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Sample records for ocular adnexal igg4-related

  1. IgG4-related systemic sclerosing disease of the ocular adnexa: a potential mimic of ocular lymphoma.

    PubMed

    Karamchandani, Jason R; Younes, Sheren F; Warnke, Roger A; Natkunam, Yasodha

    2012-05-01

    IgG4-related sclerosing disease has been described in the orbit and ocular adnexa. Of 164 biopsies of the ocular region for suspected lymphoma, we identified 6 cases of IgG4 disease, 4 of which were previously unrecognized. All 6 cases demonstrated increased plasma cells in a background of sclerosis and increased absolute numbers of IgG4-expressing cells. Our results confirm the difficulty in diagnosing IgG4-related sclerosing disease in the ocular region. Based on the findings, we suggest that specimens from biopsies of the eye and ocular adnexa for which a definitive diagnosis of lymphoma is not established undergo further workup for IgG and IgG4, particularly if increased plasma cells and sclerosis are present. When IgG4-expressing plasma cells account for greater than 50% of IgG-expressing plasma cells, a diagnosis of IgG4 disease should be considered. Timely recognition would benefit patients by allowing appropriate management with corticosteroid therapy and avoiding more aggressive or unnecessary therapeutic options. PMID:22523207

  2. Orbital IgG4-Related Disease: Clinical Features and Diagnosis.

    PubMed

    Kubota, Toshinobu; Moritani, Suzuko

    2012-01-01

    Orbital IgG4-related disease, which can occur in adults of any age, is characterized by IgG4-positive lymphoplasmacytic infiltrations in ocular adnexal tissues. The signs and symptoms include chronic noninflammatory lid swelling and proptosis. Patients often have a history of allergic disease and elevated serum levels of IgG4 and IgE as well as hypergammaglobulinemia. Orbital IgG4-related disease must be differentiated from idiopathic orbital inflammation and ocular adnexal marginal zone B-cell lymphoma to ensure appropriate and effective treatment. Systemic steroid therapy decreases the size of the lesions, but relapse often occurs when systemic steroid therapy is discontinued. PMID:22778989

  3. IgG4-related sclerosing disease

    PubMed Central

    Kamisawa, Terumi; Okamoto, Atsutake

    2008-01-01

    Based on histological and immunohistochemical examination of various organs of patients with autoimmune pancreatitis (AIP), a novel clinicopathological entity of IgG4-related sclerosing disease has been proposed. This is a systemic disease that is characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs. Clinical manifestations are apparent in the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate, in which tissue fibrosis with obliterative phlebitis is pathologically induced. AIP is not simply pancreatitis but, in fact, is a pancreatic disease indicative of IgG4-related sclerosing diseases. This disease includes AIP, sclerosing cholangitis, cholecystitis, sialadenitis, retroperitoneal fibrosis, tubulointerstitial nephritis, interstitial pneumonia, prostatitis, inflammatory pseudotumor and lymphadenopathy, all IgG4-related. Most IgG4-related sclerosing diseases have been found to be associated with AIP, but also those without pancreatic involvement have been reported. In some cases, only one or two organs are clinically involved, while in others, three or four organs are affected. The disease occurs predominantly in older men and responds well to steroid therapy. Serum IgG4 levels and immunostaining with anti-IgG4 antibody are useful in making the diagnosis. Since malignant tumors are frequently suspected on initial presentation, IgG4-related sclerosing disease should be considered in the differential diagnosis to avoid unnecessary surgery. PMID:18609677

  4. Current concepts of ocular adnexal surgery

    PubMed Central

    Borrelli, Maria; Geerling, Gerd

    2013-01-01

    Ophthalmic Plastic and Reconstructive Surgery is a specialized area of ophthalmology that deals with the management of deformities and abnormalities of the eyelids, lacrimal system and the orbit. An ophthalmoplastic surgeon is able to identify and correct abnormalities of the ocular adnexae such as ectropion, lid retraction, conjunctival scarring with severe entropion, that can cause secondary ocular surface disorders; manage patients with watering eye, and when needed intervene with a dacryocystorhinostomy by external or endonasal approach and moreover minimize disfigurement following enucleation or evisceration and prevent further corneal damage, alleviate complains of tearing and grittiness, but also cosmetic complaints in patients with Graves orbitopathy. Aim of this manuscript was to review current established and recently evolving surgical procedures. PMID:26504698

  5. IgG4-related skin disease.

    PubMed

    Tokura, Y; Yagi, H; Yanaguchi, H; Majima, Y; Kasuya, A; Ito, T; Maekawa, M; Hashizume, H

    2014-11-01

    IgG4-related disease (IgG4-RD) is a recently established clinical entity characterized by high levels of circulating IgG4, and tissue infiltration of IgG4(+) plasma cells. IgG4-RD exhibits a distinctive fibroinflammatory change involving multiple organs, such as the pancreas and salivary and lacrimal glands. The skin lesions of IgG4-RD have been poorly characterized and may stem not only from direct infiltration of plasma cells but also from IgG4-mediated inflammation. Based on the documented cases together with ours, we categorized the skin lesions into seven subtypes: (1) cutaneous plasmacytosis (multiple papulonodules or indurations on the trunk and proximal part of the limbs), (2) pseudolymphoma and angiolymphoid hyperplasia with eosinophilia (plaques and papulonodules mainly on the periauricular, cheek and mandible regions), (3) Mikulicz disease (palpebral swelling, sicca syndrome and exophthalmos), (4) psoriasis-like eruption (strikingly mimicking psoriasis vulgaris), (5) unspecified maculopapular or erythematous eruptions, (6) hypergammaglobulinaemic purpura (bilateral asymmetrical palpable purpuric lesions on the lower extremities) and urticarial vasculitis (prolonged urticarial lesions occasionally with purpura) and (7) ischaemic digit (Raynaud phenomenon and digital gangrene). It is considered that subtypes 1-3 are induced by direct infiltration of IgG4(+) plasma cells, while the other types (4-7) are caused by secondary mechanisms. IgG4-related skin disease is defined as IgG4(+) plasma-cell-infiltrating skin lesions that form plaques, nodules or tumours (types 1-3), but may manifest secondary lesions caused by IgG4(+) plasma cells and/or IgG4 (types 4-7). PMID:25065694

  6. IgG4-related prostatitis progressed from localized IgG4-related lymphadenopathy

    PubMed Central

    Li, Dujuan; Kan, Yunzhen; Fu, Fangfang; Wang, Shuhuan; Shi, Ligang; Liu, Jie; Kong, Lingfei

    2015-01-01

    Immunoglobulin G4-related disease (IgG4-RD) is a recently described inflammatory disease involving multiple organs. Prostate involvement with IgG4-RD is very rare. In this report, we describe a case of IgG4-related prostatitis progressed from localized IgG4-related lymphadenopathy. This patient was present with urine retention symptoms. MRI and CT examination revealed the prostatic enlargement and the multiple lymphadenopathy. Serum IgG4 levels were elevated. Prostatic tissue samples resected both this time and less than 1 year earlier showed the same histological type of prostatitis with histopathologic and immunohistochemical findings characteristic of IgG4-RD. The right submandibular lymph nodes excised 2 years earlier were eventually proven to be follicular hyperplasia-type IgG4-related lymphadenopathy. This is the first case of IgG4-RD that began as localized IgG4-related lymphadenopathy and progressed into a systemic disease involving prostate and multiple lymph nodes. This patient showed a good response to steroid therapy. This leads us to advocate a novel pathogenesis of prostatitis, and a novel therapeutic approach against prostatitis. Pathologists and urologists should consider this disease entity in the patients with elevated serum IgG4 levels and the symptoms of prostatic hyperplasia to avoid ineffective medical or unnecessary surgical treatment. PMID:26617921

  7. Ocular adnexal injury and complications in orbital dog bites.

    PubMed

    Gonnering, R S

    1987-01-01

    Orbital dog bites, though statistically uncommon, occur most frequently in children and are associated with severe ocular adnexal injury. Of 16 victims, two-thirds were under 10 and over half under 5 years of age. The wounds consisted of numerous periorbital punctures, and in most cases, full-thickness lid lacerations involving the tear system. There were no serious injuries to the globe. Reversible amblyopia occurred in two children under 3 years of age with damage to the levator muscle. One child suffered a naso-orbital fracture. Because of the obvious nature of the injury, most patients present early and can be managed well with meticulous wound care and primary surgical repair. The use of prophylactic antibiotics, though controversial, appears prudent in such cases. Ophthalmologists treating these injuries must be aware of serious potential complications including occult facial fracture or intracranial penetration in young children, septicemia caused by bacillus DF-2 in patients with prior splenectomy, tetanus, and rabies. PMID:3154600

  8. Successful treatment of IgG-4 related sclerosing disease with rituximab: a novel case report.

    PubMed

    Gillispie, Miriah C; Thomas, Richard D; Hennon, Theresa R

    2015-01-01

    IgG4-related sclerosing disease (IgG4-RSD) is a rare inflammatory disease that can affect multi organs. We describe a paediatric patient with ocular, nerve, and renal involvement successfully treated twice with corticosteroids and rituximab. PMID:25897489

  9. The Role of Infectious Agents in the Etiology of Ocular Adnexal Neoplasia

    PubMed Central

    Verma, Varun; Shen, Defen; Sieving, Pamela C.; Chan, Chi-Chao

    2008-01-01

    Given the fact that infectious agents contribute to around 18% of human cancers worldwide, it would seem prudent to explore their role in neoplasms of the ocular adnexa: primary malignancies of the conjunctiva, lacrimal glands, eyelids, and orbit. By elucidating the mechanisms by which infectious agents contribute to oncogenesis, the management, treatment, and prevention of these neoplasms may one day parallel what is already in place for cancers such as cervical cancer, hepatocellular carcinoma, gastric mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. Antibiotic treatment and vaccines against infectious agents may herald a future with a curtailed role for traditional therapies of surgery, radiation, and chemotherapy. Unlike other malignancies for which large epidemiological studies are available, analyzing ocular adnexal neoplasms is challenging as they are relatively rare. Additionally, putative infectious agents seemingly display an immense geographic variation that has led to much debate regarding the relative importance of one organism versus another. This review discusses the pathogenetic role of several microorganisms in different ocular adnexal malignancies, including human papilloma virus in conjunctival papilloma and squamous cell carcinoma, human immunodeficiency virus in conjunctival squamous carcinoma, Kaposi sarcoma-associated herpes virus or human herpes simplex virus-8 (KSHV/HHV-8) in conjunctival Kaposi sarcoma, Helicobacter pylori (H. pylori,), Chlamydia, and hepatitis C virus in ocular adnexal mucosa-associated lymphoid tissue lymphomas. Unlike cervical cancer where a single infectious agent, human papilloma virus, is found in greater than 99% of lesions, multiple organisms may play a role in the etiology of certain ocular adnexal neoplasms by acting through similar mechanisms of oncogenesis, including chronic antigenic stimulation and the action of infectious oncogenes. However, similar to other human malignancies, ultimately the role of infectious agents in ocular adnexal neoplasms is most likely as a cofactor to genetic and environmental risk factors. PMID:18572051

  10. Clinicopathologic Study of Chromosomal Aberrations in Ocular Adnexal Lymphomas of Korean Patients

    PubMed Central

    Choung, Hokyung; Kim, Namju; Lee, Min Joung

    2015-01-01

    Purpose The incidence and clinical correlation of MALT1 translocation and chromosomal numerical aberrations in Korean patients with ocular adnexal mucosa associated lymphoid tissue (MALT) lymphoma have not yet been reported. We investigated the incidence and clinicopathologic relationship of these chromosomal aberrations in ocular adnexal MALT lymphomas in a Korean population. Methods Thirty ocular adnexal MALT lymphomas were investigated for the t(11;18) API2-MALT1, t(14;18) IgH-MALT1 translocations and chromosomes 3 and 18 aneuploidies using fluorescence in situ hybridization. Patient medical records were reviewed retrospectively for information on demographics and clinical characteristics, including treatment response. Results The MALT1 gene rearrangement was found in one out of 30 cases. The t(14;18) IgH-MALT1 translocation was demonstrated in only one case (3.3%), and the t(11;18) API2-MALT1 translocation was not found in any of the cases. Trisomy 3 was observed in three ocular adnexal MALT lymphomas (10.0%), and five cases showed trisomy 18 (16.7%). Translocation positive cases also showed trisomy 18. One case of tumor relapse showed trisomy 18 only in the recurrent biopsies. There were no statistically significant correlations between chromosomal aberrations and clinical characteristics and treatment responses. Conclusions Translocations involving the MALT1 gene are not common in Korean ocular adnexal MALT lymphomas. The t(14;18) translocation was detected in only one out of 30 cases, and the t(11;18) translocation was not found at all. Furthermore, the chromosomal aberrations found in this study had no prognostic implications. PMID:26457033

  11. Organ Correlation in IgG4-Related Diseases.

    PubMed

    Koizumi, Satomi; Kamisawa, Terumi; Kuruma, Sawako; Tabata, Taku; Chiba, Kazuro; Iwasaki, Susumu; Kuwata, Go; Fujiwara, Takashi; Fujiwara, Junko; Arakawa, Takeo; Koizumi, Koichi; Momma, Kumiko

    2015-06-01

    IgG4-related disease (IgG4-RD) is a potentially multiorgan disorder. In this study, clinical and serological features from 132 IgG4-RD patients were compared about organ correlations. Underlying pathologies comprised autoimmune pancreatitis (AIP) in 85 cases, IgG4-related sclerosing cholangitis (IgG4-SC) in 12, IgG4-related sialadenitis (IgG4-SIA) in 56, IgG4-related dacryoadenitis (IgG4-DAC) in 38, IgG4-related lymphadenopathy (IgG4-LYM) in 20, IgG4-related retroperitoneal fibrosis (IgG4-RF) in 19, IgG4-related kidney disease (IgG4-KD) in 6, IgG4-related pseudotumor (IgG4-PT) in 3. Sixty-five patients (49%) had multiple IgG4-RD (two affected organs in 36 patients, three in 19, four in 8, five in 1, and six in 1). Serum IgG4 levels were significantly higher with multiple lesions than with a single lesion (P<0.001). The proportion of association with other IgG4-RD was 42% in AIP, the lowest of all IgG4-RDs. Serum IgG4 level was lower in AIP than in other IgG4-RDs. Frequently associated IgG4-RDs were SIA (25%) and DAC (12%) for AIP; AIP (75%) for IgG4-SC; DAC (57%), AIP (38%) and LYM (27%) for IgG4-SIA; AIP (26%) and LYM (26%) for IgG4-DAC; SIA (75%), DAC (50%) and AIP (45%) for IgG4-LYM; SIA (58%), AIP (42%) and LYM (32%) for IgG4-RF; AIP (100%) and SIA (67%) for IgG4-KID; and DAC (67%) and SIA (67%) for IgG4-PT. Most associated IgG4-RD lesions were diagnosed simultaneously, but IgG4-SIA and IgG4-DAC were sometimes identified before other lesions. About half of IgG4-RD patients had multiple IgG4-RD lesions, and some associations were seen between specific organs. PMID:26028927

  12. IgG4-related Disease from Head to Toe.

    PubMed

    Martnez-de-Alegra, Anxo; Baleato-Gonzlez, Sandra; Garca-Figueiras, Roberto; Bermdez-Naveira, Anaberta; Abdulkader-Nallib, Ihab; Daz-Peromingo, Jos A; Villalba-Martn, Carmen

    2015-01-01

    Immunoglobulin G4 (IgG4)-related disease is a relatively recently proposed clinical-pathologic entity that is characterized by fibro-inflammatory lesions rich in IgG4-positive plasma cells and, often but not always, elevated serum IgG4 concentrations. IgG4-related disease was recognized as a systemic disease in 2003, when extrapancreatic manifestations were identified in patients with autoimmune pancreatitis. Since then, the disease has been reported as affecting virtually every organ system and has been identified in the biliary tree, salivary and lacrimal glands, periorbital tissues, lungs, lymph nodes, thyroid gland, kidneys, prostate gland, testicles, breasts, and pituitary gland. Its pathogenesis is poorly understood, but findings are consistent with both an autoimmune and an allergic disorder. Although definitive diagnosis requires histopathologic analysis, imaging plays an important role in demonstrating infiltration and enlargement of involved organs. Because of the systemic nature of the disease, imaging workup of IgG4-related disease should always include whole-body examinations to detect multiorgan involvement. Patients often present with subacute development of a mass in or diffuse enlargement of the affected organ, sometimes mimicking a neoplastic process. In every anatomic location, several inflammatory and neoplastic entities must be considered in the differential diagnosis. Because IgG4-related disease usually shows a marked response to corticosteroid therapy, radiologists should be familiar with its clinical and imaging manifestations to avoid a delay in diagnosis and unnecessary surgical interventions. ()RSNA, 2015. PMID:26473450

  13. A case of IgG4-related mesenteritis.

    PubMed

    Mori, Erika; Kamisawa, Terumi; Tabata, Taku; Shibata, Satomi; Chiba, Kazuro; Kuruma, Sawako; Kuwata, Go; Onishi, Tomoko; Fujiwara, Takashi; Fujiwara, Junko; Arakawa, Takeo; Momma, Kumiko; Koizumi, Koichi; Matsumoto, Hiroshi; Horiguchi, Shinichiro

    2015-12-01

    IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefaction consisting of fibrosis with dense infiltration of IgG4-positive plasma cells; affecting various organs. A case of IgG4-related sclerosing mesenteritis is reported. A 64-year-old man was admitted to our hospital with a suspected tumor of the small intestine. Abdominal computed tomography demonstrated a 6-cm soft tissue mass in the right lower mesentery compressing the jejunum, which also showed accumulation of fluorodeoxyglucose uptake on fluorine-18 fluorodeoxyglucose positron emission tomography. With a preoperative diagnosis of suspected malignant lymphoma with lymphadenopathy in the mesentery, partial small bowel resection was performed. Macroscopically, a hard mass, including several swollen lymph nodes, was detected in the mesentery. Microscopically, marked fibrosis showing partially storiform pattern, obstructive phlebitis, follicular hyperplasia, and abundant infiltration of IgG4-positive plasma cells were detected. IgG4-related mesenteritis was diagnosed histopathologically, but the serum IgG4 level was 81mg/dl postoperatively. Five months after the surgery, an 11-cm soft tissue mass involving the left ureter appeared. Histological examination of a biopsy specimen from the retroperitoneal mass showed fibrosis with inflammatory infiltration. Although IgG4-related retroperitoneal fibrosis could not be confirmed histologically, the tumor responded well to steroid therapy. PMID:26581887

  14. [Hypocomplementemic tubulointerstitial nephritis in IgG4-related disease].

