摘要:

Orbital pseudotumor, also known as idiopathic orbital inflammatory syndrome (IOIS), may have protean clinical manifestations. Some presentations of IOIS may mimic common conditions such as orbital cellulitis and optic neuritis. IOIS should be considered a diagnosis of exclusion, with evaluation directed toward eliminating other causes of orbital disease. Orbital magnetic resonance imaging is the single most important diagnostic test, but serologic studies are necessary to exclude a systemic cause. Biopsy is usually not performed at presentation, as the risk of producing damage to vital structures within the orbit outweighs the benefits. Patients with multiple recurrences, or those unresponsive to therapy, should have biopsy samples taken. Corticosteroids are the mainstay of therapy and are administered for several months to ensure remission. Radiotherapy may be used in patients who fail to respond to steroids or who have a rapidly progressive course. For those patients who are refractory to both corticosteroids and radiotherapy, anecdotal reports have suggested the use of chemotherapeutic agents such as cyclophosphamide, methotrexate, and cyclosporine.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Any thyroid cancer can metastasize to the uveal tract, even after decades; medullary thyroid cancer can be part of multiple endocrine neoplasia syndrome. Superior limbic keratoconjunctivitis and lagophthalmos are prognostic markers for more severe thyroid-associated ophthalmopathy (TAO). The restrictive ophthalmopathy of TAO may be associated with more sustained ocular hypertension and require topical therapy. Several new studies address the therapy of TAO, ranging from retrobulbar to oral to intravenous glucocorticoids, alone or combined with radiotherapy. Endonasal decompression of the posterior orbit can be done well for severe optic nerve compression; however, leaving the anterior orbital septum intact can minimize postoperative diplopia. Smoking increases the risk and relapse rate for ophthalmopathy. Thyrotropin receptor antigen on fibroblasts diffusely in the body is causative in TAO and pretibial myxedema with even increased urinary secretion of glycosaminoglycans. Corticosteroid-responsive patients show a sustained up-regulation of the Th1/Th2 profile.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Nonarteritic anterior ischemic optic neuropathy refers to an idiopathic ischemic process of the anterior portion of the optic nerve. The typical presentation is sudden and painless visual loss with examination features of an optic neuropathy. Among the various associated risk factors are optic disc morphology, advanced age, systemic arterial hypertension, diabetes mellitus, and nocturnal hypotension. Currently, there is no proven effective long-term treatment for this disorder.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Normal tension glaucoma and dominant optic atrophy share many overlapping clinical features, and differentiating between these two diseases is often difficult. The gene responsible for dominant optic atrophy is theOPA1gene located on chromosome 3. This gene encodes for a protein product that is involved in mitochondrial metabolic function. Recent genetic linkage analysis of patients with normal tension glaucoma has shown an association with polymorphisms of theOPA1gene. This association suggests that normal tension glaucoma may actually be a hereditary optic neuropathy with a pathophysiology based in mitochondrial dysfunction.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The absolute reliance on abnormal neuro-ophthalmologic findings as signposts for particular lesions of the neuraxis must be tempered by a working knowledge of false and nonlocalizing signs and symptoms. Transient monocular visual loss or complex visual hallucinations may lead to neuroanatomic ambiguity, and elevated intracranial pressure is not the most common cause of swollen optic disks in late life. Sixth nerve palsy associated with increased intracranial pressure is possibly the best-known false localizing sign, but other ocular motility disturbances (divergence paresis, convergence insufficiency, and skew deviation) also elude localization. Lastly, the localizing pitfalls of anisocoria—Horner and Raeder syndromes, physiologic anisocoria, pupil-invol-ving third nerve palsy, and benign pupillary dilation—are discussed.