflammatory, and neoplastic conditions diculopathies, and hydrocephalus. In this review we define associated with the uveo-meningeal syndrome. and describe the clinical manifestations of different types of Conclusions: Inflammatory or autoimmune diseases are probably uveitis and discuss the individual entities most often associ- the most common clinically recognized causes of true uveo-menin- ated with the uveo-meningeal syndrome. We review the geal syndromes. These entities often cause inflammation of various distinctive signs in specific causes for uveo-meningeal dis- tissues in the body, including ocular structures and the meninges (eg, ease and discuss our evaluation of these patients. Wegener granulomatosis, sarcoidosis, Behc¸et disease, Vogt-Koy- anagi-Harada syndrome, and acute posterior multifocal placoid pig- ment epitheliopathy). The association of an infectious uveitis with an acute or chronic meningoencephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a The uveo-meningeal syndromes are a specific organism responsible for a meningeal syndrome. One should consider the diagnosis of primary ocular-CNS lymphoma in heterogeneous group of disorders that share patients 40 years of age or older with bilateral uveitis, especially involvement of the uvea, retina, and meninges. -
Approach to Intermediate Uveitis Kirti Jaisingh, Amit Khosla, Murthy Somasheila, Reema Bansal, Parthopratim Dutta Majumder, Padmamalini Mahendradas
Ophthalmic Deliberations Approach to Intermediate Uveitis Kirti Jaisingh, Amit Khosla, Murthy Somasheila, Reema Bansal, Parthopratim Dutta Majumder, Padmamalini Mahendradas The term “intermediate uveitis” describes inflammation of the anterior vitreous, ciliary body and peripheral retina Kirti Jaisingh MS, DNB, FICO which may or may not be associated with infection or Fellow, Vitreo-Retinal Surgery systemic disease. A subset of this, which is not associated Sir Ganga Ram Hospital with any systemic disease is termed as “pars planitis”.1 It Rajinder Nagar, Delhi, India comprises of approximately 9.5-17.4% of all uveitis.2,3 The prevalence of active intermediate uveitis in a South India- based study was 0.25%.3-5 Intermediate uveitis presents with minimal symptoms, commonly blurred vision and floaters.5-7 The characteristic Amit Khosla MS, DNB of this subtype of ocular inflammatory disease is a relapsing Senior Consultant, remitting nature of inflammation leading to chronicity, Uveitis and Vitreo-Retinal Services hence significant complications. Corticosteroids have been Sir Ganga Ram Hospital Rajinder Nagar, Delhi, India recommended as the first line of treatment. However, in a country known to be endemic for tuberculosis, steroids can only be given after ruling out tuberculosis with the aid of various investigations like Mantoux, Quantiferon Gold, chest X ray(CXR), Computerised tomography of chest (CECT), PCR from ocular fluids, etc. Improper treatment or early taper of drugs are often responsible for recurrences.8,10 Still, Somasheila Murthy MS, DOMS, FCP Head of Service, Corneal Diseases, there is no consensus regarding the end point of treatment. Tej Kohli Cornea Institute, Consultant, Although with the advent of immunosuppressives11-15, Uveitis Service,L.V.Prasad Eye Institute, complications due to long term steroid use have reduced Kallam Anji Reddy Campus, L.V.Prasad Marg, Banjara Hills, Hyderabad, India markedly, adequate management of intermediate uveitis is still lacking in multiple areas. -
UVEITIS Eye74 (1)
UVEITIS Eye74 (1) Uveitis Last updated: May 9, 2019 Classification .................................................................................................................................... 1 Etiologic categories .......................................................................................................................... 2 Treatment ......................................................................................................................................... 2 Complications ................................................................................................................................... 2 COMMON UVEITIC SYNDROMES ............................................................................................................. 2 Masquerade Syndromes ................................................................................................................... 3 UVEITIS - heterogenous ocular diseases - inflammation of any component of uveal tract (iris, ciliary body, choroid). CLASSIFICATION ANTERIOR UVEITIS (most common uveitis) - localized to anterior segment - iritis and iridocyclitis. IRITIS - white cells confined solely to anterior chamber. IRIDOCYCLITIS - cellular activity also involves retrolental vitreous. etiology (most do not have underlying systemic disease): 1) idiopathic postviral syndrome (most commonly 38-60%) 2) HLA-B27 syndromes, many arthritic syndromes (≈ 17%) 3) trauma (5.7%) 4) herpes simplex, herpes zoster disease (1.9-12.4%) 5) iatrogenic (postoperative). tends to -