    PubMed

    Rolla, Davide; Bellino, Diego; Pistoni, Giada; Peloso, Gian Carlo; Rastaldi, Maria Pia; Simonini, Paola; Ravetti, Jean Louis; Cannella, Giuseppe

    2012-01-01

    A novel lymphoproliferative disorder producing plasma cell expansion in the affected organ with fibrotic or sclerosing changes, known as ''IgG4-related disease'', was defined in Japan by Umehara's group in 2010. We present the first case reported in Italy. In 2007, a 63-year-old man presented with epigastric pain and elevated serum lipase levels. Computed tomography of the abdomen revealed a Kuttner's tumor of the pancreas. The patient underwent a biliary-enteric anastomosis, and biopsy of the pancreas revealed massive infiltration of lymphocytes and plasma cells. The patient was diagnosed with chronic sclerosing pancreatitis. After one year, he began to show signs of sicca syndrome and at the same time developed progressive renal failure. Immunological tests revealed hypocomplementemia, and the renal biopsy specimen showed diffuse interstitial inflammation. The infiltrate was composed of lymphocytes, while infiltrating plasma cells showed immunoreactivity to IgG-4. Sialography using a radioisotope revealed severe involvement of the salivary glands, and Schirmer's test gave a positive result. This led us to diagnose hypocomplementemic tubulointerstitial nephritis in IgG4-related disease. Corticosteroid treatment resulted in rapid improvement including disappearance of the sicca syndrome and progressive amelioration of renal function. After six months, we discontinued steroid administration and started mycophenolate mofetil to maintain a low degree of immunosuppression. Follow-up after two years showed that this therapy continued to be quite effective in our patient. PMID:22718459

  15. Primary bilateral small lymphocytic lymphoma of ocular adnexal origin: Imprint cytology suggests the intraoperative diagnosis

    PubMed Central

    Bandyopadhyay, Arghya; Majumdar, Kaushik; Gangopadhyay, Mimi; Khan, Kalyan; Chakraborty, Subrata; Ghosh, Asim Kr.

    2012-01-01

    Ocular adnexal lymphomas (OAL) involve the peri-global soft tissues like orbit, eyelid, conjunctiva, lacrimal gland. We describe a rare case of primary bilateral OAL, histomorphologically small lymphocytic lymphoma, B cell phenotype of lacrimal gland origin. Rapid intraoperative diagnosis can be suggested on imprint cytology; subsequent histology and immunohistochemistry are helpful for confirmation and further line of management. Since no preformed lymphoid structures are expected within the orbit or lacrimal gland, any lymphoid mass here should be critically evaluated as a lymphoproliferative lesion. PMID:23964191

  16. Diagnosis of IgG4-Related Tubulointerstitial Nephritis

    PubMed Central

    Raissian, Yassaman; Nasr, Samih H.; Larsen, Christopher P.; Colvin, Robert B.; Smyrk, Thomas C.; Takahashi, Naoki; Bhalodia, Ami; Sohani, Aliyah R.; Zhang, Lizhi; Chari, Suresh; Sethi, Sanjeev; Fidler, Mary E.

    2011-01-01

    IgG4-related systemic disease is an autoimmune disease that was first recognized in the pancreas but also affects other organs. This disease may manifest as tubulointerstitial nephritis (IgG4-TIN), but its clinicopathologic features in the kidney are not well described. Of the 35 patients with IgG4-TIN whose renal tissue specimens we examined, 27 (77%) had acute or progressive chronic renal failure, 29 (83%) had involvement of other organ systems, and 18 of 23 (78%) had radiographic abnormalities. Elevated total IgG or IgG4 serum levels were present in 79%. All pathologic specimens featured plasma cellrich TIN, with most showing diffuse, expansile interstitial fibrosis. Immune complexes along the tubular basement membranes were present in 25 of 30 (83%). All specimens had a moderate to marked increase in IgG4+ plasma cells by immunohistochemistry. We used a control group of 175 pathologic specimens with plasma cellrich interstitial infiltrates that can mimic IgG4-TIN to examine the diagnostic utility of IgG4 immunostaining. Excluding pauci-immune necrotizing and crescentic glomerulonephritis, IgG4 immunohistochemistry had a sensitivity of 100% (95% CI 90100%) and a specificity of 92% (95% CI 8695%) for IgG4-TIN. Of the 19 patients with renal failure for whom treatment and follow-up data were available, 17 (89%) responded to prednisone. In summary, because no single test definitively diagnoses IgG4-related systemic disease, we rely on a combination of histologic, immunophenotypic, clinical, radiographic, and laboratory features. When the disease manifests in the kidney, our data support diagnostic criteria that can distinguish IgG4-TIN from other types of TIN. PMID:21719792

  17. IgG4-related Orbital Disease and Its Mimics in a Western Population.

    PubMed

    Ferry, Judith A; Klepeis, Veronica; Sohani, Aliyah R; Harris, Nancy Lee; Preffer, Frederic I; Stone, John H; Grove, Arthur; Deshpande, Vikram

    2015-12-01

    Although chronic inflammatory disorders of the ocular adnexa are relatively common, their pathogenesis is in many cases poorly understood. Recent investigation suggests that many cases of sclerosing orbital inflammation are a manifestation of IgG4-related disease; however, most patients reported have been Asian, and it is not clear whether the results of studies from the Far East can be reliably extrapolated to draw conclusions about Western patients. We evaluated 38 cases previously diagnosed as orbital inflammatory pseudotumor or chronic dacryoadenitis to determine whether our cases fulfill the criteria for IgG4-RD (IgG4-related dacryoadenitis when involving the lacrimal gland, and IgG4-related sclerosing orbital inflammation when involving orbital soft tissue). Fifteen patients had IgG4-related dacryoadenitis or orbital inflammation. These patients included 9 men and 6 women, aged 24 to 77 years (median, 64 y). Lesions involved orbital soft tissue (8 cases), lacrimal gland (6 cases), and canthus (1 case). In 1 case, focal in situ follicular neoplasia was seen in a background of IgG4-RD. In another case, a clonal IGH gene rearrangement was detected. Four patients with IgG4-RD had evidence of IgG4-RD in other anatomic sites. Five patients, 1 man and 4 women, aged 26 to 74 years (median 50 y) had orbital lesions (2 involving lacrimal gland, 3 involving soft tissue) suspicious for, but not diagnostic of, IgG4-RD. Of 16 patients with IgG4-RD or probable IgG4-RD with information available regarding the course of their disease, 11 patients experienced recurrent or persistent orbital disease. However, no patient developed lymphoma, and no patient died of complications of IgG4-RD. Eighteen patients had lesions not representing IgG4-RD. They included 6 male and 12 female individuals aged 6 to 77 years (median, 47 y). These patients had a variety of diseases, including granulomatosis with polyangiitis (3 cases), Rosai-Dorfman disease (1 case), nonspecific chronic inflammation and fibrosis involving lacrimal gland or soft tissue (12 cases), and others. Clinical and pathologic findings among our patients with IgG4-RD involving the orbit are similar to those previously described in Asian patients. Careful evaluation of histologic and immunophenotypic features and clinical correlation are required to distinguish orbital IgG4-RD from other sclerosing inflammatory lesions in the orbit. PMID:26379149

  18. Diagnosis of IgG4-related sclerosing cholangitis

    PubMed Central

    Nakazawa, Takahiro; Naitoh, Itaru; Hayashi, Kazuki; Miyabe, Katsuyuki; Simizu, Shuya; Joh, Takashi

    2013-01-01

    IgG4-related sclerosing cholangitis (IgG4-SC) is often associated with autoimmune pancreatitis. However, the diffuse cholangiographic abnormalities observed in IgG4-SC may resemble those observed in primary sclerosing cholangitis (PSC), and the presence of segmental stenosis suggests cholangiocarcinoma (CC). IgG4-SC responds well to steroid therapy, whereas PSC is only effectively treated with liver transplantation and CC requires surgical intervention. Since IgG4-SC was first described, it has become a third distinct clinical entity of sclerosing cholangitis. The aim of this review was to introduce the diagnostic methods for IgG4-SC. IgG4-SC should be carefully diagnosed based on a combination of characteristic clinical, serological, morphological, and histopathological features after cholangiographic classification and targeting of a disease for differential diagnosis. When intrapancreatic stenosis is detected, pancreatic cancer or CC should be ruled out. If multiple intrahepatic stenoses are evident, PSC should be distinguished on the basis of cholangiographic findings and liver biopsy with IgG4 immunostaining. Associated inflammatory bowel disease is suggestive of PSC. If stenosis is demonstrated in the hepatic hilar region, CC should be discriminated by ultrasonography, intraductal ultrasonography, bile duct biopsy, and a higher cutoff serum IgG4 level of 182 mg/dL. PMID:24282356

  19. IgG4-related disease and hypertrophic pachymeningitis.

    PubMed

    Wallace, Zachary S; Carruthers, Mollie N; Khosroshahi, Arezou; Carruthers, Robert; Shinagare, Shweta; Stemmer-Rachamimov, Anat; Deshpande, Vikram; Stone, John H

    2013-07-01

    Hypertrophic pachymeningitis (HP) is an inflammatory condition in which the dura mater of the cranium or spine becomes thickened, leading to symptoms that result from mass effect, nerve compression, or vascular compromise. The differential diagnosis of HP includes immune-mediated conditions such as rheumatoid arthritis and vasculitis, malignancies, and infections. Many times, no diagnosis is reached; in such cases, the disease has been described as idiopathic HP. IgG4-related disease (IgG4-RD) is a recently described inflammatory condition known to cause tumefactive lesions at myriad anatomical locations. Both IgG4-RD and idiopathic HP share similar demographics, histopathology, and natural history. We hypothesized that IgG4-RD is a common cause of idiopathic HP.To investigate this hypothesis, we identified all pathology specimens diagnosed as noninfectious HP during 25 years at our institution. Fourteen cases had stained slides and paraffin blocks to permit review of the original hematoxylin and eosin stained slides as well as immunostaining of cell blocks. Recently published consensus guidelines describing characteristic histopathology and the necessary quantity of IgG4+ plasma cell infiltrate were used to diagnose IgG4-RD.Four cases (66.6%) that had been regarded previously as representing idiopathic HP were diagnosed as IgG4-RD; of all the reviewed cases, IgG4-RD represented 29% of cases. Of the remaining cases, 3 cases were associated with granulomatosis with polyangiitis (GPA), 2 with lymphoma, and 1 each with rheumatoid arthritis, giant cell arteritis, and sarcoidosis. Two of the cases could not be diagnosed more precisely and were classified as undifferentiated HP. Clinical history, serologic tests, cerebrospinal fluid studies, and radiology alone could not identify the cause of HP. Rather, biopsy with histopathology and immunostaining was necessary to reach an accurate diagnosis. Significant IgG4+ plasma cell infiltrates were observed in rheumatoid arthritis, granulomatosis with polyangiitis, and lymphoma, underscoring the importance of histopathology in making the diagnosis of IgG4-RD.This case series demonstrates that IgG4-RD may be the most common etiology of noninfectious HP and highlights the necessity of biopsy for accurate diagnosis. PMID:23793110

  20. Clinicopathological Analysis of Ocular Adnexal Extranodal Marginal Zone B-Cell Lymphoma with IgG4-Positive Cells

    PubMed Central

    Lee, Min Joung; Kim, Namju; Choe, Ji-Young; Khwarg, Sang In; Jeon, Yoon Kyung

    2015-01-01

    This study aims to analyze clinical and pathological characteristics of ocular adnexal extranodal marginal zone B-cell lymphoma (EMZL) accompanying IgG4-positive cells. Fifty patients with a diagnosis of primary non-conjunctival ocular adnexal EMZL were enrolled in this study. The number of IgG4-positive cells and the ratio of IgG/IgG4 were evaluated by immunohistochemistry in the biopsy specimens. The patients were divided into two groups based on the absolute number and the ratio of IgG4-positive cells (IgG4-posivite vs IgG4-negative groups). The demographic data, clinical staging at diagnosis, histopathological characteristics, and response to initial treatment were comparatively analyzed between the 2 groups. Five (10%) of 50 patients were defined as IgG4-positive group, and all the cases showed characteristic histological features such as extensive plasma cell infiltration and dense fibrosis. Most of these patients (4 of 5 patients) had lymphoma of the lacrimal gland. The patients from the IgG4-positive group showed a lower response rate to initial treatment (87.5 vs 33%, p = 0.03) than IgG4-negative group with a median follow-up period of 38 months. A part of the ocular adnexal EMZLs were accompanied with IgG4-positive cells. Significantly, most IgG4-positive ocular adnexal EMZLs occurred in the lacrimal gland, and can be related with a more frequent treatment failure. PMID:26111022

  1. IgG4 related renal disease: A wolf in sheep's clothing.

    PubMed

    Rohan, A; Ravishankar, B; Vishwanath, S; Vankalakunti, M; Kishore, B; Ballal, H S

    2014-11-01

    IgG4 related disease is a fibro-inflammatory condition with involvement of renal and extra renal organs, characterized by lymphoplasmacytic infiltration with organ dysfunction. We describe three cases of IgG4 related renal disease from a tertiary care hospital in south India. PMID:25484534

  2. IgG4 related renal disease: A wolf in sheep's clothing

    PubMed Central

    Rohan, A.; Ravishankar, B.; Vishwanath, S.; Vankalakunti, M.; Kishore, B.; Ballal, H. S.

    2014-01-01

    IgG4 related disease is a fibro-inflammatory condition with involvement of renal and extra renal organs, characterized by lymphoplasmacytic infiltration with organ dysfunction. We describe three cases of IgG4 related renal disease from a tertiary care hospital in south India. PMID:25484534

  3. Molecular and genomic aberrations in Chlamydophila psittaci negative ocular adnexal marginal zone lymphomas.

    PubMed

    Zhu, Daxing; Ikpatt, Offiong F; Dubovy, Sander R; Lossos, Chen; Natkunam, Yasodha; Chapman-Fredricks, Jennifer R; Fan, Yao-Shan; Lossos, Izidore S

    2013-09-01

    The etiology and pathogenesis of ocular adnexal extranodal marginal zone lymphoma (OAEMZL) are still unknown and the association with Chlamydophila psittaci (C. psittaci) has been shown in only some geographic regions. Herein, we comprehensively examined the frequency of chromosomal translocations as well as CARD11, MYD88 (L265P), and A20 mutations/deletions in 45 C. psittaci negative OAEMZLs. t(14;18)(q32;q21) IGH-MALT1 and t(11;18)(q21;q21) API2-MALT1 were not detected in any of the analyzed tumors while three tumors harbored IGH translocations to an unidentified partner. CARD11 mutations were not found in all analyzed tumors, while the MYD88 L265P mutation was detected in three (6.7%) tumors. A20 mutations and deletions were each detected in seven (15.6%) and six (13.3%) tumors, respectively. Therefore, the observed genetic aberrations could account for the activation of the nuclear factor (NF)-kB signaling pathway in only a minority of the cases. Further studies are needed to identify the molecular mechanisms underlying the pathogenesis of OAEMZL. PMID:23720088

  4. Molecular and Genomic Aberrations in Chlamydophila psittaci Negative Ocular Adnexal Marginal Zone Lymphomas

    PubMed Central

    Zhu, Daxing; Ikpatt, Offiong F; Dubovy, Sander R; Lossos, Chen; Natkunam, Yasodha; Chapman-Fredricks, Jennifer R.; Fan, Yao-Shan; Lossos, Izidore S.

    2013-01-01

    The etiology and pathogenesis of ocular adnexal extranodal marginal zone lymphoma (OAEMZL) are still unknown and the association with Chlamydophila psittaci (C. psittaci) has been shown in only some geographic regions. Herein we comprehensively examined the frequency of chromosomal translocations as well as CARD11, MYD88 (L265P) and A20 mutations /deletions in 45 C. psittaci negative OAEMZLs. t(14;18)(q32;q21) IGH-MALT1 and t(11;18)(q21;q21) API2-MALT1 were not detected in any of the analyzed tumors while 3 tumors harbored IGH translocations to an unidentified partner. CARD11 mutations were not found in all the analyzed tumors while MYD88 L265P mutation was detected in 3 (6.7%) tumors. A20 mutations and deletions were each detected in 7(15.6%) and 6(13.3%) of the tumors, respectively. Therefore, the observed genetic aberrations could account for the activation of NF-kB signaling pathway in only a minority of the cases. Further studies are needed to identify the molecular mechanisms underlying the pathogenesis of OAEMZL. PMID:23720088

  5. IgG4-related disease in the sinonasal cavity accompanied by intranasal structure loss.

    PubMed

    Inoue, Akiko; Wada, Kota; Matsuura, Kentaro; Osafune, Hiroshi; Ida, Yutaro; Kosakai, Arifumi; Edamatsu, Hideo

    2016-02-01

    IgG4-related disease was recently proposed under the classification of systemic chronic inflammatory disease. In the field of otolaryngology, organ-specific diagnostic criteria have been established for the occurrence of this condition in the salivary glands, but not in the sinonasal cavity. Here we report a case involving a 70-year-old man with IgG4-related disease in the sinonasal cavity. The patient, with the chief complaint of nasal bleeding, first visited a physician. However, the patient experienced recurrent bleeding with intranasal structure loss and was subsequently referred to our hospital. His IgG4 level was elevated, and histopathological examination of a tissue sample obtained from the edematous sphenoid sinus showed increased IgG4-positive plasma cells and storiform fibrosclerosis. A definitive diagnosis of IgG4-related rhinosinusitis was made on the basis of comprehensive criteria for IgG4-related disease. The disease showed a progressively destructive course that was clearly different from that of chronic sinusitis and represented a very rare case of IgG4-related rhinosinusitis. IgG4-related disease originating in the sinonasal cavity is rare, and, to the best of our knowledge, this is the first primary case of IgG4-related disease that originated in one side of the sinonasal cavity and showed progressive destruction. PMID:26104224

  6. A Case of IgG4-Related Lung Disease Presenting as Interstitial Lung Disease

    PubMed Central

    Ahn, Jee Hwan; Hong, Sun In; Cho, Dong Hui; Chae, Eun Jin; Song, Joon Seon

    2014-01-01

    Intrathoracic involvement of immunoglobulin G4 (IgG4)-related disease has recently been reported. However, a subset of the disease presenting as interstitial lung disease is rare. Here, we report a case of a 35-year-old man with IgG4-related lung disease with manifestations similar to those of interstitial lung disease. Chest computed tomography showed diffuse ground glass opacities and rapidly progressive pleural and subpleural fibrosis in both upper lobes. Histological findings showed diffuse interstitial lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. Serum levels of IgG and IgG4 were also increased. The patient was diagnosed with IgG4-related lung disease, treated with anti-inflammatory agents, and showed improvement. Lung involvement of IgG4-related disease can present as interstitial lung disease and, therefore, should be differentiated when evaluating interstitial lung disease. PMID:25237380

  7. IgG4-related cholecystitis presenting as biliary malignancy: report of three cases.

    PubMed

    Feely, Michael M; Gonzalo, David H; Corbera, Montserrat; Hughes, Steven J; Trevino, Jose G