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Acute demyelinating optic neuritis associated with multiple sclerosis (MS) is the most common cause of inflammation of the optic nerve. The Optic Neuritis Treatment Trial (ONTT) has provided important clinical data on the use of corticosteroids, and demonstrated that patients with characteristic inflammatory lesions within the brain on magnetic resonance imaging had a greater chance of developing clinically definite MS (CDMS).The current approach to patients with optic neuritis has been modified by the results of the Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS). Patients with an initial clinical episode of demyelination (optic neuritis, incomplete transverse myelitis, or brain-stem/cerebellar syndrome) and at least two characteristic demyelinating lesions within the brain were randomized to receive interferon &bgr;-1a or placebo after initial treatment with intravenous corticosteroids. At the 3-year point patients treated with interferon &bgr;-1a showed a 50% less risk of CDMS. The results of this study have set the standard for patients with a first bout of demyelinating optic neuritis.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Uveitis is a well-known late complication of systemic leptospirosis, a zoonotic disease caused by the water-borne spirocheteLeptospira.Although it is one of the world's most widespread febrile diseases, it remains underdiagnosed, mainly because of protean manifestations, lack of awareness, and nonavailability of laboratory support. Systematic collection of published literature was conducted using Medline, the Cochrane library, and bibliographies of retrieved reports. Articles directly applicable to ocular leptospirosis and current reports on the epidemiology, basic research, clinical presentations, and management of leptospirosis were reviewed. Changing trends in risk factors and an expanding spectrum of ocular and systemic findings have been reported. Molecular research on leptospirosis has shown remarkable progress; several rapid diagnostic modalities are currently under study. Awareness of this entity is absolutely essential to arrive at an accurate diagnosis and to prevent its potential reversible and irreversible ocular complications.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The diagnosis of ocular toxoplasmosis is based most often on the presence of characteristic clinical findings, which include focal retinochoroiditis, an adjacent or nearby retinochoroidal scar, and moderate to severe vitreous inflammation. However, a variety of less common, “atypical” presentations may be unfamiliar to clinicians, delaying both diagnosis and treatment. Patients who are immunocompromised or elderly may, for example, present with large, multiple and/or bilateral lesions. Other unusual manifestations include punctate outer retinal toxoplasmosis, retinal vasculitis, retinal vascular occlusions, rhegmatogenous and serous retinal detachments, a unilateral pigmentary retinopathy mimicking retinitis pigmentosa, neuroretinitis and other forms of optic neuropathy, and scleritis. Although in the past most cases of ocular toxoplasmosis were considered to result from reactivation of a congenital infection, it is now believed that postnatally acquired infection accounts for many cases of this disease. With appropriate use of antiparasitic therapy, the visual prognosis for patients with both typical and atypical forms of ocular toxoplasmosis may be good.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Sarcoidosis commonly involves the eye, causing uveitis, the lacrimal gland, and the cranial nerves, including the optic nerve itself. Several microorganism types have recently been located in sarcoid granulomas, suggesting an infective cause in predisposed individuals. The approach to diagnosis has been refined, including the use of high-resolution computed tomography of the chest. New ophthalmic manifestations have been described, suggesting a wider role for sarcoidosis in intraocular inflammation, and indocyanine green angiography has clarified choroidal involvement. Immunosuppressive and anticytokine treatments can be effective in severe systemic sarcoidosis and should be considered in sight-threatening disease.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

HIV/AIDS affects millions of people worldwide. In the early stages of epidemic, eyes were affected because the CD4 T-lymphocytes count of HIV-infected patients dropped rapidly. Today, with the advent of highly active antiretroviral therapy, HIV-positive individuals live longer with a better quality of life. However, because a cure has not been found, many patients with HIV will develop ocular complications at some point. Ophthalmologists play an important role in the care of these patients. We must be prepared to work as part of a multidisciplinary staff, helping to understand the causes and try to achieve the best management of disease in order to prevent blindness. Most HIV-related ocular manifestations are discussed in this article, with a review of studies within the past 2 years. We hope government authorities, pharmaceutical industries, researchers and people from all nations stand together with two goals—less suffering and definitive cure.

ISSN:1040-8738    

出版商:OVID    

年代:2002

数据来源: OVID