Noninfectious Uveitis of the Posterior Segment Original Release: May 1, 2018 Expiration: May 31, 2019
CME Monograph global approaches for managing NoNINfEctIouS uVEItIS of thE PoStErIor SEGMENt Original Release: May 1, 2018 Expiration: May 31, 2019 Visit https://tinyurl.com/CMEUVEITIS for online testing and instant CME certificate. Faculty Quan Dong Nguyen Bahram Bodaghi Diana V. Do James P. Dunn Vishali Gupta MD, MSc (Chair) MD, PhD MD MD MD This continuing medical education activity is jointly provided by New York Eye and Ear Infirmary of Mount Sinai and MedEdicus LLC. This continuing medical education activity is supported through an unrestricted educational grant from Santen Pharmaceutical Co, Ltd. Distributed with LEARNING METHOD AND MEDIUM Diana V. Do, MD, and her partner/spouse had a financial This educational activity consists of a supplement and ten agreement or affiliation during the past year with the (10) study questions. The participant should, in order, read following commercial interests in the form of the learning objectives contained at the beginning of this Consultant/Advisory Board: Santen Pharmaceutical Co, Ltd; supplement, read the supplement, answer all questions in Contracted Research: Santen Pharmaceutical Co, Ltd. the post test, and complete the Activity Evaluation/Credit James P. Dunn, MD, had a financial agreement or affiliation Request form. To receive credit for this activity, please follow during the past year with the following commercial interests the instructions provided on the post test and Activity in the form of Consultant/Advisory Board: Santen Faculty Evaluation/Credit Request form. This educational activity Pharmaceutical Co, Ltd; Honoraria from promotional, should take a maximum of 1.5 hours to complete. advertising or non-CME services received directly from Quan Dong Nguyen, MD, MSc (Chair) CONTENT SOURCE commercial interest of their Agents (eg, Speakers Bureaus): Professor of Ophthalmology This continuing medical education (CME) activity captures AbbVie Inc. -
Evaluation of Fluocinolone Acetonide 0.19 Mg Intravitreal Implant in the Management of Birdshot Retinochoroiditis AUTH
TITLE: Evaluation of Fluocinolone Acetonide 0.19 mg Intravitreal Implant in the management of Birdshot Retinochoroiditis AUTHORS: Sofia Ajamil-Rodanes1, Ilaria Testi1, Joshua Luis1, Anthony G. Robson1, 2, Mark Westcott1, 2, Carlos Pavesio1, 2 Corresponding Author Sofia Ajamil-Rodanes Ophthalmology department Moorfields Eye Hospital NHS Foundation Trust 162 City Rd, Old Street, London EC1V 2PD [email protected] Full name, department, institution, city and country of all co-authors Testi, Ilaria;Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Luis, Joshua; Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK. Robson, Anthony G; Electrophysiology department. Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom. Institute of Ophthalmology, University College London, United Kingdom Pavesio, Carlos; Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK. Institute of Ophthalmology, University College London, United Kingdom Westcott, Mark; Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK. Institute of Ophthalmology, University College London, United Kingdom Word count, excluding title page, abstract, references, figures and tables 3393 words SYNOPSIS Retrospective study to examine therapeutic action of Iluvien® in retinal and choroidal inflammation in patients with birdshot retinochoroiditis. Our findings suggest retinal improvement but choroidal inflammation seems to persist. ABSTRACT Purpose: To report treatment outcomes -
Intermediate Uveitis