    2014-09-01

    An increased awareness of IgG4-related diseases has led to an escalation in the number of sites known to be involved by this fibroinflammatory disease. We report three cases of IgG4-related cholecystitis which were thought to represent biliary malignancies both clinically and radiographically. All three cases underwent surgery tailored towards presumed malignant neoplasms. Only following pathologic examination was the true nature of the disease identified. Recognition of the clinical, radiographic, and pathologic presentation of IgG4-related cholecystitis is essential for the consideration of this disease process prior to surgical management for suspected gallbladder malignancies. However, the pre-operative diagnosis remains challenging and extensive surgical intervention is often necessary given the distressing presentation of IgG4-related cholecystitis. PMID:24944152

  8. IgG4-related disease with sinonasal involvement: A case series

    PubMed Central

    Prabhu, Shailesh M; Yadav, Vikas; Irodi, Aparna; Mani, Sunithi; Varghese, Ajoy Mathew

    2014-01-01

    We present the imaging findings in two cases of IgG4-related disease involving the sinonasal region in the pediatric age group. Imaging findings in IgG4-related disease affecting the nasal cavity and paranasal sinuses have been rarely reported in literature. The diagnosis is made by a combination of clinical, imaging, and histopathologic findings. Radiologists should be aware of the imaging findings of this condition to ensure early diagnosis and treatment. PMID:25024517

  9. IgG4-related mastitis, a rare disease, can radiologically and histologically mimic malignancy.

    PubMed

    Yamada, Rin; Horiguchi, Shin-Ichiro; Yamashita, Toshinari; Kamisawa, Terumi

    2016-01-01

    IgG4-related disease (IgG4-RD) is characterised by high serum concentrations of IgG4, dense lymphoplasmacytic infiltrates, storiform fibrosis and increased IgG4-positive plasma cells in tissues. This systemic disease occurs in various organs metachronously, but IgG4-related mastitis appears extremely rare. We report a case of IgG4-related mastitis, radiologically considered to represent breast cancer mainly composed of intraductal component and requiring histological differentiation from mucosa-associated lymphoid tissue (MALT) lymphoma. The breast mass disappeared with steroid therapy. When patients have a breast mass, regardless of the presence or absence of IgG4-RD, IgG4-related mastitis should be considered in addition to breast cancer. If histological findings show dense lymphoplasmacytic infiltrates, IgG4-related mastitis should be suspected in addition to malignant lymphoma, and lack of monoclonality should be confirmed. To avoid unnecessary surgery or chemotherapy, knowledge and accurate diagnosis of the entity of IgG4-related mastitis is necessary. PMID:27009197

  10. Nontuberculous mycobacterial infection with concurrent IgG4-related lymphadenopathy.

    PubMed

    Liu, Ting-Ting; Weng, Shao-Wen; Wang, Ming-Chung; Huang, Wan-Ting

    2016-03-01

    Disseminated nontuberculous mycobacteria (NTM) infection with concurrent IgG4-related lymphadenopathy has not been reported. We described a patient with neutralizing autoantibodies to interferon-gamma (IFN-?) and elevated levels of serum IgG4 presenting with generalized lymphadenopathy and reactive dermatosis. Histologically, lymph nodes (LNs) showed effaced nodal architecture with polymorphic infiltrates, mimicking angioimmunoblastic T-cell lymphoma. Both the absolute number and the ratio of IgG4+ plasma cells to IgG+ plasma cells were increased. Mycobacterium abscessus was isolated from cultures of LNs, and demonstrated by polymerase chain reaction-restriction fragment length polymorphism. The skin biopsy showed neutrophilic dermatosis, consistent with Sweet syndrome. The patient met the criteria of both adult-onset immunodeficiency syndrome and IgG4-related lymphadenopathy. This case provides evidence of disseminated NTM infection with concurrent type III IgG4-related lymphadenopathy in the patient with anti-IFN-? autoantibodies. PMID:26660641

  11. [Severe asthmatic crisis during general anesthesia in a patient with IgG4 related disease].

    PubMed

    Moriya, Machika; Oda, Shinya; Nakane, Masaki; Kawamae, Kaneyuki

    2014-04-01

    We experienced severe asthmatic crisis during general anesthesia in a 45-year-old man with IgG4-related disease, COPD and athma undergoing removal of submandibular gland. The ventilatiory failure was caused by the stimulation of the operation, sputum, and neostigmine. His serum IgG4 level was extremely high. IgG4 related disease is a recently emerging entity characterized by a diffuse or mass forming inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosclerosis and obliterative phlebitis. It is associated with an elevated serum level of IgG4 and an allergic disease. We must be careful in perioperative management of the patients with IgG4-related disease because general anesthesia can induce asthmatic crisis. PMID:24783608

  12. IgG4-Related Esophageal Disease Presenting as Esophagitis Dissecans Superficialis With Chronic Strictures

    PubMed Central

    Dumas-Campagna, Myriam; Bouchard, Simon; Soucy, Genevieve; Bouin, Mickael

    2014-01-01

    IgG4-related disease is a recently recognized autoimmune systemic disorder that has been described in various organs. The disease is characterized histologically by a dense lymphoplasmocytic infiltrate of IgG4-positive cells, storiform fibrosis and can be associated with tumefactive lesions. IgG4-related disease involving the upper gastrointestinal tract is rare and only two previous case reports have reported IgG4-related esophageal disease. We report the case of a 63-year-old female patient with a long-standing history of severe dysphagia and odynophagia with an initial diagnosis of reflux esophagitis. Symptoms persisted despite anti-acid therapy and control esophagogastroduodenoscopy (EGD) revealed endoscopic images consistent with esophagitis dissecans superficialis (sloughing esophagitis). An underlying autoimmune process was suspected and immunosuppressant agents were tried to control her disease. The patient eventually developed disabling dysphagia secondary to multiple chronic esophageal strictures. A diagnosis of IgG4-related disease was eventually made after reviewing esophageal biopsies and performing an immunohistochemical study with an anti-IgG4 antibody. Treatment attempts with corticosteroids and rituximab was not associated with a significant improvement of the symptoms of dysphagia and odynophagia, possibly because of the chronic nature of the disease associated with a high fibrotic component. Our case report describes this unique case of IgG4-related esophageal disease presenting as chronic esophagitis dissecans with strictures. We also briefly review the main histopathological features and treatment options in IgG4-related disease. PMID:24883156

  13. IgG4-Related Disease Presenting as a Solitary Neck Mass

    PubMed Central

    McKinnon, Tyler; Randazzo, William T.; Kim, Brian D.; Biddinger, Paul; Forseen, Scott

    2015-01-01

    IgG4-related disease is a newly recognized entity associated with autoimmune conditions involving almost every organ system. It is characterized by elevated serum IgG4 as well as mass like tissue infiltration by IgG4-positive plasma cells. Imaging findings are nonspecific, vary depending on the site of disease, and include mass like enlargement of the salivary or lacrimal glands and enlarged lymph nodes. Radiographic findings often mimic malignancy, necessitating tissue sampling to confirm the diagnosis. Distinguishing IgG4-related disease from malignancy is important as IgG4 responds well to steroids and conservative management. PMID:25926922

  14. Lymphadenopathy of IgG4-related disease: an underdiagnosed and overdiagnosed entity.

    PubMed

    Cheuk, Wah; Chan, John K C

    2012-11-01

    Lymphadenopathy is a common occurrence in IgG4-related disease; it can appear before, concurrent with, or after the diagnosis of this disease, which is characterized by tumefactive sclerosing inflammatory lesions predominantly affecting extranodal sites, such as the pancreas, salivary gland, and lacrimal gland. Although multiple lymph node groups are commonly involved, constitutional symptoms are absent. The lymph nodes can show a broad morphologic spectrum, including multicentric Castleman disease-like (type I), follicular hyperplasia (type II), interfollicular expansion (type III), progressive transformation of germinal centers (type IV), and inflammatory pseudotumor-like (type V). All are characterized by an increase in IgG4+ plasma cells (>100 per high power field) and IgG4/IgG ratio (>40%). IgG4-related lymphadenopathy is both an underdiagnosed and overdiagnosed entity. The former is because of the fact that this entity has not been characterized until recently, while the latter results from pathologists' enthusiasm in diagnosing "new" entities and the lack of specificity of the morphologic and immunophenotypic features of IgG4-related lymphadenopathy. It is prudent to render this diagnosis only for patients with known IgG4-related disease or in the presence of corroborating clinical and laboratory findings (such as elderly men, systemic lymphadenopathy, elevated serum IgG4, IgG, and IgE but not IgM and IgA, and low titers of autoantibodies). Outside these circumstances, a descriptive diagnosis of "reactive lymphoid hyperplasia with increased IgG4+ cells" accompanied by a recommendation for follow-up will be appropriate because IgG4-related disease will likely ensue only in a minority of such patients. PMID:23068302

  15. Systemic IgG4-related lymphadenopathy: a clinical and pathologic comparison to multicentric Castleman's disease.

    PubMed

    Sato, Yasuharu; Kojima, Masaru; Takata, Katsuyoshi; Morito, Toshiaki; Asaoku, Hideki; Takeuchi, Tamotsu; Mizobuchi, Kohichi; Fujihara, Megumu; Kuraoka, Kazuya; Nakai, Tokiko; Ichimura, Kouichi; Tanaka, Takehiro; Tamura, Maiko; Nishikawa, Yuriko; Yoshino, Tadashi

    2009-04-01

    IgG4-related disease sometimes involves regional and/or systemic lymph nodes, and often clinically and/or histologically mimics multicentric Castleman's disease or malignant lymphoma. In this study, we examined clinical and pathologic findings of nine patients with systemic IgG4-related lymphadenopathy. None of these cases were associated with human herpes virus-8 or human immunodeficiency virus infection, and there was no T-cell receptor or immunoglobulin gene rearrangement. Histologically, systemic IgG4-related lymphadenopathy was classified into two types by the infiltration pattern of IgG4-positive cells: interfollicular plasmacytosis type and intra-germinal center plasmacytosis type. The interfollicular plasmacytosis type showed either Castleman's disease-like features or atypical lymphoplasmacytic and immunoblastic proliferation-like features. By contrast, the intra-germinal center plasmacytosis type showed marked follicular hyperplasia, and infiltration of IgG4-positive cells mainly into the germinal centers, and some cases exhibited features of progressively transformed germinal centers. Interestingly, eight of our nine (89%) cases showed eosinophil infiltration in the affected lymph nodes, and examined patients showed high elevation of serum IgE. Laboratory examinations revealed elevation of serum IgG4 and soluble interleukin-2 receptors. However, the levels of interleukin-6, C-reactive protein, and lactate dehydrogenase were within normal limits or only slightly elevated in almost all patients. One patient showed a high interleukin-6 level whereas C-reactive protein was within the normal limit. Autoantibodies were examined in five patients and detected in four. Compared with the previously reported cases of multicentric Castleman's disease, our patients with systemic IgG4-related lymphadenopathy were significantly older and had significantly lower C-reactive protein and interleukin-6 levels. In conclusion, in our systemic IgG4-related lymphadenopathy showed pathologic features only partially overlapping those of multicentric Castleman's disease, and serum data (especially C-reactive protein and interleukin-6) are useful for differentiating the two. Our findings of eosinophil infiltration in the affected tissue and elevation of serum IgE may suggest an allergic mechanism in the pathogenesis of systemic IgG4-related lymphadenopathy. PMID:19270642

  16. IgG4-related systemic sclerosing disease: a diagnosis to be considered

    PubMed Central

    Dasari, Bobby V M; McElvanna, Kevin; Loughrey, Maurice; Diamond, Tom

    2013-01-01

    IgG4-related systemic sclerosing disease is a chronic autoimmune disorder with diverse clinical presentation. We report a 56-year-old patient who has presented with obstructive jaundice, bulky pancreas and mesenteric lymph node mass. He was later diagnosed to have IgG4-sclerosing disease involving pancreas, small bowel mesentery, common bile duct, liver, gallbladder and submandibular salivary glands and has required multiple surgical interventions. IgG4-related systemic sclerosing disease appears to be more commonly encountered than it was once thought and needs considered in patients presenting with pancreatitis of no obvious underlying cause. Although the disease is primarily managed by medical therapy, there is a role for surgical intervention in order to obtain tissue for diagnosis, exclude other possible neoplastic aetiology and to manage disease-related complications. PMID:23542646

  17. Acute Interstitial Nephritis and Membranous Nephropathy in the Context of IgG4-Related Disease

    PubMed Central

    Stylianou, Kostas; Maragkaki, Eleftheria; Tzanakakis, Michael; Stratakis, Stavros; Gakiopoulou, Hariklia; Daphnis, Eugene

    2015-01-01

    We present the case of a patient with IgG4-related disease, which manifested in an asynchronous manner as vitiligo, cholecystitis, sialadenitis, lymphadenopathy, facial palsy and kidney dysfunction. The patient underwent a renal biopsy, and a presumptive diagnosis of lupus nephritis was made due to compatible clinical and immunological findings. The biopsy revealed IgG4-related kidney disease with severe interstitial nephritis and membranous nephropathy. Corticosteroids treatment restored all disease manifestations. We bring this case to the attention of the nephrologists because of the protean, asynchronous, multisystemic nature of the disease that necessitates a multidisciplinary approach, a low threshold for kidney biopsy and a high index of suspicion for making the correct diagnosis and treatment. PMID:25849674

  18. Cholangiocarcinoma developed in a patient with IgG4-related disease

    PubMed Central

    Douhara, Akitoshi; Mitoro, Akira; Otani, Emi; Furukawa, Masanori; Kaji, Kosuke; Uejima, Masakazu; Sawai, Masayoshi; Yoshida, Motoyuki; Yoshiji, Hitoshi; Yamao, Junichi; Fukui, Hiroshi

    2013-01-01

    A 77-year-old man with jaundice and a pancreatic head tumor was referred to our hospital in August 2006. The initial laboratory tests, computed tomography (CT) scan, magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography suggested IgG4-related cholangitis and autoimmune pancreatitis. Oral prednisolone (PSL) was then administered. This treatment reduced the size of the pancreatic parenchyma, and the lower common bile duct (CBD) returned to its normal size. Thus, the oral PSL was gradually tapered to a maintenance dose. In February 2010, a CT scan and MRI showed segmental wall thickening and stenosis of the middle CBD, the progression of which led to extrahepatic obstructive jaundice. We suspected the emergence of a cholangiocarcinoma rather than the exacerbation of the IgG4-related sclerosing cholangitis because the stricture of the CBD was short and localized. Then, a percutaneous transhepatic biliary drainage was performed. The biopsy specimens obtained via the percutaneous transhepatic tract indicated an abnormal glandular formation, suggesting the presence of a moderate, well-differencated adenocarcinoma. The gross examination, microscopic examination and immunohistochemical analysis of the pancreaticoduodenectomy specimen suggested that a cholangiocarcinoma developed from the IgG4-related sclerosing cholangitis. PMID:24009815

  19. Azathioprine as successful maintenance therapy in IgG4-related tubulointerstitial nephritis

    PubMed Central

    Brochriou, Isabelle; Demetter, Pieter; Matos, Celso; Delhaye, Myriam; Devire, Jacques; Nortier, Jolle L.

    2012-01-01

    A 65-year-old man presented with a progressive increase in plasma creatinine (PCr). Two years before, diffusion-weighted magnetic resonance imaging had revealed a relapse of immunoglobulin G4 (IgG4)-related autoimmune pancreatitis (AIP) associated with sclerosing cholangitis. Bilateral hypointense renal cortical nodules were also described. Kidney biopsy showed patchy disappearance of tubules, sparse interstitial fibrosis and IgG4+ plasma cells (>30 per high power field) leading to the diagnosis of IgG4-related tubulointerstitial nephritis (TIN). Despite methylprednisolone, PCr and serum IgG4 levels remained elevated. Starting azathioprine (AZA) normalized IgG4 levels, which elicited corticosteroid withdrawal after 17 months. One year later, renal function remains stable. Our clinical observation underlines the importance of biological and radiological long-term follow-up of patients with previous AIP in order to early detect IgG4-related renal involvement. Corticosteroids are the first choice, but in the case of adverse effects or partial remission, AZA could be a useful and safe alternative therapy. PMID:26069770

  20. Orbital immunoglobulin IgG4-related inflammatory fibrosclerosing lesion treated with pentoxifylline and ?-tocopherol: case report.

    PubMed

    Lee, R; MacKinnon, C A; Aburn, N; Tan, S T

    2015-02-01

    Immunoglobulin G4 (IgG4)-related disease is a distinct group of disorders that are characterised by intense infiltration of an organ with IgG4(+) cells, subsequent inflammation, fibrosis, and masses. We report a new treatment of orbital IgG4-related disease with pentoxyphylline and ?-tocopherol, both of which are anti-inflammatory and antifibrotic agents. PMID:25467248

  1. A new surgical "noose" technique for excision of pediatric ocular adnexal and anterior orbital cysts.

    PubMed

    Arcot Sadagopan, Karthikeyan; Perumalsamy, Vijayalakshmi

    2015-08-01

    We describe a "noose technique" that facilitates complete surgical excision of all forms of pediatric adnexal and anterior orbital extraocular cysts, including conjunctival retention cysts, parasitic cysts involving the conjunctiva, Tenon's capsule, or rectus muscle, superficial cysts, and deep dermoid cysts. The technique provides good exposure and facilitates handling of tissues, maintains surgical planes, minimizes bleeding, decreases injury to collateral tissues, reduces surgical time, allows for utilization of less skilled assistants, and ensures complete excision in most cases. The noose technique is a versatile procedure that can be applied to extraocular cysts of any location or size both in children and adults. We demonstrate the technique in 3 different pediatric extraocular cysts. PMID:26239211

  2. Diagnostic Approach to the Complexity of IgG4-Related Disease.

    PubMed

    Stone, John H; Brito-Zern, Pilar; Bosch, Xavier; Ramos-Casals, Manuel

    2015-07-01

    IgG4-related disease (IgG4-RD) is a systemic disease characterized by the infiltration of IgG4-bearing plasma cells and, more importantly, distinctive histopathological features: storiform fibrosis, obliterative phlebitis, a lymphoplasmacytic infiltrate, and mild-to-moderate tissue eosinophilia. The diagnostic approach is complex and relies on the coexistence of various clinical, laboratory, and histopathological findings, none of which is pathognomonic in and of itself. IgG4-related disease should be suspected in patients presenting with unexplained enlargement or swelling of 1 or more organs or tissue organs. Four laboratory abnormalities often provide initial clues to the diagnosis of IgG4-RD: peripheral eosinophilia, hypergammaglobulinemia, elevated serum IgE levels, and hypocomplementemia. Elevated serum IgG4 levels provided critical information in identifying the first cases of IgG4-RD, but recent studies have reported substantial limitations to the measurement of serum IgG4 concentrations, precluding reliance on serum IgG4 concentrations for diagnostic purposes. In contrast, new studies have suggested a promising role of flow cytometry studies in the diagnosis and longitudinal management of IgG4-RD. Demonstration of the classic histopathological features of IgG4-RD remains crucial to diagnosis in most cases, and biopsy proof is preferred strongly by most disease experts before the initiation of treatment. Of note, the multiorgan nature of IgG4-RD was first established in 2003. This review intends to provide most recent knowledge about the clinical, laboratory, radiological, and pathological characteristics of IgG4-RD that may guide the physician to establish an early diagnosis. We searched PubMed and MEDLINE for relevant articles published between January 1, 2000, and November 1, 2014, using the search terms IgG4 and IgG4-related. PMID:26141331

  3. IgG4-related plasma cell granuloma of the maxillary sinus: A report of 2 cases.

    PubMed

    Kojima, Masaru; Nakazato, Yoshimasa; Hirabayashi, Kaoru; Masawa, Nobuhide; Nakamura, Naoya

    2015-09-01

    We report 2 rare cases of IgG4-related plasma cell granuloma of the maxillary sinus. Histologically, both lesions were characterized by severe lymphoplasmacytic infiltration. In 1 case, fibrous sclerosis and obliterative arteritis were observed. Immunohistochemical study demonstrated that IgG4-positive cells comprised more than 40% of the IgG-positive plasma cells. Moreover, the serum IgG4 level was elevated in both cases. A good responsiveness to steroid therapy has been seen in IgG4-related disease. From a therapeutic perspective, it is important to recognize IgG4-related plasma cell granuloma. PMID:26401675

  4. The first case of IgG4-related disease in Italy

    PubMed Central

    Rolla, Davide; Bellino, Diego; Peloso, Giancarlo; Pia Rastaldi, Maria; Simonini, Paola; Louis Ravetti, Jean

    2013-01-01

    Background:Recently, Mikuliczs disease has been defined as an IgG-4 related disease, a systemic condition, where the hallmark pathology findings are lymphoplasmacytic infiltrates, immunoglobulin (Ig)G4-positive plasma cells, modest tissue eosinophilia, and intense fibrosis. Case:We present a case of 63-year-old man who showed epigastralgia and elevated serum lipase levels. Computed tomography of the abdomen revealed a bulky mass of the pancreas, so he underwent bilious-digestive anastomosis, and biopsy of the pancreas revealed massive infiltration of lymphocytes and plasma cells. The patient was therefore diagnosed with sclerosing chronic pancreatitis (Kuttners tumour). After one year, the patient began to exhibit signs of sicca syndrome, and at the same time, he demonstrated progressive renal failure. Immunological tests showed hypocomplementemia, and the renal biopsy specimen demonstrated interstitial inflammation, in which infiltrate was composed of lymphocytes, while infiltrating plasma cells showed immunoreactivity to IgG4. Sialography revealed severe involvement of the salivary glands, and Schirmers test resulted positive. Conclusions: Here, we report successful treatment of the first case in Italy of a patient with hypocomplementemic tubulointerstitial nephritis in IgG4-related disease. PMID:24475442

  5. Colovesical fistula caused by glucocorticoid therapy for IgG4-related intrapelvic mass

    PubMed Central

    Yabuuchi, Yohei; Matsubayashi, Hiroyuki; Matsuzaki, Masato; Shiomi, Akio; Moriguchi, Michihisa; Kawamura, Ichiro; Ito, Ichiro; Ono, Hiroyuki

    2015-01-01

    IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder that can occur in almost all systemic organs and generally responds to corticosteroid treatment. We report a rare case of an IgG4-related intrapelvic mass lesion that responded to steroid therapy but caused a fistula between the sigmoid colon and bladder. A 71-year-old man was followed after treatment for hepatocellular carcinoma. Follow-up computed tomography (CT) incidentally depicted left hydronephrosis with an ill-demarcated intrapelvic mass lesion. This lesion was histologically diagnosed as IgG4-RD by open biopsy, and peroral steroid therapy was initiated. One month after starting steroids, a colovesical fistula was detected by follow-up CT. A colostomy and urethral catheterization were emergently performed. The patient recovered and the mass lesion was drastically minimized by the initiation of glucocorticoids; however, he still needs urethral catheterization. IgG4-RD develops in various systemic organs and generally responds well to steroids. Clinicians must be watchful for the complications of responses to corticosteroids, such as fistulization, when the mass lesion of IgG4-RD is adjacent to multiple luminal organs. PMID:26677450

  6. Colovesical fistula caused by glucocorticoid therapy for IgG4-related intrapelvic mass.

    PubMed

    Yabuuchi, Yohei; Matsubayashi, Hiroyuki; Matsuzaki, Masato; Shiomi, Akio; Moriguchi, Michihisa; Kawamura, Ichiro; Ito, Ichiro; Ono, Hiroyuki

    2015-12-16

    IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder that can occur in almost all systemic organs and generally responds to corticosteroid treatment. We report a rare case of an IgG4-related intrapelvic mass lesion that responded to steroid therapy but caused a fistula between the sigmoid colon and bladder. A 71-year-old man was followed after treatment for hepatocellular carcinoma. Follow-up computed tomography (CT) incidentally depicted left hydronephrosis with an ill-demarcated intrapelvic mass lesion. This lesion was histologically diagnosed as IgG4-RD by open biopsy, and peroral steroid therapy was initiated. One month after starting steroids, a colovesical fistula was detected by follow-up CT. A colostomy and urethral catheterization were emergently performed. The patient recovered and the mass lesion was drastically minimized by the initiation of glucocorticoids; however, he still needs urethral catheterization. IgG4-RD develops in various systemic organs and generally responds well to steroids. Clinicians must be watchful for the complications of responses to corticosteroids, such as fistulization, when the mass lesion of IgG4-RD is adjacent to multiple luminal organs. PMID:26677450

  7. IgG4-related lung disease: a case series of 6 patients and review of the literature.

    PubMed

    Keenan, Joseph C; Miller, Elizabeth; Jessurun, Jose; Allen, Tadashi; Kim, Hyun Joo

    2016-01-01

    IgG4 related disease has been recently proposed as a unifying term for a group of inflammatory conditions previously referred to by a plethora of other names. The common denominator for these entities is the histopathologic finding of lymphocytic infiltrates rich in IgG4 producing plasma cells, often accompanied by storiform fibrosis and obliterative phlebitis. Many medical conditions have been attributed to IgG4-related disease,but few reports of IgG4-related lung disease have been published, and it remains a rare condition about which little is known. In this report, we describe the clinical and pathologic features of six patients with IgG4-related disease of the lung. Patients were followed 1 - 5 years following their diagnosis. We describe unique features of IgG4- related lung disease, including one patient who presented with alveolar hemorrhage and a positive anti-neutrophil cytoplasmic antibody and two patients whose disease improved after treatment with mycophenylate mofetil. Two patients presented with pulmonary pseudotumor. We conclude that the clinical presentation of IgG4-related lung disease varies widely, and histopathology remains the key to diagnosis. PMID:26847104

  8. IgG4-related sclerosing disease: a critical appraisal of an evolving clinicopathologic entity.

    PubMed

    Cheuk, Wah; Chan, John K C

    2010-09-01

    An elevated serum titer of immunoglobulin G4 (IgG4), the least common (3% to 6%) of the 4 subclasses of IgG, is a surrogate marker for the recently characterized IgG4-related sclerosing disease. The syndrome affects predominantly middle-aged and elderly patients, with male predominance. The patients present with symptoms referable to the involvement of 1 or more sites, usually in the form of mass lesions. The prototype is IgG4-related sclerosing pancreatitis (also known as autoimmune pancreatitis), most commonly presenting as painless obstructive jaundice with or without a pancreatic mass. Other common sites of involvement are the hepatobiliary tract, salivary gland, orbit, and lymph node, but practically any organ-site can be affected, such as retroperitoneum, aorta, mediastinum, soft tissue, skin, central nervous system, breast, kidney, prostate, upper aerodigestive tract, and lung. The patients usually have a good general condition, with no fever or constitutional symptoms. Common laboratory findings include raised serum globulin, IgG, IgG4, and IgE, whereas lactate dehydrogenase is usually not raised. Some patients have low titers of autoantibodies (such as antinuclear antibodies and rheumatoid factor). The disease often shows excellent response to steroid therapy. The natural history is characterized by the development of multiple sites of involvement with time, sometimes after many years. However, the disease can remain localized to 1 site in occasional patients. The main pathologic findings in various extranodal sites include lymphoplasmacytic infiltration, lymphoid follicle formation, sclerosis and obliterative phlebitis, accompanied by atrophy and loss of the specialized structures of the involved tissue (such as secretory acini in pancreas, salivary gland, or lacrimal gland). The relative predominance of the lymphoplasmacytic and sclerotic components results in 3 histologic patterns: pseudolymphomatous, mixed, and sclerosing. Immunostaining shows increased IgG4+ cells in the involved tissues (>50 per high-power field, with IgG4/IgG ratio >40%). The lymph nodes show multicentric Castleman disease-like features, reactive follicular hyperplasia, interfollicular expansion, or progressive transformation of germinal centers, with the unifying feature being an increase in IgG4+ plasma cells on immunostaining. The nature and pathogenesis of IgG4-related sclerosing disease are still elusive. Occasionally, the disease can be complicated by the development of malignant lymphoma and possibly carcinoma. PMID:20733352

  9. [A case of IgG4-related sclerosing disorders involving the mesentery and the pancreas].

    PubMed

    Sakemi, Ryosuke; So, Suketo; Morimitsu, Yosuke; Uchiyama, Daiji; Kakiuchi, Seiya; Ishihara, Yuji; Matsushima, Yu; Kubo, Yasuhiko; Matsugaki, Satoru; Ono, Tetsujiro; Takane, Junko; Sasaki, Ei; Sakemi, Miyuki; Shimokobe, Masayuki; Sata, Michio

    2011-06-01

    A 78-year-old man presented with upper abdominal pain. He underwent an abdominal computed tomography scan which revealed irregularly shaped mass lesions in the mesentery and in the pancreatic head and body. The mass lesions were suspected to be pancreatic cancer with peritoneal dissemination and a surgical biopsy was performed. Histologic studies revealed lymphoplasmacytic sclerosing pancreatitis with significant infiltration of IgG4-positive plasma cells. His serum IgG4 level was 223 mg/dl. Findings from histologic and serum studies were compatible with IgG4-related sclerosing disorders. The mass lesions responded to steroid therapy and disappeared. The difficulty in making a definitive diagnosis is discussed. PMID:21646765

  10. Nasal manifestations of IgG4-related disease: A report of two cases.

    PubMed

    Ohno, Keiko; Matsuda, Yoko; Arai, Tomio; Kimura, Yurika

    2015-12-01

    IgG4-related disease (IgG4-RD) is a recently recognized clinical disease entity characterized by elevated serum IgG4, tumefaction, tissue infiltration of IgG4-positive plasma cells and fibrosis. IgG4-RD may occur, either synchronously or metachronously, in a variety of organs throughout the body. We describe herein two representative cases of the nasal manifestations of IgG4-RD, characterized by diffuse, crusty, erosive lesions on nasal mucosa. Oral steroid administration was effective in treating these nasal manifestations. We report a decrease in IgG4 positive plasma cell infiltrates in nasal mucosa biopsy specimens after steroid therapy, demonstrating that infiltration of IgG4-positive cells is reversible. PMID:26060132

  11. [An IgG4-related pancreatitis mimicking an adenocarcinoma: A case report].

    PubMed

    Courcet, Emilie; Beltjens, Franoise; Charon-Barra, Cline; Guy, France; Orry, David; Ghiringhelli, Franois; Arnould, Laurent

    2015-12-01

    Type1 auto-immune pancreatitis (type1 AIP) is the pancreatic manifestation of IgG4-related systemic disease (IgG4-RD). This disease has recently been individualized and is characterized by elevated serum IgG4 levels and extrapancreatic lesions with common histologic characteristic: dense infiltration of lymphocytes, IgG4-positive plasma cells and storiforme fibrosis. Obliterative phlebitis is frequently detected. The pancreas is frequently involved in this disease. As approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological and histopathological features. In pseudotumoral cases, AIP can be misdiagnosed as pancreatic cancer. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection. We report here a case of a patient who underwent surgery for presumed pancreatic cancer. The final diagnosis was type1 AIP. PMID:26596693

  12. IgG4-related sclerosing cholangitis: all we need to know.

    PubMed

    Zen, Yoh; Kawakami, Hiroshi; Kim, Jung Hoon

    2016-04-01

    Our knowledge and experience of IgG4-related sclerosing cholangitis (ISC) have expanded in the last decade. ISC is one of the common organ manifestations of IgG4-related disease (IgG4-RD); approximately 60 % of patients with this systemic condition have ISC in the proximal and/or distal bile ducts. ISC needs to be discriminated from primary sclerosing cholangitis, cholangiocarcinoma, and other rare forms of lymphoplasmacytic cholangiopathy (e.g., follicular cholangitis and sclerosing cholangitis with granulocytic epithelial lesions). Its diagnosis requires a multidisciplinary approach, in which serology, histology, and imaging play crucial roles. Treatments with high-dose corticosteroids typically lead to the rapid and consistent induction of disease remission. Another promising therapeutic approach is B-cell depletion with rituximab. Although disease relapse is relatively common, provided that appropriate treatments are administered, ISC is considered a "benign" disease with a low risk of liver failure and biliary malignancy. Its molecular pathology is characterized by Th2-dominant immune reactions, regulatory T-cell activation, and CCL1-CCR8 interactions. Particular subsets of B cells such as plasmablasts and regulatory B cells also expand. A recent global proteomic study demonstrated that three significantly activated immunological cascades in ISC were all B-cell- or immunoglobulin-related (Fc-gamma receptor-mediated phagocytosis, B-cell receptor signaling pathway, and Fc-epsilon receptor I signaling pathway), suggesting the crucial roles of B cells in the underlying immune reactions. Despite the expansion of our knowledge of the pathophysiology of ISC, the exact role of IgG4 remains unclear. A better understanding of its immunopathology will offer some potential drug targets for this emerging biliary disease. PMID:26817943

  13. Hypermethylation of MST1 in IgG4-related autoimmune pancreatitis and rheumatoid arthritis.

    PubMed

    Fukuhara, Takataro; Tomiyama, Takashi; Yasuda, Kaneki; Ueda, Yoshihiro; Ozaki, Yoshio; Son, Yonsu; Nomura, Shosaku; Uchida, Kazushige; Okazaki, Kazuichi; Kinashi, Tatsuo

    2015-08-01

    The serine/threonine kinase Mst1 plays important roles in the control of immune cell trafficking, proliferation, and differentiation. Previously, we reported that Mst1 was required for thymocyte selection and regulatory T-cell functions, thereby the prevention of autoimmunity in mice. In humans, MST1 null mutations cause T-cell immunodeficiency and hypergammaglobulinemia with autoantibody production. RASSF5C(RAPL) is an activator of MST1 and it is frequently methylated in some tumors. Herein, we investigated methylation of the promoter regions of MST1 and RASSF5C(RAPL) in leukocytes from patients with IgG4-related autoimmune pancreatitis (AIP) and rheumatoid arthritis (RA). Increased number of CpG methylation in the 5' region of MST1 was detected in AIP patients with extrapancreatic lesions, whereas AIP patients without extrapancreatic lesions were similar to controls. In RA patients, we detected a slight increased CpG methylation in MST1, although the overall number of methylation sites was lower than that of AIP patients with extrapancreatic lesions. There were no significant changes of the methylation levels of the CpG islands in the 5' region of RASSF5C(RAPL) in leukocytes from AIP and RA patients. Consistently, we found a significantly down-regulated expression of MST1 in regulatory T cells of AIP patients. Our results suggest that the decreased expression of MST1 in regulatory T cells due to hypermethylation of the promoter contributes to the pathogenesis of IgG4-related AIP. PMID:26056943

  14. Rituximab for the Treatment of IgG4-Related Tubulointerstitial Nephritis

    PubMed Central

    McMahon, Blaithin A.; Novick, Tessa; Scheel, Paul J.; Bagnasco, Serena; Atta, Mohamed G.