Intermediate Uveitis Vakur Pinar, MD Case Presentation A 32-year old woman presented with visual loss in her right eye on8/9/95. She was diagnosed with bilateral pars planitis with vitreoushemorrhage and inferior snowbank in the left eye in 1986. Subsequently she developed rhegmatogenous retinal detachment in that eye. Pars plana vitrecromy with endolaser panretinal photocoagulation (PRP) and scleral buckling OS was done. One year later she had cataract extraction with posterior chamber IOL implantation OS. Her right eye was treated with monthly periocular corticosteroid injections and peripheral cryotherapy. She was intolerant to Prednisone and discontinued Motrin after 2 months because "it didn't work". Review of systems revealed paresthesias in legs for the past 10 years, multiple allergies, arthritis, sinusitis, peptic ulcer and seizures since she had encephalitis in 1989. VA was 20/70 OD and counting fingers from 2 feet OS. Intraocular pressures were 19 mmHg OD, 9 mmHg OS. Slit lamp examination revealed normal anterior segment findings in the right eye; a few small,round white keratic precipitates (KPs) inferiorly, 2+ cells and 1+ flare in the anterior chamber OS. There was a large superior peripheral iridectomy OS. PC IOL was coated with inflammatory cells and there was a dense posterior capsule opacification. Fundus examination of the right eye revealed 1+ vitreous cells, cystoid macular edema, mild optic disc edema and peripapillary edema which were confirmed by fluorescein angiography (Figure1). Fig 1 There was a collagen band over the pars plana and pigmentary changes in the peripheral retina OD. There was no view due to hazy media in the left eye. -
Intermediate Uveitis
Ocular Inflammation Service, Oxford Eye Hospital Intermediate Uveitis Information for patients, parents and carers page 2 What is intermediate uveitis? Uveitis is an inflammation of the inside of the eye, specifically the layer of the eye called the uvea. The term, ‘intermediate uveitis’ is used to describe the location of the inflammation in the eye. The part of the eye affected is the peripheral part (outer edge) of the retina (inner most layer of the eye), the vitreous and the pars plana. The part of the eye affected in intermediate uveitis. Retina Pars plana Vitreous Cornea Macula Lens Fovea Iris Optic nerve Uvea area affected by intermediate uvelitis The older terms ‘pars planitis’ and ‘cyclitis’ are often used to describe intermediate uveitis. Intermediate uveitis most commonly affects teenagers, but can also occur in very young children. page 3 Symptoms This is generally not a painful condition and your eyes are not likely to be red or sore. You are likely to have blurred vision and/or floaters (black dots or wispy lines that move across your field of vision). Both of your eyes are likely to be affected but not always at the same time and not to the same degree. You may have this condition for quite some time before it is diagnosed, because you might not have been aware of any problem. The severity of the condition varies greatly. Often vision may not be affected at all but complications such as vitreous opacification and macular oedema may cause vision loss (see next section for details). Some people with intermediate uveitis also develop anterior uveitis (also known as iritis). -
Melanocortin in the Pathogenesis of Inflammatory Eye Diseases
CME Monograph IL-6 ROS IL-6 ROS IL-6 ROS IL-12 TNFα IL-6 IL-12 TNFα IL-12 ROSTNF α IL-12 TNFα Melanocortin in the Pathogenesis of Infl ammatory Eye Diseases: Considerations for Treatment Visit https://tinyurl.com/melanocortin for online testing and instant CME certifi cate. ORIGINAL RELEASE: November 1, 2018 EXPIRATION: November 30, 2019 FACULTY QUAN DONG NGUYEN, MD, MSc (CHAIR) FRANCIS S. MAH, MD ROBERT P. BAUGHMAN, MD ROBERT C. SERGOTT, MD DAVID S. CHU, MD ANDREW W. TAYLOR, PhD This continuing medical education activity is supported through an unrestricted educational grant from Mallinckrodt. This continuing medical education activity is jointly provided by New York Eye and Ear Infi rmary of Mount Sinai and MedEdicus LLC. Distributed with LEARNING METHOD AND MEDIUM David S. Chu, MD, had a fi nancial agreement or affi liation during the past This educational activity consists of a supplement and six (6) study questions. year with the following commercial interests in the form of Consultant/Advisory The participant should, in order, read the learning objectives contained at the Board: AbbVie Inc; Aldeyra Therapeutics; Allakos Inc; Mallinckrodt; and Santen beginning of this supplement, read the supplement, answer all questions in the Pharmaceutical Co, Ltd; Contracted Research: Aldeyra Therapeutics; Allakos, Inc; post test, and complete the Activity Evaluation/Credit Request form. To receive Gilead; and Mallinckrodt; Honoraria from promotional, advertising or non-CME services received directly from commercial interest or their Agents (e.g., Speakers’ credit for this activity, please follow the instructions provided on the post test and Bureaus): AbbVie Inc; and Novartis Pharmaceuticals Corporation. -
Systemic Disease with a Twist of Neuro