    2015-01-01

    Abstract Immunoglobulin type gamma 4 (IgG4)-related disease is a relatively newly described clinical entity characterized by a distinctive histopathological appearance, increased numbers of IgG4 positive plasma cells and often, but not always, elevated serum IgG4 concentrations. The most common renal manifestation of IgG4-related disease is tubulointerstitial nephritis marked with proteinuria, hematuria, decreased kidney function, hypocomplementemia, and radiologic abnormalities. Renal biopsy characteristics include dense lymphoplasmacytic tubulointerstitial nephritis that stains for IgG4, storiform fibrosis, and immune complex deposition in the interstitium and along tubule basement membranes. Treatment traditionally consists of prolonged glucocorticoids but cases refractory to glucocorticoids have been reported. We report a case of a 58-year-old Caucasian man who presented with fatigue, 50 pound weight loss, dyspnea, lymphadenopathy, and nephromegaly. The patient was first misdiagnosed as chronic interstitial nephritis secondary to renal sarcoid and was treated with repeated doses of prednisone. On his third relapse, he underwent a repeat renal biopsy and a diagnosis of IgG4-tubulointerstitial nephritis was confirmed. He was refractory to treatment with prednisone. The patient received Rituximab and had prompt sustained improvement in renal function. At 1 year post Rituximab treatment, his serum creatinine remains at baseline and imaging study revealed reduction in his kidney size. This is the first case report using Rituximab as a steroid sparing option for refractory IgG4-tubulointerstitial nephritis. More information is needed on the long-term effects of using of B-cell depleting agents for glucocorticoid resistant IgG4-tubulointerstitial nephritis. PMID:26266393

  15. CT features and pathologic characteristics of IgG4-related systemic disease of submandibular gland

    PubMed Central

    Wang, Zhiwei; Feng, Ruie; Chen, Yu; Duan, Miao; Wang, Man; Jin, Zhengyu; Rumboldt, Zoran; Zhang, Zhuhua

    2015-01-01

    The submandibular gland is one of the most frequently affected salivary gland in IgG4-related systemic disease, usually demonstrate homogeneous attenuation on CT imaging as reported, but without much pathological comparison of many cases. This article is to investigate and analyze the typical CT findings and pathologic characteristics of IgG4-related systemic disease (IgG4-RSD) of submandibular gland. A retrospective analysis of the preoperative CT findings in patients with IgG4-RSD of submandibular glands who underwent surgical resection between January 2010 and February 2014 was performed. Twenty patients (16 women) were identified, with a mean age of 58.110.2 years. All patients presented with painless submandibular gland swelling. Diffuse gland enlargement, with clear margins and homogeneous density, was found on non-enhanced CT scans in all cases. There were no calcifications or stones within the involved glands. Based on contrast-enhanced CT appearance the patients could be divided into two groups: 11 cases showed homogeneous gland enhancement; and multiple hyperenhancing foci, with a crazy-paving pattern, were detected in 9 cases, which were in consistent with the pathologic findings. The maximum submandibular gland diameter on transverse images was significantly larger (P=0.008) in patients with crazy-paving appearance (324 mm) compared to patients with homogeneous enhancement (283 mm). It is concluded that the submandibular glands with IgG4-RSD can be characterized by either homogenous appearance or crazy-paving pattern on contrast-enhanced CT imaging. PMID:26884889

  16. Clinical relevance of Küttner tumour and IgG4-related dacryoadenitis and sialoadenitis

    PubMed Central

    Furukawa, S; Moriyama, M; Kawano, S; Tanaka, A; Maehara, T; Hayashida, J-N; Goto, Y; Kiyoshima, T; Shiratsuchi, H; Ohyama, Y; Ohta, M; Imabayashi, Y; Nakamura, S

    2015-01-01

    Objectives Küttner tumour (KT), so-called chronic sclerosing sialoadenitis, is characterised by concomitant swelling of the submandibular glands secondary to strong lymphocytic infiltration and fibrosis independent of sialolith formation. However, recent studies have indicated that some patients with KT develop high serum levels of IgG4 and infiltration of IgG4-positive plasma cells, namely IgG4-related dacryoadenitis and sialoadenitis (IgG4-DS), so-called Mikulicz's disease. The aim of this study was to clarify the clinical and pathological associations between KT and IgG4-DS. Materials and Methods Fifty-four patients pathologically diagnosed with KT or chronic sialoadenitis were divided into two groups according to the presence or absence of sialolith (KT-S (+) or KT-S (−), respectively). Results There were no significant differences in the clinical findings, including the mean age, sex and disease duration, between the two groups. All patients in the KT-S (+) group showed unilateral swelling without infiltration of IgG4-positive plasma cells or a history of other IgG4-related diseases (IgG4-RD), while those in the KT-S (−) group showed bilateral swelling (37.5%), strong infiltration of IgG4-positive plasma cells (87.5%) and a history of other IgG4-RD (12.5%). Conclusions These results suggest an association between the pathogeneses of KT-S (−) and IgG4-DS, but not KT-S (+). PMID:24844187

  17. Multicentric Castleman Disease With Tubulointerstitial Nephritis Mimicking IgG4-related Disease: Two Case Reports.

    PubMed

    Zoshima, Takeshi; Yamada, Kazunori; Hara, Satoshi; Mizushima, Ichiro; Yamagishi, Masakazu; Harada, Kenichi; Sato, Yasuharu; Kawano, Mitsuhiro

    2016-04-01

    Multicentric Castleman disease is a benign lymphoproliferative disorder with heterogenous clinical symptoms and involves systemic organs in addition to lymph nodes. Elevated serum IgG4 levels and IgG4-positive plasma cell (IgG4+PC) infiltrates have been reported in lymph nodes, lung and skin in some multicentric Castleman disease cases, resembling IgG4-related disease (IgG4-RD) histologically. However, no report has been available regarding IgG4+PC infiltration in the kidneys of multicentric Castleman disease. Here, we report 2 cases of multicentric Castleman disease complicated by IgG4-related disease (IgG4-RD) histologically. However, there has been no report published on PC-rich tubulointerstitial nephritis, lymphadenopathy, with numerous IgG4+PC infiltration, and elevated serum IgG4 levels, mimicking IgG4-RD. The blood examinations revealed systemic inflammation and elevated C-reactive protein and interleukin-6 levels. Corticosteroid therapy was partially effective in both cases, and combination therapy of corticosteroid and tocilizumab was needed in both cases. Moreover, after triple therapy with corticosteroid, rituximab and cyclophosphamide were used in 1 case to tame the severe inflammation. The present cases suggest that if continuously elevated serum C-reactive protein levels and partial corticosteroid responsiveness are encountered, multicentric Castleman disease should be considered rather than IgG4-RD as a differential diagnosis even if serum IgG4 is elevated and IgG4+PCs infiltrate systemic organs. PMID:26598921

  18. The changing faces of IgG4-related disease: Clinical manifestations and pathogenesis.

    PubMed

    Islam, Arshia Duza; Selmi, Carlo; Datta-Mitra, Ananya; Sonu, Rebecca; Chen, Mingyi; Gershwin, M Eric; Raychaudhuri, Siba P

    2015-10-01

    Since the earliest reports in 2001, immunoglobulin G4 (IgG4)-related disease has been defined as an autoimmune systemic disease characterized by the lymphoplasmacytic infiltration of affected tissues leading to fibrosis and obliterative phlebitis along with elevated serum IgG4 levels. Prior to this unifying hypothesis, a plethora of clinical manifestations were considered as separate entities despite the similar laboratory profile. The pathology can be observed in virtually all organs and may thus be a challenging diagnosis, especially when the adequate clinical suspicion is not present or when obtaining a tissue biopsy is not feasible. Nonetheless, the most frequently involved organs are the pancreas and exocrine glands but these may be spared. Immunosuppressants lead to a prompt clinical response in virtually all cases and prevent histological sequelae and, as a consequence, an early differential diagnosis from other conditions, particularly infections and cancer, as well as an early treatment should be pursued. We describe herein two cases in which atypical disease manifestations were observed, i.e., one with recurrent neck lymph node enlargement and proptosis, and one with jaundice. Our understanding of the pathogenesis of IgG4-related disease is largely incomplete but data support a significant role for Th2 cytokines with the contribution of innate immunity factors such as Toll-like receptors, macrophages and basophils. Further, macrophages activated by IL4 overexpress B cell activating factors and contribute to chronic inflammation and the development of fibrosis. We cannot rule out the possibility that the largely variable disease phenotypes reflect different pathogenetic mechanisms and the tissue microenvironment may then contribute to the organ involvement. PMID:26112170

  19. Ocular adnexal and orbital amyloidosis: a case series and literature review.

    PubMed

    Mora-Horna, Eduardo R; Rojas-Padilla, Rubí; López, Vianhi G; Guzmán, Martín J; Ceriotto, Ariel; Salcedo, Guillermo

    2016-04-01

    The purpose of the study was to describe the main clinical and epidemiologic characteristics, treatment options, and outcome in a large series of patients with periocular and orbital amyloidosis. This is a retrospective, descriptive, observational study of a case series of 14 patients with periocular and orbital amyloidosis and is a review of previously published cases with this diagnosis between September 2004 and January 2015. In this study, we analyzed our 14 patients in conjunction with 69 well-documented cases of orbital and/or periocular amyloidosis previously reported, with a total of 83. Of these, 54 were female (65.1 %), 28 male (33.7 %), and one with unspecified gender. The mean age at diagnosis was 54.9 years (range, 18-87). The localization of the amyloidosis was classified as superficial, deep and combined, with involvement of 53 (63.9 %), 26 (31.3 %), and four cases (4.8 %) in each group, respectively. The main findings in superficial amyloidosis were mass or tissue infiltration (84.9 %) and ptosis (30.2 %) and, in the cases with deep involvement, mass (65.4 %), proptosis (57.7 %), limited ocular movements (34.6 %), ocular displacement (30.8 %), and ptosis (26.9 %). The cases with combined involvement presented with signs and symptoms of the two groups. Regarding the outcome, 43 patients were reported stable after the diagnosis and 21 had recurrence or required new surgical procedures. Periocular and orbital amyloidosis is a rare disease that can present with a variety of symptoms and signs depending on the localization and extension of involvement. Its prompt recognition is important in order to investigate systemic disease, which will affect the prognosis of each case. PMID:26466598

  20. A case of non-lacrimal immunoglobulin G4 (IgG4)-related orbital disease with mastitis.

    PubMed

    Farooq, Tahir Ali; Mudhar, Hardeep; Sandramouli, S

    2016-02-01

    IgG4-related orbital disease is a recognised cause for orbital inflammation. As its awareness increases and diagnostic accuracy improves there will be an increased number of cases being identified. This unique case demonstrates for the first time, with histological evidence, a case of a non-lacrimal IgG4-related orbital disease with concurrent IgG4-related mastitis. We describe a 47 year old who presented with a supraorbital swelling and mass. This was initially successfully treated with oral steroids and was later excised on recurrence. Immunohistochemical and blood serum analysis confirmed IgG4-related orbital disease. On systemic enquiry she was found to have a mass of the breast, which was shown to be IgG4-related mastitis. She is currently asymptomatic with no sign of recurrence and is under long-term surveillance. This case highlights the importance of systemic work up in patients presenting with orbital foci of IgG4 disease. PMID:26700191

  1. Overview of IgG4-Related Tubulointerstitial Nephritis and Its Mimickers.

    PubMed

    Jeong, Hyeon Joo; Shin, Su-Jin; Lim, Beom Jin

    2016-01-01

    Tubulointerstitial nephritis (TIN) is the most common form of renal involvement in IgG4-related disease. It is characterized by a dominant infiltrate of IgG4-positive plasma cells in the interstitium and storiform fibrosis. Demonstration of IgG4-positive plasma cells is essential for diagnosis, but the number of IgG4-positive cells and the ratio of IgG4-positive/IgG-positive plasma cells may vary from case to case and depending on the methods of tissue sampling even in the same case. IgG4-positive plasma cells can be seen in TIN associated with systemic lupus erythematosus, Sjgren syndrome, or anti-neutrophil cytoplasmic antibody-associated vasculitis, which further add diagnostic confusion and difficulties. To have a more clear view of IgG4-TIN and to delineate differential points from other TIN with IgG4-positive plasma cell infiltrates, clinical and histological features of IgG4-TIN and its mimickers were reviewed. In the rear part, cases suggesting overlap of IgG4-TIN and its mimickers and glomerulonephritis associated with IgG4-TIN were briefly described. PMID:26666884

  2. Enterocolic lymphocytic phlebitis as a newly recognized manifestation of IgG4-related disease.

    PubMed

    Laco, Jan; rhalmi, Jlius; Brtov, Jolana; Zimandlov, Dana

    2015-04-01

    Herein we present a case of a 65-year-old woman with enterocolic lymphocytic phlebitis (ELP) who presented with anemic syndrome and in whom severe stenosis of the right flexure of large bowel was detected. The microscopic examination revealed fibrosis of the submucosa and lymphoplasmacytic phlebitis of small veins and venules, whereas arteries were spared. There were 110 IgG4-positive and 160 IgG-positive plasma cells in 1 high-power field, respectively, with corresponding IgG4/IgG ratio of 0.69. The IgG4 serum level was 2.42 g/L. According to the currently proposed criteria, this ELP case is the first that may be diagnosed as definite IgG4-related disease (IgG4-RD). Although based on the sole case description, taken together with a recent review and a case report, we presume that a subset of ELPs is a manifestation of IgG4-RD. PMID:24942897

  3. IgG4-related Kidney Disease Mimicking Malignant Ureter Tumor: Case Report and Literature Review.

    PubMed

    Lei, Wen-Hui; Xin, Jun; Shao, Chu-Xiao; Mao, Ming-Feng; Zhu, Chao-Yong; Wu, Chui-Fen; Jin, Lie

    2016-01-01

    Immunoglobulin G4-related disease is a recently recognized systemic disease that can affect any organ or tissue in the body, including the kidneys. IgG4-related kidney disease (IgG4-RKD) is an important part of immunoglobulin G4-related disease. The most common renal manifestation of IgG4-RKD is tubulointerstitial nephritis and glomerular lesions. There, however, is few case of IgG4-RKD mimicking malignant ureter tumor leading to severe hydronephrosis. We herein report an unusual case of IgG4-RKD mimicking malignancy.A 66-year-old Asian man presented to the nephrologist with soreness of loins, anorexia, and acute kidney injury in 2010. His renal function spontaneously improved after 2 weeks' hemodialysis without systemic steroid therapy. Four years later, he presented to the urologist with severe left hydronephrosis because of marked thickness of the left ureter wall. As a ureteral malignancy could not be ruled out, laparoscopic nephroureterectomy was performed.IgG4-related kidney disease was confirmed by the histologic examination. Then, repeat laboratory test showed almost complete recovery of renal function after initiation of steroidal therapy.This case highlights the rare possibility of IgG4-RKD mimicking malignant ureter tumor. Nephrologist and pathologists should be aware of the possibility that hydronephrosis with ureter obstruction may be involved in IgG4-RKD. PMID:26817905

  4. An Overlapping Case of Lupus Nephritis and IgG4-Related Kidney Disease

    PubMed Central

    Zaarour, Mazen; Weerasinghe, Chanudi; Eter, Ahmad; El-Sayegh, Suzanne; El-Charabaty, Elie

    2015-01-01

    We report a case of a 71-year-old Filipino female who was admitted to the hospital for abdominal pain, vomiting and diarrhea of 8 days duration. The patient was found to have marked acute kidney injury (AKI), which required hemodialysis in the next 3 days. Extensive workup revealed hematuria, subnephrotic range proteinuria, elevated anti-nuclear antibody (ANA) and elevated total immunoglobulin G (IgG) levels, with normal IgG4 and anti-dsDNA levels. On kidney biopsy, mild membranous glomerulonephritis was found, along with autoimmune tubulointerstitial nephritis (TIN) with a “full-house” pattern of immune deposits. These findings were suggestive of lupus interstitial nephritis. However, IgG4+ plasma cells were detected in the interstitium by immunostaining, favoring a diagnosis of IgG4-related kidney disease (IgG4-RKD). Our case highlights the difficulty in differentiating lupus nephritis (LN) from IgG4-RKD in some patients, raising the suspicion that these two entities can co-exist. PMID:26015827

  5. Overview of IgG4-Related Tubulointerstitial Nephritis and Its Mimickers

    PubMed Central

    Jeong, Hyeon Joo; Shin, Su-Jin; Lim, Beom Jin

    2016-01-01

    Tubulointerstitial nephritis (TIN) is the most common form of renal involvement in IgG4-related disease. It is characterized by a dominant infiltrate of IgG4-positive plasma cells in the interstitium and storiform fibrosis. Demonstration of IgG4-positive plasma cells is essential for diagnosis, but the number of IgG4-positive cells and the ratio of IgG4-positive/IgG-positive plasma cells may vary from case to case and depending on the methods of tissue sampling even in the same case. IgG4-positive plasma cells can be seen in TIN associated with systemic lupus erythematosus, Sjögren syndrome, or anti-neutrophil cytoplasmic antibody–associated vasculitis, which further add diagnostic confusion and difficulties. To have a more clear view of IgG4-TIN and to delineate differential points from other TIN with IgG4-positive plasma cell infiltrates, clinical and histological features of IgG4-TIN and its mimickers were reviewed. In the rear part, cases suggesting overlap of IgG4-TIN and its mimickers and glomerulonephritis associated with IgG4-TIN were briefly described. PMID:26666884

  6. IgG4-related disease: A relatively new concept for clinicians.

    PubMed

    Vasaitis, Lilian

    2016-01-01

    IgG4-related disease (IgG4-RD) is a recently recognized chronic fibrotic inflammation, which can affect almost every organ, and may come to clinical attention first due to visible organ swelling or organ dysfunction, or is identified incidentally by imaging and specific biopsy. The disorder has an allergic background and is immune-mediated. Up-regulated responses of T helper 2 and T regulatory cells and their cytokines play a major role in disease progression. About 30-50% of patients are atopic or have mild eosinophilia. IgG4-RD predominantly affects middle-aged male patients. The cornerstones of diagnosis of the disease are compatible clinical features and typical histopathology. Swelling of salivary and lacrimal glands, lymphadenopathy, and type 1 autoimmune pancreatitis (AIP) are the most common manifestations of the disease. However, other tissues and organs, such as retroperitoneum, lung, kidney, aorta, upper airways, thyroid gland, meninges, heart, mesenterium and skin may be involved. Typical histopathology is lymphoplasmacytic infiltration abundant in IgG4-positive plasma cells, storiform-type fibrosis, and obliterative phlebitis. Elevated serum IgG4 concentration supports the diagnosis. Characteristic imaging features such as a "capsule-like rim" surrounding the pancreatic lesions is highly specific to type 1 AIP. 18F-fluorodeoxyglucose positron emission tomography/computed tomography enables mapping the sites of inflammation, permits evaluation of the extent of the disease, helps in guiding biopsy decision, and may be used in monitoring response to treatment. Glucocorticoids alone or in combination with B-cell depletion with rituximab induces prompt clinical response to IgG4-RD. This article reviews the current understanding, different clinical manifestations, and approaches to diagnosis and treatment of IgG4-RD. PMID:26481243

  7. Idiopathic granulomatous orchitis: morphology and evaluation of its relationship to IgG4 related disease.

    PubMed

    Karram, Sarah; Kao, Chia-Sui; Osunkoya, Adeboye O; Ulbright, Thomas M; Epstein, Jonathan I

    2014-04-01

    Idiopathic granulomatous orchitis (IGO) is rare, thought to result from an autoimmune reaction to spermatogenic elements. Its relationship to IgG4-related disease (IgG4-RD) has not been evaluated. Sixteen orchiectomy specimens (1984-2012) with a prominent intratubular granulomatous reaction were reviewed: IGO (n = 6); intratubular germ cell neoplasia unclassified (IGCNU) with a granulomatous reaction and associated seminoma (GS, n = 6); and unclassified intratubular granulomatous orchitis not fitting into a specific entity (UGO, n = 4). Men with IGO were 32 to 86 years old, presenting with a mass suspicious for malignancy. Only one patient had a history of an inflammatory disease. Clinical follow-up was available for 2 patients with IGO, and both had no evidence of systemic IgG4-RD. All IGO cases had an epithelioid granulomatous reaction confined to seminiferous tubules, an extensive interstitial lymphoplasmacytic inflammation, 3 of 6 had prominent interstitial fibrosis, and 3 of 6 cases had plasma cells with an IgG4+/IgG+ ratio >40%. In GS, 10% to 100% of tubules with IGCNU had a granulomatous reaction, which in 3 cases replaced IGCNU cells. In contrast to IGO, GS had more intratubular multinucleated giant cells, more peritubular sclerosis, fewer interstitial plasma cells, and no interstitial fibrosis. Of the 4 UGO cases, most had predominantly interstitial with less intratubular granulomatous inflammation. Only 1 non-IGO case had elevated tissue IgG4 (GS case). It is critical and sometimes difficult to distinguish GS from IGO. IGO shares some features with IgG4-RD, yet current evidence does not support its classification as a localized manifestation of IgG4-RD occurring in the testis. PMID:24656095

  8. IgG4-Related Disease: Results From a Multicenter Spanish Registry

    PubMed Central

    Fernndez-Codina, Andreu; Martnez-Valle, Fernando; Pinilla, Blanca; Lpez, Cristina; DeTorres, Ins; Solans-Laqu, Roser; Fraile-Rodrguez, Guadalupe; Casanovas-Martnez, Arnau; Lpez-Dupla, Miguel; Robles-Marhuenda, ngel; Barragn-Gonzlez, Mara Jess; Cid, Maria Cinta; Prieto-Gonzlez, Sergio; Brito-Zern, Pilar; Cruces-Moreno, Mara Teresa; Fonseca-Aizpuru, Eva; Lpez-Torres, Manuel; Gil, Judith; Nez-Fernndez, Manuel Jess; Pardos-Gea, Jos; Salvador-Cervell, Gonzalo

    2015-01-01

    Abstract IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients. To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients. A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis. Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses. Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent. This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD. PMID:26266361

  9. A rare cause for lower back pain: a case of an IgG4-related periaortitis.

    PubMed

    Löffler, Christian; Hoffend, Johannes; Rebel, Martin; Waldherr, Rüdiger; Uppenkamp, Michael; Bergner, Raoul

    2016-01-01

    IgG4-related disease (IgG4-RD) are a group of autoinflammatory diseases often presenting as tumor-like lesions because of their infiltrative or mass forming behavior. They are characterized by a typical histology consisting of storiform fibrosis, high numbers of infiltrating IgG4-positive plasma cells, obliterative phlebitis, and a moderate presence of eosinophilic cells. Serum IgG4 levels can be elevated. We present a case of a 57 year-old male patient with immobilizing lower back pain, fever, and night sweats. We diagnosed IgG4-related periaortitis using serum IgG4 levels, abdominal ultrasound, PET/CT, and histology. We successfully treated the patient with glucocorticoids (GC) and azathioprine. Periaortitis is a rare presentation of IgG4-RD and therefore noteworthy. It has to be considered in patients with a retroperitoneal mass. PMID:24562718

  10. A Case Report of an Atypical Presentation of IgG4-Related Disease and Idiopathic CD4 Lymphocytopenia.

    PubMed

    Rapisarda, Francesco; Zanoli, Luca; Portale, Grazia; Scuto, Salvo; Castellino, Pietro

    2015-01-01

    The IgG4-related disease is a fibroinflammatory disease characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum levels of IgG4. Idiopathic CD4 lymphocytopenia is a heterogenic and rare syndrome characterized by the detection of a persistent absolute CD4 T cells count <300?cells/mm(3) (or <20% of total T cells) in more than one occasion and no evidence of HIV infection in absence of immunodeficiency or therapy associated with depressed levels of CD4 T cells. We report the case of a 50-year-old man with a multiorgan IgG4-related disease presenting in a temporal association with a profound and symptomatic idiopathic CD4 lymphocytopenia. Both clinical pictures improved after steroid treatment. Idiopathic CD4 lymphocytopenia has been associated with a number of autoimmune conditions but, to the best of our knowledge, this is the first case in which an association with the IgG4-related disease is reported. PMID:26491451

  11. A Case Report of an Atypical Presentation of IgG4-Related Disease and Idiopathic CD4 Lymphocytopenia

    PubMed Central

    Rapisarda, Francesco; Zanoli, Luca; Portale, Grazia; Scuto, Salvo; Castellino, Pietro

    2015-01-01

    The IgG4-related disease is a fibroinflammatory disease characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum levels of IgG4. Idiopathic CD4 lymphocytopenia is a heterogenic and rare syndrome characterized by the detection of a persistent absolute CD4 T cells count <300 cells/mm3 (or <20% of total T cells) in more than one occasion and no evidence of HIV infection in absence of immunodeficiency or therapy associated with depressed levels of CD4 T cells. We report the case of a 50-year-old man with a multiorgan IgG4-related disease presenting in a temporal association with a profound and symptomatic idiopathic CD4 lymphocytopenia. Both clinical pictures improved after steroid treatment. Idiopathic CD4 lymphocytopenia has been associated with a number of autoimmune conditions but, to the best of our knowledge, this is the first case in which an association with the IgG4-related disease is reported. PMID:26491451

  12. [Multiple cranial neuropathies in a patient with IgG4-related hypertrophic pachymeningitis: a case report].

    PubMed

    Tsugawa, Jun; Ouma, Shinji; Fukae, Jiro; Tsuboi, Yoshio; Sakata, Noriyuki; Inoue, Toru

    2014-07-01

    We describe the case of a 75-year-old woman who presented with acute loss of vision. She experienced subacute headache, hearing loss on the left side, hoarseness, and dysphagia during the previous 10 months. On admission, she had bilateral loss of vision, without any ophthalmological abnormalities, and multiple cranial nerve palsies, including left hearing loss and right IX, X, and XI nerve palsies. Head magnetic resonance imaging with contrast enhancement revealed hypertrophic pachymeningitis. Laboratory findings showed no abnormalities except for an increased sedimentation rate and increased C-reactive protein levels. A biopsy of the dura mater was performed, and histopathological analysis revealed inflammatory thickening of the dura mater with plasma cell infiltration; the infiltrating cells were immunoreactive to an anti-IgG4 antibody, thereby indicating an IgG4-related disorder. Furthermore, the histopathological analysis revealed evidence of vasculitis in both veins and arteries. After corticosteroid treatment, her visual acuity dramatically improved. Acute loss of vision with multiple cranial nerve palsies may be an uncommon presentation of IgG4-related hypertrophic pachymeningitis. However, it should be recognized that these conditions might be underdiagnosed. The possibility of central nervous system involvement in IgG4-related disorders should be considered in patients with multiple cranial nerve neuropathies associated with hypertrophic pachymeningitis, even in the absence of systemic sclerosis symptoms. In our case, early treatment with corticosteroids showed immediate effectiveness in correcting the visual symptoms. PMID:24998832

  13. Adnexal Torsion

    MedlinePLUS

    ... the Cervix Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, cutting off the ... diagnosis. Surgery is done immediately to untwist the ovary or to remove it. An ovary and sometimes ...

  14. Chronic sclerosing sialadenitis of the submandibular gland: an entity of IgG4-related sclerosing disease

    PubMed Central

    Wei, Tzu-Wei; Lien, Ching-Feng; Hsu, Tun-Yen; He, Hong-Lin

    2015-01-01

    Chronic sclerosing sialadenitis typically involves the submandibular gland. It usually occurs in the middle-aged and elderly adults with a slight male predominance. Recent evidences have suggested that it is an entity of IgG4-related sclerosing disease and has distinct histopathological features, such as a dense lymphoplasmacytic infiltrate, sclerosis and obliterative phlebitis. It is important to discriminate this entity from other diseases, trying to give effective treatment to the patients. In this report, we described a patient having chronic sclerosing sialadenitis in the submandibular gland. PMID:26339446

  15. Usefulness of Intraductal Ultrasonography in the Diagnosis of Cholangiocarcinoma and IgG4-Related Sclerosing Cholangitis

    PubMed Central

    Naitoh, Itaru; Hayashi, Kazuki

    2012-01-01

    The technique of intraductal ultrasonography (IDUS) of the bile duct with a thin-caliber probe and a ropeway system has provided excellent images of the bile duct and periductal structures and is an easy transpapillary approach. In addition, once the guide wire is inserted into the bile duct, IDUS and transpapillary biopsy after endoscopic retrograde cholangiopancreatography can be performed in a single session. Here, we review the usefulness of IDUS in the diagnosis of cholangiocarcinoma and IgG4-related sclerosing cholangitis. PMID:22977830

  16. Adult Onset Asthma and Periocular Xanthogranuloma (AAPOX), a Rare Entity With a Strong Link to IgG4-Related Disease: An Observational Case Report Study.

    PubMed

    London, Jonathan; Martin, Antoine; Soussan, Michael; Badelon, Isabelle; Gille, Thomas; Uzunhan, Yurdagul; Giroux-Leprieur, Bndicte; Warzocha, Ursula; Rgent, Alexis; Galatoire, Olivier; Dhote, Robin; Abad, Sbastien

    2015-10-01

    Adult onset asthma and periocular xanthogranuloma (AAPOX) is a rare non-Langerhans histiocytosis characterized histopathologically by a periocular infiltration of foamy histiocytes and Touton giant cells. Benign hyperplasia with plasma cell infiltration is classically described in eyelids or lymph nodes of AAPOX patients. It is also a characteristic feature of IgG4-related disease (IgG4-RD), a new entity defined by an IgG4-bearing plasma cell infiltration of organs.To determine if AAPOX syndrome shares clinical, biological, and histopathological characteristics with IgG4-RD, we used the comprehensive clinical diagnostic criteria for IgG4-RD in a retrospective case series of three consecutive patients with histologically-proven AAPOX. Patients who were diagnosed with AAPOX at a French academic referral center for orbital inflammation between November 1996 and March 2013 were enrolled. Biopsies from ocular adnexa or other organs were systematically reexamined. For each patient, clinical and serological data, radiologic findings, and treatment were retrospectively analyzed.Two AAPOX patients fulfilled all of the diagnostic criteria for a definite IgG4-RD. One patient who lacked the serological criteria fulfilled the criteria of a probable IgG4-RD.These 3 cases of AAPOX patients fulfilled the IgG4-RD comprehensive clinical diagnostic criteria. To our knowledge, this is the first observational case report study to clearly show a strong relationship between IgG4-RD and AAPOX syndrome. PMID:26512617

  17. Acquired hemophilia A associated with IgG4-related lung disease in a patient with autoimmune pancreatitis.

    PubMed

    Sugino, Keishi; Gocho, Kyoko; Ishida, Fumiaki; Kikuchi, Naoshi; Hirota, Nao; Sato, Keita; Sano, Go; Isobe, Kazutoshi; Sakamoto, Susumu; Takai, Yujiro; Hata, Yoshinobu; Shibuya, Kazutoshi; Uekusa, Toshimasa; Kurosaki, Atsuko; Homma, Sakae

    2012-01-01

    Immunoglobulin G4 (IgG4)-related lung diseases can occur in patients with autoimmune pancreatitis (AIP). However, the causal relationship between AIP and acquired hemophilia A (AH) is unknown. We herein report the first case of AH associated with IgG4-related lung disease that developed in a patient with AIP. A 65-year-old asymptomatic man with a history of AIP and sclerosing cholangitis diagnosed at the age of 57 was admitted to our hospital due to an abnormal reticulonodular shadow on chest X-ray. An examination of lung biopsy specimens revealed IgG4-positive plasma cell infiltration in the interstitium. The serum IgG4 level was elevated. One year later, the patient developed a progressive severe hematoma in the left femoral muscle. On admission, laboratory examinations revealed severe anemia with a markedly prolonged activated partial prothrombin time, a decreased level of factor VIII (FVIII) activity, and the existence of anti-FVIII antibodies. These findings were consistent with a diagnosis of AH. No relapse has been observed over the past 25 months, during which time, corticosteroid therapy has been continuously administered. PMID:23154722

  18. A novel clinical entity, IgG4-related disease (IgG4RD): general concept and details.

    PubMed

    Umehara, Hisanori; Okazaki, Kazuichi; Masaki, Yasufumi; Kawano, Mitsuhiro; Yamamoto, Motohisa; Saeki, Takako; Matsui, Shoko; Sumida, Takayuki; Mimori, Tsuneyo; Tanaka, Yoshiya; Tsubota, Kazuo; Yoshino, Tadashi; Kawa, Shigeyuki; Suzuki, Ritsuro; Takegami, Tsutomu; Tomosugi, Naohisa; Kurose, Nozomu; Ishigaki, Yasuhito; Azumi, Atsushi; Kojima, Masaru; Nakamura, Shigeo; Inoue, Dai

    2012-02-01

    IgG4-related disease (IgG4RD) is a novel clinical disease entity characterized by elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4-positive plasma cells. IgG4RD may be present in a certain proportion of patients with a wide variety of diseases, including Mikulicz's disease, autoimmune pancreatitis, hypophysitis, Riedel thyroiditis, interstitial pneumonitis, interstitial nephritis, prostatitis, lymphadenopathy, retroperitoneal fibrosis, inflammatory aortic aneurysm, and inflammatory pseudotumor. Although IgG4RD forms a distinct, clinically independent disease category and is attracting strong attention as a new clinical entity, many questions and problems still remain to be elucidated, including its pathogenesis, the establishment of diagnostic criteria, and the role of IgG4. Here we describe the concept of IgG4RD and up-to-date information on this emerging disease entity. PMID:21881964

  19. IgG4-related disease and its pathogenesiscross-talk between innate and acquired immunity

    PubMed Central

    Nakajima, Akio; Nakamura, Takuji; Kawanami, Takafumi; Tanaka, Masao; Dong, Lingli; Kawano, Mitsuhiro

    2014-01-01

    IgG4-related disease (IgG4-RD) is a novel clinical entity proposed in Japan in the 21th century and is attracting strong attention over the world. The characteristic manifestations of IgG4-RD are increased serum IgG4 concentration and tumefaction by IgG4+ plasma cells. Although the clinical manifestations in various organs have been established, the pathogenesis of IgG4-RD is still unknown. Recently, many reports of aberrant acquired immunity such as Th2-diminated immune responses have been published. However, many questions still remain, including questions about the pathogenesis of IgG4-RD and the roles of IgG4. In this review, we discuss the pathogenesis of IgG4-RD by focusing on the cross-talk between innate and acquired immunity. PMID:25024397

  20. Inflammatory angiomyolipoma of the liver: an unusual case suggesting relationship to IgG4-related pseudotumor

    PubMed Central

    Agaimy, Abbas; Mrkl, Bruno

    2013-01-01

    Hepatic angiomyolipoma (AML) is rare. Based on its wide histomorphological range, several distinctive histological variants have been delineated. However, hepatic AML displaying predominantly or exclusively inflammatory pattern closely mimicking inflammatory pseudotumor (IPT) is exceptionally rare with only 7 cases reported so far. We herein describe a new case of hepatic inflammatory AML in a 51-year-old woman who presented with unexplained constitutional symptoms suggesting an infectious disease. A liver mass was detected during imaging examination and resected (4.3 cm in maximum diameter). The patients symptoms resolved completely after surgery. Currently, she is alive and well 7 years after surgery. She has no evidence of other organ manifestations of IgG4-related systemic disease. The tumor displayed a pure IPT-like histological pattern with dense infiltrates of plasma cells, lymphocytes and histiocytes admixed with scattered few adipocytes, irregularly distributed thick-walled vessels (some of them showed obliterative phlebitis) as well as aggregates and fascicles of histiocytoid and spindle-shaped myoid cells that were immunoreactive for HMB45 and Melan A with focal expression of alpha smooth muscle actin. Lesional cells were negative for desmin, protein S100, CD21, CD23, CD15, CD30, HepPar-1, pankeratin (KL-1), ALK1, and EBV in situ hybridization (EBER). The surrounding liver parenchyma showed striking lymphoplasmacytic non-destructive pericholangitis. Numerous scattered and aggregated IgG4 positive plasma cells were seen within the mass and in the peritumoral inflammatory lesions (mean, 37 cells/HPF; IgG4: IgG ratio = 28%). To our knowledge, this is the first report of hepatic inflammatory AML closely resembling IgG4-related IPT of the liver. A possible role for IgG4 seems likely to explain the peculiar histological features and the unusual clinical presentation in this case. PMID:23573326

  1. Rituximab for the Treatment of IgG4-Related Tubulointerstitial Nephritis: Case Report and Review of the Literature.

    PubMed

    McMahon, Blaithin A; Novick, Tessa; Scheel, Paul J; Bagnasco, Serena; Atta, Mohamed G

    2015-08-01

    Immunoglobulin type gamma 4 (IgG4)-related disease is a relatively newly described clinical entity characterized by a distinctive histopathological appearance, increased numbers of IgG4 positive plasma cells and often, but not always, elevated serum IgG4 concentrations. The most common renal manifestation of IgG4-related disease is tubulointerstitial nephritis marked with proteinuria, hematuria, decreased kidney function, hypocomplementemia, and radiologic abnormalities. Renal biopsy characteristics include dense lymphoplasmacytic tubulointerstitial nephritis that stains for IgG4, storiform fibrosis, and immune complex deposition in the interstitium and along tubule basement membranes. Treatment traditionally consists of prolonged glucocorticoids but cases refractory to glucocorticoids have been reported.We report a case of a 58-year-old Caucasian man who presented with fatigue, 50 pound weight loss, dyspnea, lymphadenopathy, and nephromegaly. The patient was first misdiagnosed as chronic interstitial nephritis secondary to renal sarcoid and was treated with repeated doses of prednisone. On his third relapse, he underwent a repeat renal biopsy and a diagnosis of IgG4-tubulointerstitial nephritis was confirmed. He was refractory to treatment with prednisone. The patient received Rituximab and had prompt sustained improvement in renal function. At 1 year post Rituximab treatment, his serum creatinine remains at baseline and imaging study revealed reduction in his kidney size.This is the first case report using Rituximab as a steroid sparing option for refractory IgG4-tubulointerstitial nephritis. More information is needed on the long-term effects of using of B-cell depleting agents for glucocorticoid resistant IgG4-tubulointerstitial nephritis. PMID:26266393

  2. Long-term outcomes of first-line treatment with doxycycline in patients with previously untreated ocular adnexal marginal zone B cell lymphoma.