6/14/2021 Systemic Disease Straight Up…. AOA’s definition of Optometry approved Sept 2012 with a Twist of Neuro! Doctors of optometry (ODs) are the independent primary health care Beth A. Steele, OD, FAAO professionals for the eye. Optometrists examine, diagnose, treat, and [email protected] manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. PREVENTION Not just this… TREATING THE WHOLE PATIENT But also this… MEDICAL OPTOMETRY …..where do we fit in? 1 6/14/2021 29 AA F Hx ESRD, on dialysis Blood Pressure Classifications and Referral Guidelines (adapted from the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure –JNC 7, no symptoms, visual or systemic 2003) Hypotension normal Pre‐ HTN Stage 1Stage 2 Critical High Point Systolic < 90 < 120 120‐139 140‐ 159 ≥160 >180 Diastolic < 60 < 80 80 ‐ 89 90‐99 ≥100 >110 Refer Refer Evaluate or refer From: 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members within 2 within 1 immediately or BP 159/116 Appointed to the Eighth Joint National Committee (JNC 8) months month within 1 week JNC vs. ACC/AHA Guidelines All values ~10mmHg lower than JNC • 2017 ACC/AHA Clinical Practice Guidelines lowered thresholds by 10mmHg for diagnosis and treatment goals! • 26% increase in US prevalence HTN • Very controversial 2 6/14/2021 Atherosclerotic cardiovascular disease (ASCVD) risk calculator • 10‐year risk of CVD • http://tools.acc.org/ASCVD‐Risk‐Estimator/ • age >65 • atherosclerosis or risk of developing it (e.g. -
Retina/Vitreous 2017-2019
Academy MOC Essentials® Practicing Ophthalmologists Curriculum 2017–2019 Retina/Vitreous *** Retina/Vitreous 2 © AAO 2017-2019 Practicing Ophthalmologists Curriculum Disclaimer and Limitation of Liability As a service to its members and American Board of Ophthalmology (ABO) diplomates, the American Academy of Ophthalmology has developed the Practicing Ophthalmologists Curriculum (POC) as a tool for members to prepare for the Maintenance of Certification (MOC) -related examinations. The Academy provides this material for educational purposes only. The POC should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the best results. The physician must make the ultimate judgment about the propriety of the care of a particular patient in light of all the circumstances presented by that patient. The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any information contained herein. References to certain drugs, instruments, and other products in the POC are made for illustrative purposes only and are not intended to constitute an endorsement of such. Such material may include information on applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use, and to use them with appropriate patient consent in compliance with applicable law. -
TITILE: Ocular Sequelae in a Patient Diagnosed with Sarcoidosis
TITILE: ACE Testing: When Sarcoidosis Calls ABSTRACT: Sarcoidosis is an inflammatory condition which predominantly affects the lungs, skin, and eyes. Anterior uveitis is a common ocular manifestation of the condition that has the potential to cause sight threatening consequences. I. CASE HISTORY -Patient demographics – 61 y/o AA female -Chief complaint- bilateral redness x 3 weeks, accompanied by pain OS only -Ocular history - corneal gutatta, visually insignificant cataracts -Medical History - osteoporosis, depression, chronic insomnia -Medications - alendronate, cetirizine, fluoxetine, zolpidem -Other salient information: - patient was told she had ‘systemic inflammation’ several months ago - went away over time with vitamin D supplements II. PERTINENT FINDINGS -Anterior segment at first visit: OD: tr/1 cells OS: 2+ cells with mild flare with focal area of posterior synechiae OS @ 1:00 -Posterior segment within normal limits at first visit -Lab tests ordered: CBC, ESR, CRP, RF, ANA, ACE, lysozyme, RPR, TB-gold, HLA-B27, lyme Of those, ACE and lysozymes returned elevated -Radiology study: chest x-ray results: mild bilateral prominence of both hila -Pt sent to pulmonologist, where she was diagnosed with sarcoidosis -Patient returned 2 months later reporting a ‘spider web’ in vision OS for the past 2 weeks, and then sudden vision loss -Newly noted intermediate uveitis with macular edema OD, mild optic nerve head edema OU -Case discussed with ophthalmology and pt started on 60mg oral prednisone -MRI of brain and orbits did not reveal ONH or chiasmal enhancement or intracranial/orbit granulomas -carotid/echocardiograms – negative -Sent to ophthalmology and diagnosed with bilateral sarcoid uveitis – anterior and intermediate, now with sarcoid- related atypical optic neuritis OS III.