    PubMed

    Han, Jae Joon; Kim, Tae Min; Jeon, Yoon Kyung; Kim, Mee Kum; Khwarg, Sang In; Kim, Chul-Woo; Kim, Il Han; Heo, Dae Seog

    2015-04-01

    Ocular adnexal lymphoma (OAL) has been associated with Chlamydophila psittaci infection, for which doxycycline has been suggested as a treatment option. We conducted this study to evaluate the long-term results of first-line doxycycline treatment in patients with OAL. Ninety patients with histologically confirmed OAL with marginal zone B cell lymphoma were enrolled. Each patient received one or two cycles of doxycycline (100 mg bid) for 3 weeks. After a median follow-up period of 40.5 months (8-85), the 5-year progression-free survival (PFS) rate was 60.9 %. All patients were alive at the last follow-up date. Thirty-one patients (34 %) showed local treatment failure without systemic spread. However, PFS rate in these patients was 100 % after salvage chemotherapy and/or radiotherapy. PFS was independently predicted in multivariate analysis by the tumor-node-metastasis (TNM) staging (hazard ratio [HR], 4.35; 95 % confidence interval [CI], 2.03-9.32; P < 0.001) and number of cycles of doxycycline (HR, 0.31; 95 % CI, 0.14-0.69; P = 0.004). No serious adverse event was reported during doxycycline therapy. In conclusion, first-line doxycycline therapy was effective and safe. Patients who failed to respond to doxycycline therapy were successfully salvaged with chemotherapy and/or radiotherapy without compromising long-term outcomes. Patients with T1N0M0 disease could be considered good candidates for first-line doxycycline. PMID:25338969

  3. Long-Term Outcome and Patterns of Failure in Primary Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiotherapy

    SciTech Connect

    Hashimoto, Naoki; Sasaki, Ryohei; Nishimura, Hideki; Yoshida, Kenji; Miyawaki, Daisuke; Nakayama, Masao; Uehara, Kazuyuki; Okamoto, Yoshiaki; Ejima, Yasuo; Azumi, Atsushi; Matsui, Toshimitsu; Sugimura, Kazuro

    2012-03-15

    Purpose: To evaluate the long-term treatment outcome and disease behavior of primary ocular adnexal MALT (mucosa-associated lymphoid tissue) lymphoma (POAML) after treatment with radiotherapy. Methods and Materials: Seventy-eight patients (42 male, 36 female) diagnosed with stage I POAML between 1991 and 2010 at Kobe University Hospital were included. The median age was 60 years (range, 22-85 years). The median radiation dose administered was 30.6 Gy. Rituximab-based targeted therapy and/or chemotherapy was performed in 20 patients (25.6%). Local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. Results: The median follow-up duration was 66 months. Major tumor sites were conjunctiva in 37 patients (47.4%), orbita in 29 (37.2%), and lacrimal glands in 12 (15.4%). The 5- and 10-year OS rates were 98.1% and 95.3%, respectively. The 5- and 10-year LC rates were both 100%, and the 5- and 10-year RFS rates were 88.5% and 75.9%, respectively. Patients treated with a combination of radiotherapy and targeted therapy and/or chemotherapy had a trend for a better RFS compared with those treated with radiotherapy alone (p = 0.114). None developed greater than Grade 2 acute morbidity. There were 14 patients who experienced Grade 2 morbidities (cataract: 14; retinal disorders: 7; dry eye: 3), 23 patients who had Grade 3 morbidities (cataract: 23; dry eye: 1), and 1 patient who had Grade 4 glaucoma. Conclusions: Radiotherapy for POAML was shown to be highly effective and safe for LC and OS on the basis of long-term observation. The absence of systemic relapse in patients with combined-modality treatment suggests that lower doses of radiation combined with targeted therapy may be worth further study.

  4. Localized Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy: A Long-Term Outcome in 86 Patients With 104 Treated Eyes

    SciTech Connect

    Harada, Ken; Murakami, Naoya; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Yoshio, Kotaro; Inaba, Koji; Morota, Madoka; Ito, Yoshinori; Sumi, Minako; Suzuki, Shigenobu; Tobinai, Kensei; Uno, Takashi; Itami, Jun

    2014-03-01

    Purpose: To evaluate the natural history, behavior of progression, prognostic factors, and treatment-related adverse effects of primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML). Methods and Materials: Eighty-six patients with histologically proven stage I POAML treated with radiation therapy at National Cancer Center Hospital, Tokyo between 1990 and 2010 were retrospectively reviewed. The median age was 56 years (range, 18-85 years). The median dose administered was 30 Gy (range, 30-46 Gy). Seventy-seven patients (90%) were treated by radiation therapy alone. Results: The median follow-up duration was 9 years (range, 0.9-22 years). The 5- and 10-year overall survival (OS) rates were 97.6% and 93.5%, respectively, and no patients died of lymphoma. Patients with tumor sizes ≥4 cm showed a greater risk of contralateral relapse (P=.012). Six patients with contralateral relapse were seen and treated by radiation therapy alone, and all the lesions were controlled well, with follow-up times of 3 to 12 years. There was 1 case of local relapse after radiation therapy alone, and 3 cases of relapse occurred in a distant site. Cataracts developed in 36 of the 65 eyes treated without lens shielding and in 12 of the 39 patients with lens shielding (P=.037). Conclusions: The majority of patients with POAML showed behavior consistent with that of localized, indolent diseases. Thirty gray of local irradiation seems to be quite effective. The initial bilateral involvement and contralateral orbital relapses can be also controlled with radiation therapy alone. Lens shielding reduces the risk of cataract.

  5. Successful treatment of pediatric IgG4 related systemic disease with mycophenolate mofetil: case report and a review of the pediatric autoimmune pancreatitis literature

    PubMed Central

    2011-01-01

    Autoimmune pancreatitis is frequently associated with elevated serum and tissue IgG4 levels in the adult population, but there are few reports of pediatric autoimmune pancreatitis, and even fewer reports of IgG4 related systemic disease in a pediatric population. The standard of care treatment in adults is systemic corticosteroids with resolution of symptoms in most cases; however, multiple courses of corticosteroids are occasionally required and some patients require long term corticosteroids. In these instances, steroid sparing disease modify treatments are in demand. We describe a 13-year-old girl with IgG4 related systemic disease who presented with chronic recurrent autoimmune pancreatitis resulting in surgical intervention for obstructive hyperbilirubinemia and chronic corticosteroid treatment. In addition, she developed fibrosing medianstinitis as part of her IgG4 related systemic disease. She was eventually successfully treated with mycophenolate mofetil allowing for discontinuation of corticosteroids. This is the first reported use of mycophenolate mofetil for IgG4 related pancreatitis. Although autoimmune pancreatitis as part of IgG4 related systemic disease is rarely reported in pediatrics, autoimmune pancreatitis is also characterized as idiopathic fibrosing pancreatitis. All pediatric autoimmune pancreatitis cases reported in the world medical literature were identified via a PUBMED search and are reviewed herein. Twelve reports of pediatric autoimmune pancreatitis were identified, most of which were treated with corticosteroids or surgical approaches. Most case reports failed to report IgG4 levels, so it remains unclear how commonly IgG4 related autoimmune pancreatitis occurs during childhood. Increased evaluation of IgG4 levels in patients with autoimmune pancreatitis may shed further light on the association of IgG4 with pancreatitis and the underlying pathophysiology. PMID:21205323

  6. De novo oligoclonal expansions of circulating plasmablasts in active and relapsing IgG4-related disease

    PubMed Central

    Mattoo, Hamid; Mahajan, Vinay S.; Della-Torre, Emanuel; Sekigami, Yurie; Carruthers, Mollie; Wallace, Zachary S.; Deshpande, Vikram; Stone, John H.; Pillai, Shiv

    2014-01-01

    Background IgG4-related disease (IgG4-RD) is a poorly understood, multi-organ, chronic inflammatory disease characterized by tumefactive lesions, storiform fibrosis, obliterative phlebitis and the accumulation of IgG4-expressing plasma cells at disease sites. Objective The role of B cells and IgG4 antibodies in IgG4-RD pathogenesis is not well defined. We evaluated patients with IgG4-RD for activated B cells in disease lesions as well as peripheral blood and investigated their role in disease pathogenesis. Methods B cell populations were analyzed from the peripheral blood of 84 patients with active IgG4-RD using flow cytometry. The repertoire of B cell populations was analyzed in a subset of patients by Next-generation Sequencing. Fourteen of these patients, were longitudinally followed for 9-15 months after Rituximab therapy. Results CD19+CD27+CD20-CD38hi plasmablasts, which are largely IgG4+, are elevated in patients with active IgG4-RD. These expanded plasmablasts are oligoclonal, exhibit extensive somatic hypermutation and their numbers decline following rituximab-mediated B-cell depletion therapy; this loss correlates with disease remission. A subset of patients relapse after rituximab therapy, and circulating plasmablasts that re-emerge in these subjects are clonally distinct and exhibit enhanced somatic hypermutation. Cloning and expression of Ig heavy and light chain genes from expanded plasmablasts at the peak of disease reveals that disease-associated IgG4 antibodies are self-reactive. Conclusions Clonally expanded CD19+CD27+CD20-CD38hi plasmablasts are a hallmark of active IgG4-RD. Enhanced somatic mutation in activated B cells and plasmablasts and emergence of distinct plasmablast clones upon relapse indicate that the disease pathogenesis is linked to de novo recruitment of nave B cells into T-dependent responses by CD4+ T cells, likely driving a self-reactive disease process. PMID:24815737

  7. Diagnostic Performance of Serum IgG4 Levels in Patients With IgG4-Related Disease

    PubMed Central

    Yu, Kuang-Hui; Chan, Tien-Ming; Tsai, Ping-Han; Chen, Ching-Hui; Chang, Pi-Yueh

    2015-01-01

    Abstract The aim of this study is to study the clinical features and diagnostic performance of IgG4 in Chinese populations with IgG4-related diseases (IgG4-RDs). The medical records of 2901 adult subjects who underwent serum IgG4 level tests conducted between December 2007 and May 2014 were reviewed. Serum concentrations of IgG4 were measured in 2901 cases, including 161 (5.6%) patients with IgG4-RD and 2740 (94.4%) patients without IgG4-RD (non-IgG4-RD group). The mean age of the IgG4-RD patients was 58.4??16.1 years (range: 2187), and 48 (29.8%) were women. The mean serum IgG4 level was significantly much higher in IgG4-RD patients than in non-IgG4-RD (1062.6 vs 104.3?mg/dL, P?135?mg/dL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR)+, and LR? were 86%, 77%, 18%, 99%, 3.70, and 0.19, respectively. When the upper limit of normal was doubled for an IgG4 >270?mg/dL, the corresponding data were 75%, 94%, 43%, 98%, 12.79, and 0.26, respectively. For IgG4 >405?mg/dL (tripling the upper limit of normal), the corresponding data were 62%, 98%, 68%, 98%, 37.00, and 0.39, respectively. When calculated according to the manufacturer's package insert cutoff (>201?mg/dL) for the diagnosis of IgG4-RD, the corresponding sensitivity, specificity, PPV, NPV, LR+, and LR? were 80%, 89%, 29%, 99%, 7.00, and 0.23, respectively. For IgG4 >402?mg/dL (>2 the upper limit of the normal range), the corresponding data were 62%, 98%, 68%, 98%, 36.21, and 0.39, respectively. For IgG4 >603?mg/dL (>3 the upper limit of the normal range), the corresponding data were 50%, 99%, 84%, 97%, 90.77 and 0.51, respectively. The optimal cutoff value of serum IgG4 (measured by nephelometry using a Siemens BN ProSpec instrument and Siemens reagent) for the diagnosis of IgG4-RD was 248?mg/dL, the sensitivity and specificity were 77.6% and 92.8%, respectively. The present study demonstrated that 2 or 3 times the upper limit of the manufacturer's reference range of the IgG4 level was a useful marker for the diagnosis of various types of IgG4-RD and the optimal cutoff level was 248?mg/dL. PMID:26469909

  8. Type 1 Autoimmune Pancreatitis and IgG4-Related Sclerosing Cholangitis Is Associated With Extrapancreatic Organ Failure, Malignancy, and Mortality in a Prospective UK Cohort

    PubMed Central

    Kumar, M.; Hurst, J.M.; Rodriguez-Justo, M.; Chapman, M.H.; Johnson, G.J.; Pereira, S.P.; Chapman, R.W.

    2015-01-01

    OBJECTIVES Type I autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-related SC) are now recognized as components of a multisystem IgG4-related disease (IgG4-RD). We aimed to define the clinical course and long-term outcomes in patients with AIP/IgG4-SC recruited from two large UK tertiary referral centers. METHODS Data were collected from 115 patients identified between 2004 and 2013, and all were followed up prospectively from diagnosis for a median of 33 months (range 1107), and evaluated for response to therapy, the development of multiorgan involvement, and malignancy. Comparisons were made with national UK statistics. RESULTS Although there was an initial response to steroids in 97%, relapse occurred in 50% of patients. IgG4-SC was an important predictor of relapse (P < 0.01). Malignancy occurred in 11% shortly before or after the diagnosis of IgG4-RD, including three hepatopancreaticobiliary cancers. The risk of any cancer at diagnosis or during follow-up when compared with matched national statistics was increased (odds ratio = 2.25, CI = 1.123.94, P = 0.02). Organ dysfunction occurred within the pancreas, liver, kidney, lung, and brain. Mortality occurred in 10% of patients during follow-up. The risk of death was increased compared with matched national statistics (odds ratio = 2.07, CI = 1.073.55, P = 0.02). CONCLUSIONS Our findings suggest that AIP and IgG4-SC are associated with significant morbidity and mortality owing to extrapancreatic organ failure and malignancy. Detailed clinical evaluation for evidence of organ dysfunction and associated malignancy is required both at first presentation and during long-term follow-up. PMID:25155229

  9. A Patient with Autoimmune Pancreatitis Type 1 with Previously Known Lymphadenopathy, Both in the Context of IgG4-related Disease

    PubMed Central

    Alidjan, Fazil M.; Karim, Faiz; Verdijk, Rob M.; van Esser, Joost W.; van Heerde, Marianne J.

    2015-01-01

    Patient: Male, 62 Final Diagnosis: Auto-immune pancreatitis Symptoms: Jaundice lymfadenopathy Medication: Clinical Procedure: Laboratory imaging Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: Autoimmune pancreatitis (AIP) is an important clinical pathologic concept of IgG-4-related disease. AIP is a rare cause of chronic pancreatitis, characterized by a fibroinflammatory process by lymphoplasmacytic infiltrates, storiform fibrosis, obliterative phlebitis, and increased IgG4+ plasma cells, leading to dysfunction of the pancreas. Affected patients with AIP frequently have disease affecting other organs or sites with similar histologic changes, elevated IgG4+ plasma cell infiltrate, and good response to corticosteroid therapy. These diseases often are not limited to the pancreas and the pancreas may not be involved at all. Case Report: We report a 62-year-old man with obstructive jaundice with pre-existent submandibular lymphadenopathy. Diagnosis of AIP was based on diagnostic criteria by the HISORT-criteria in combination with elevated IgG-4 serum levels. CT revealed a focal enlargement of the head of the pancreas, as well as mesenteric peripancreatic and mediastinal lymphadenopathy. He was treated with high-dose steroid in combination with azathioprine and showed good clinical response. Conclusions: We report a case with pre-existent submandibular lymphadenopathy and obstructive jaundice based on AIP type 1, both in the context of IgG4-related disease. PMID:26537530

  10. Ocular Sarcoidosis.

    PubMed

    Pasadhika, Sirichai; Rosenbaum, James T

    2015-12-01

    Sarcoidosis is one of the leading causes of inflammatory eye disease. Ocular sarcoidosis can involve any part of the eye and its adnexal tissues and may cause uveitis, episcleritis/scleritis, eyelid abnormalities, conjunctival granuloma, optic neuropathy, lacrimal gland enlargement, and orbital inflammation. Glaucoma and cataract can be complications from inflammation itself or adverse effects from therapy. Ophthalmic manifestations can be isolated or associated with other organ involvement. Patients with ocular sarcoidosis can present with a wide range of clinical presentations and severity. Multidisciplinary approaches are required to achieve the best treatment outcomes for both ocular and systemic manifestations. PMID:26593141

  11. DNA Microarray Analysis of Submandibular Glands in IgG4-Related Disease Indicates a Role for MARCO and Other Innate Immune-Related Proteins.

    PubMed

    Ohta, Miho; Moriyama, Masafumi; Maehara, Takashi; Gion, Yuka; Furukawa, Sachiko; Tanaka, Akihiko; Hayashida, Jun-Nosuke; Yamauchi, Masaki; Ishiguro, Noriko; Mikami, Yurie; Tsuboi, Hiroto; Iizuka-Koga, Mana; Kawano, Shintaro; Sato, Yasuharu; Kiyoshima, Tamotsu; Sumida, Takayuki; Nakamura, Seiji

    2016-02-01

    IgG4-related disease (IgG4-RD) is a novel systemic disease entity characterized by elevated serum IgG4 and tissue infiltration of IgG4-positive plasma cells accompanied by severe fibrosis. Although recent studies demonstrated that innate immune cells including monocytes and macrophages might promote local fibrosis and IgG4 production, the pathological mechanism remains unclear. In this study, we sought to identify the disease-associated genes, especially innate immune molecules.Gene expression was analyzed by DNA microarray in submandibular glands (SMGs) from patients with IgG4-RD (n = 5), chronic sialoadenitis (CS) (n = 3), and controls (n = 3). Differentially expressed genes (DEGs) were validated by real-time polymerase chain reaction (PCR) and immunohistochemical staining in IgG4-RD (n = 18), CS (n = 4), Sjögren syndrome (n = 11), and controls (n = 10).Gene expression patterns in the 3 groups were quite different from each other by the pvclust method and principal components analysis. In IgG4-RD, 1028 upregulated genes and 692 downregulated genes were identified as DEGs (P < 0.05). Gene Ontology (GO) term analysis indicated that the upregulated DEGs in IgG4-RD encoded proteins involved in T/B cell activation and chemotaxis. PCR validated significantly higher expression of macrophage receptor with collagenous structure (MARCO), a pattern-recognition receptor, in IgG4-RD compared with the other groups (P < 0.01). Immunohistochemical analysis confirmed that the expression pattern of MARCO was similar to that of the M2 macrophage marker CD163.MARCO was identified as a disease-associated molecule in IgG4-RD by DNA microarray. Moreover, M2 macrophages might contribute to the initiation of IgG4-RD via MARCO. PMID:26886650

  12. Decreased Expression of Innate Immunity-Related Genes in Peripheral Blood Mononuclear Cells from Patients with IgG4-Related Disease

    PubMed Central

    Nakajima, Akio; Masaki, Yasufumi; Nakamura, Takuji; Kawanami, Takafumi; Ishigaki, Yasuhito; Takegami, Tsutomu; Kawano, Mitsuhiro; Yamada, Kazunori; Tsukamoto, Norifumi; Matsui, Shoko; Saeki, Takako; Okazaki, Kazuichi; Kamisawa, Terumi; Miyashita, Taiichiro; Yakushijin, Yoshihiro; Fujikawa, Keita; Yamamoto, Motohisa; Hamano, Hideaki; Origuchi, Tomoki; Hirata, Shintaro; Tsuboi, Hiroto; Sumida, Takayuki; Morimoto, Hisanori; Sato, Tomomi; Iwao, Haruka; Miki, Miyuki; Sakai, Tomoyuki; Fujita, Yoshimasa; Tanaka, Masao; Fukushima, Toshihiro; Okazaki, Toshiro; Umehara, Hisanori

    2015-01-01

    Background IgG4-related disease (IgG4-RD) is a new clinical entity of unknown etiology characterized by elevated serum IgG4 and tissue infiltration by IgG4-positive plasma cells. Although aberrancies in acquired immune system functions, including increases in Th2 and Treg cytokines observed in patients with IgG4-RD, its true etiology remains unclear. To investigate the pathogenesis of IgG4-RD, this study compared the expression of genes related to innate immunity in patients with IgG4-RD and healthy controls. Materials and Methods Peripheral blood mononuclear cells (PBMCs) were obtained from patients with IgG4-RD before and after steroid therapy and from healthy controls. Total RNA was extracted and DNA microarray analysis was performed in two IgG4-RD patients to screen for genes showing changes in expression. Candidate genes were validated by real-time RT-PCR in 27 patients with IgG4-RD and 13 healthy controls. Results DNA microarray analysis identified 21 genes that showed a greater than 3-fold difference in expression between IgG4-RD patients and healthy controls and 30 genes that showed a greater than 3-fold change in IgG4-RD patients following steroid therapy. Candidate genes related to innate immunity, including those encoding Charcot–Leyden crystal protein (CLC), membrane-spanning 4-domain subfamily A member 3 (MS4A3), defensin alpha (DEFA) 3 and 4, and interleukin-8 receptors (IL8R), were validated by real-time RT-PCR. Expression of all genes was significantly lower in IgG4-RD patients than in healthy controls. Steroid therapy significantly increased the expression of DEFA3, DEFA4 and MS4A3, but had no effect on the expression of CLC, IL8RA and IL8RB. Conclusions The expression of genes related to allergy or innate immunity, including CLC, MS4A3, DEFA3, DEFA4, IL8RA and IL8RB, was lower in PBMCs from patients with IgG4-RD than from healthy controls. Although there is the limitation in the number of patients applied in DNA microarray, impaired expression of genes related to innate immunity may be involved in the pathogenesis of IgG4-RD as well as in abnormalities of acquired immunity. PMID:25973893

  13. IgG4-related tubulointerstitial nephritis associated with only lymphadenopathy and without elevated serum IgG4 or renal imaging abnormalities: a case report and literature review

    PubMed Central

    Qiao, Xi; Wang, Lihua; Wang, Chen; Gao, Lifang; Yao, Shulei; Wu, Liran; Zhang, Xiaoqin

    2015-01-01

    IgG4-related tubulointerstitial nephritis (IgG4-TIN) is the most common renal manifestation of IgG4-related kidney disease (IgG4-RKD) and may cause acute or chronic renal dysfunction. Imaging often shows heterogeneous densities in the kidneys, such as a mass or multiple nodules. Serology usually demonstrates high levels of serum IgG4 and total IgG. Most patients have other organs involvement by IgG4 related disease. Although lymphadenopathy is frequently observed in patients with IgG4-TIN, it is rarely presented as the only extrarenal lesion. Herein, we present a rare case of IgG4-TIN associated with only lymphadenopathy and without elevated serum IgG4 or renal imaging abnormalities. A 61-year-old Chinese man was admitted to our hospital with seven months history of generalized lymphadenopathy and five months history of renal dysfunction. His renal imaging was normal. He had no current or previous clinical, radiographic, and/or histologic evidence of other organ involvement except for the lymphadenopathy. Renal biopsy indicated plasma cell-rich TIN with an increased number of IgG4-positive plasma cells and storiform fibrosis. Repeated lymph nodes biopsy revealed IgG4-related lymphadenopathy. However, he did not have elevated serum IgG4 or total IgG levels. Oral prednisone therapy improved his renal function and lymphadenopathy. These findings supported our final diagnosis of IgG4-TIN. Clinicians should be aware of this condition and steroid therapy should be considered for such patients. An early diagnosis and appropriate therapy can induce remission and preserve renal function. PMID:26770608

  14. Management of ocular, orbital, and adnexal trauma

    SciTech Connect

    Spoor, T.C.; Nesi, F.A.

    1988-01-01

    This book contains 20 chapters. Some of the chapter titles are: The Ruptured Globe: Primary Care; Corneal Trauma, Endophthalmitis; Antibiotic Usage; Radiology of Orbital Trauma; Maxillofacial Fractures; Orbital Infections; and Basic Management of Soft Tissue Injury.

  15. Ocular Adnexal Lymphoma Presenting with Visual Loss

    PubMed Central

    Gulati, Shuchi; Corrêa, Zélia M.; Karim, Nagla; Medlin, Stephen

    2016-01-01

    Context: Elderly patients with visual loss often have age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract as common causes of visual loss. Other less common etiologies should be considered, especially in those presenting with systemic associations. Case Report: The patient discussed in our review is an 80-year-old female, with a history of diabetic retinopathy and macular degeneration who presented with a sudden deterioration of vision. While this was initially attributed to diabetic retinopathy, she was eventually noted to have a salmon patch lesion in her conjunctiva, diagnosed on biopsy to be a diffuse large B-cell lymphoma. Conclusion: Because of the significant rate of disseminated disease among patients with lymphomas in the orbit that carries a worse prognosis, early diagnosis is essential to promote better overall survival of these patients. We describe here a patient diagnosed with conjunctival lymphoma associated with pronounced visual loss and review the literature on this subject. PMID:27011948

  16. Microcystic adnexal carcinoma simulating scarring alopecia*

    PubMed Central

    Castanon, Maria Christina Marques Nogueira; Casali, Sandra Maria Gasparete; Lamim, Raul Fernando Binato; Nagahama, Marina Vieira; Silva, Camila Bastos Xavier Vassimon; de Carvalho, Rafael Guerra Nannetti

    2015-01-01

    The microcystic adnexal carcinoma is a rare, locally aggressive malignant adnexal neoplasm associated with signifi cant morbidity. It is often underdiagnosed due to clinical and histopathological resemblance with other cutaneous neoplasms and / or a combination of lack of familiarity associated with inadequate samples. We report a case with clinical hypothesis of scarring alopecia and histopathological diagnosis of microcystic adnexal carcinoma with favorable outcome in a follow-up of eleven years, after surgical treatment. PMID:26312669

  17. Increased IgG4 responses to multiple food and animal antigens indicate a polyclonal expansion and differentiation of pre-existing B cells in IgG4-related disease

    PubMed Central

    Culver, Emma L; Vermeulen, Ellen; Makuch, Mateusz; van Leeuwen, Astrid; Sadler, Ross; Cargill, Tamsin; Klenerman, Paul; Aalberse, Rob C; van Ham, S Marieke; Barnes, Eleanor; Rispens, Theo

    2015-01-01

    Background IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition, characterised by an elevated serum IgG4 concentration and abundant IgG4-positive plasma cells in the involved organs. An important question is whether the elevated IgG4 response is causal or a reflection of immune-regulatory mechanisms of the disease. Objectives To investigate if the IgG4 response in IgG4-RD represents a generalised polyclonal amplification by examining the response to common environmental antigens. Methods Serum from 24 patients with IgG4-RD (14 treatment-naive, 10 treatment-experienced), 9 patients with primary sclerosing cholangitis and an elevated serum IgG4 (PSC-high IgG4), and 18 healthy controls were tested against egg white and yolk, milk, banana, cat, peanut, rice and wheat antigens by radioimmunoassay. Results We demonstrated an elevated polyclonal IgG4 response to multiple antigens in patients with IgG4-RD and in PSC-high IgG4, compared with healthy controls. There was a strong correlation between serum IgG4 and antigen-specific responses. Responses to antigens were higher in treatment-naive compared with treatment-experienced patients with IgG4-RD. Serum electrophoresis and immunofixation demonstrated polyclonality. Conclusions This is the first study to show enhanced levels of polyclonal IgG4 to multiple antigens in IgG4-RD. This supports that elevated IgG4 levels reflect an aberrant immunological regulation of the overall IgG4 response, but does not exclude that causality of disease could be antigen-driven. PMID:25646372

  18. Antibiotic therapy for ocular infection.

    PubMed Central

    Snyder, R W; Glasser, D B

    1994-01-01

    Infections of the eye can rapidly damage important functional structures and lead to permanent vision loss or blindness. Broad-spectrum antibiotics should be administered to the appropriate site of infection as soon as a diagnosis is made. Topical drops are preferred for corneal and conjunctival infections. Intravitreal antibiotics, and possibly subconjunctival and parenteral antibiotics, are preferred for endophthalmitis. Parenteral antibiotics are recommended for infection in deep adnexal structures. We review specific aspects of antibiotic therapy for ocular and periocular infection. PMID:7856158

  19. Ocular Hypertension

    MedlinePLUS

    ... News Ask an Eye M.D. Espaol Ocular Hypertension What Is Ocular Hypertension? Ocular Hypertension Causes Ocular ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Written by: Kierstan Boyd Reviewed by: J Kevin ...

  20. Rituximab as Single Agent in Primary MALT Lymphoma of the Ocular Adnexa.

    PubMed

    Annibali, Ombretta; Chiodi, Francesca; Sarlo, Chiara; Cortes, Magdalena; Quaranta-Leoni, Francesco M; Quattrocchi, Carlo; Bianchi, Antonella; Bonini, Stefano; Avvisati, Giuseppe

    2015-01-01

    Ocular Adnexal Lymphomas are the first cause of primary ocular malignancies, and among them the most common are MALT Ocular Adnexal Lymphomas. Recently systemic immunotherapy with anti-CD20 monoclonal antibody has been investigated as first-line treatment; however, the optimal management for MALT Ocular Adnexal Lymphomas is still unknown. The present study evaluated retrospectively the outcome of seven consecutive patients with primary MALT Ocular Adnexal Lymphomas, of whom six were treated with single agent Rituximab. All patients received 6 cycles of Rituximab 375?mg/mq every 3 weeks intravenously. The overall response rate was 100%; four patients (67%) achieved a Complete Remission, and two (33%) achieved a partial response. In four patients an additional Rituximab maintenance every 2-3 months was given for two years. After a median follow-up of 29 months (range 8-34), no recurrences were observed, without of therapy- or disease-related severe adverse events. None of the patients needed additional radiotherapy or other treatments. Rituximab as a single agent is highly effective and tolerable in first-line treatment of primary MALT Ocular adnexal Lymphomas. Furthermore, durable responses are achievable with the same-agent maintenance. Rituximab can be considered the agent of choice in the management of an indolent disease in whom the "quality of life" matter is of primary importance. PMID:26425558

  1. Rituximab as Single Agent in Primary MALT Lymphoma of the Ocular Adnexa

    PubMed Central

    Annibali, Ombretta; Chiodi, Francesca; Sarlo, Chiara; Cortes, Magdalena; Quaranta-Leoni, Francesco M.; Quattrocchi, Carlo; Bianchi, Antonella; Bonini, Stefano; Avvisati, Giuseppe

    2015-01-01

    Ocular Adnexal Lymphomas are the first cause of primary ocular malignancies, and among them the most common are MALT Ocular Adnexal Lymphomas. Recently systemic immunotherapy with anti-CD20 monoclonal antibody has been investigated as first-line treatment; however, the optimal management for MALT Ocular Adnexal Lymphomas is still unknown. The present study evaluated retrospectively the outcome of seven consecutive patients with primary MALT Ocular Adnexal Lymphomas, of whom six were treated with single agent Rituximab. All patients received 6 cycles of Rituximab 375?mg/mq every 3 weeks intravenously. The overall response rate was 100%; four patients (67%) achieved a Complete Remission, and two (33%) achieved a partial response. In four patients an additional Rituximab maintenance every 2-3 months was given for two years. After a median follow-up of 29 months (range 834), no recurrences were observed, without of therapy- or disease-related severe adverse events. None of the patients needed additional radiotherapy or other treatments. Rituximab as a single agent is highly effective and tolerable in first-line treatment of primary MALT Ocular adnexal Lymphomas. Furthermore, durable responses are achievable with the same-agent maintenance. Rituximab can be considered the agent of choice in the management of an indolent disease in whom the quality of life matter is of primary importance. PMID:26425558

  2. Extranodal marginal zone lymphoma of the ocular adnexa

    PubMed Central

    Stefanovic, Alexandra

    2009-01-01

    Lymphomas of the ocular adnexa are a heterogeneous group of malignancies, composing approximately 1% to 2% of non-Hodgkin lymphomas (NHLs) and 8% of extranodal lymphomas. The most common subtype, accounting for up to 80% of cases of primary ocular adnexal lymphoma, is marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type. In the recent past, there have been significant advances in our understanding of the clinical characteristics, morphology and phenotype, etiology, pathogenesis, diagnosis, natural history, treatment approaches, outcome, and prognostic factors of this disease entity. Novel immunologic and molecular techniques have aided in the distinction between MALT lymphoma and other lymphoproliferative disorders and led to the identification of tissue markers of prognostic significance. Modern imaging modalities provide invaluable tools for accurate staging and treatment planning. Besides radiotherapy and chemotherapy, a variety of new treatment options have emerged in the management of patients with ocular adnexal MALT lymphoma, especially monoclonal antibody therapy and antibiotic therapy against Chlamydia psittaci, which has been associated with the pathogenesis of ocular adnexal lymphomas in some parts of the world. In this review, we present a state-of-the-art summary of ocular adnexal MALT lymphomas. PMID:19372259

  3. Assessment of adnexal masses using ultrasound: a practical review

    PubMed Central

    Smorgick, Noam; Maymon, Ron

    2014-01-01

    Pelvic ultrasound is commonly used as part of the routine gynecologic exams, resulting in diagnosis of adnexal masses, the majority of which are functional or benign. However, due to the possible complications involving benign adnexal cysts (ie, adnexal torsion, pelvic pain) and the utmost importance of early diagnosis and treatment of ovarian cancer, the correct ultrasound diagnosis of adnexal masses is essential in clinical practice. This review will describe the typical ultrasound appearance of the common physiologic, benign, and malignant adnexal masses with the aim of aiding the clinician to reach the correct diagnosis. PMID:25285023

  4. Transgenic mouse model of cutaneous adnexal tumors

    PubMed Central

    Kito, Yusuke; Saigo, Chiemi; Atsushi, Kurabayashi; Mutsuo, Furihata; Tamotsu, Takeuchi

    2014-01-01

    TMEM207 was first characterized as being an important molecule for the invasion activity of gastric signet-ring cell carcinoma cells. In order to unravel the pathological properties of TMEM207, we generated several transgenic mouse lines, designated C57BL/6-Tg (ITF-TMEM207), in which murine TMEM207 was ectopically expressed under a truncated (by ~200 bp) proximal promoter of the murine intestinal trefoil factor (ITF) gene (also known as Tff3). Unexpectedly, a C57BL/6-Tg (ITF-TMEM207) mouse line exhibited a high incidence of spontaneous intradermal tumors with histopathological features that resembled those of various human cutaneous adnexal tumors. These tumors were found in ~14% female and 13% of male 6- to 12-month-old mice. TMEM207 immunoreactivity was found in hair follicle bulge cells in non-tumorous skin, as well as in cutaneous adnexal tumors of the transgenic mouse. The ITF-TMEM207 construct in this line appeared to be inserted to a major satellite repeat sequence at chromosome 2, in which no definite coding molecule was found. In addition, we also observed cutaneous adnexal tumors in three other C57BL/6-Tg (ITF-TMEM207) transgenic mouse lines. We believe that the C57BL/6-Tg (ITF-TMEM207) mouse might be a useful model to understand human cutaneous adnexal tumors. PMID:25305140

  5. Managing Adnexal Masses: A Medical Quandary

    PubMed Central

    Mohan, Surender; Kapoor, Garima; Nagpal, Praveen Kumar; Aggarwal, Raju; Gami, Neha

    2013-01-01

    Introduction: Management of Adnexal masses poses a double edged problem. There is a dilemma of performing extensive surgery in the form of staging laparotomy for a benign disease on one hand and the lurking fear of missing the diagnosis of malignancy on the other. Thus, it seems that it is important to establish risk profiles of all patients with adnexal masses so that they can reap the benefit of minimally invasive surgery wherever possible and be rightly subjected to staging laparotomy where indicated. Material and Methods: This prospective study was carried out at a Tertiary care Hospital. 136 women with an adnexal mass on ultrasound which met the said criteria were enrolled into the study from January 2008 to July 2011. They were then taken up for laparoscopic management. Results: All but 2 cases were found to be benign (134/136) after the final histopathology report using the said criteria. Conclusion: Hence, by using simple readily available investigations like ultrasound (pattern recognition approach, Tumour morphology and ascites) and CA125, the nature of adnexal mass can be reliably predicted and these patients can be safely offered the benefits of laparoscopic surgery. PMID:24179912

  6. [Clinical presentation of cutaneous adnexal tumors].

    PubMed

    Zelger, B; Kazakov, D V; Zelger, B G

    2014-09-01

    Cutaneous adnexal lesions can sometimes be clinically diagnosed even by an experienced clinician or a differential diagnosis can at least be narrowed down. However, clinical findings alone cannot replace histological investigations and diagnosis or make them superfluous. This expertise is based on an algorithm which first differentiates inflammatory pseudo-tumors, such as ruptured infundibular cysts (atheroma) from authentic neoplastic adnexal lesions. In a second step criteria of regularity and/or chaos, such as asymmetry, irregular border, color variation and/or destruction with exulceration help to evaluate the dignity. In a third step criteria of differentiation allow the characterization of lesions varying in size from macules to papules, plaques, nodules and tumors to the subgroups of adnexal differentiation. Infundibular differentiation is characterized by comedones and is skin-colored, yellow or white and hard. Follicular differentiation notifies hair and is skin-colored, pearl-like to occasionally brown-black and variably hard. Sebaceous differentiation signifies lobulation and is yellow to skin-colored or red and soft. Apocrine lesions are reddish and fleshy. Eccrine differentiation shows either papillary reddish-brown (differential diagnosis viral warts) or skin-colored hard lesions. Multiple, monomorphous lesions are characteristic of syndromes, such as Spiegler-Brooke-Fend, Birt-Hogg-Dubé, Muir-Torre, and Gorlin-Goltz.One peculiarity of adnexal lesions is their potential to form cysts. Cysts with horny or hairy material are skin-colored to yellow, with glandular fluid fluctuation, a bluish character, and with illumination a Tyndall phenomenon becomes obvious, while ruptured cysts reveal an erythematous-reddish, ill-defined foreign body reaction. Brown to bluish-gray and black color is seen by the presence of melanocytes with melanin in lesions with mostly follicular differentiation. Strong vascularization and bleeding are reddish, soft, spongy and compressible and in due course variably dark due to the presence of hemosiderin. PMID:25154603

  7. Female adnexal tumour of probable Wolffian origin.

    PubMed Central

    Sivathondan, Y; Salm, R; Hughesdon, P E; Faccini, J M

    1979-01-01

    Two further cases of 'female adnexal tumour of probable Wolffian origin' are described Both were retroperitoneal and presented a unique histology of uniformly close-packed bland spaces. solid islands, cords, and diffuse areas. A small hamartoma in a female fetus, part of which resembled the tumours, was traced to an area of near apposition with some paroophoron canals, providing further evidence of a Wolffian origin. The literature of this and some other putative Wolffian tumours is briefly reviewed, and the relation to rete adenomas is discussed. Images Fig. 2 Fig. 3 Fig. 1 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 PMID:469017

  8. Meibomian glands and ocular surface inflammation.

    PubMed

    Suzuki, Tomo; Teramukai, Satoshi; Kinoshita, Shigeru

    2015-04-01

    The purpose of this review was to systematically analyze publications related to the role of meibomian gland disease in ocular surface inflammation, with special reference to meibomitis as an inflammatory form of meibomian gland dysfunction (MGD). Meibomian gland inflammation is often present with the ocular surface inflammation in conditions such as blepharokeratoconjunctivitis, ocular rosacea, and phlyctenular keratitis, but its contribution is often overlooked, especially in younger subjects. This can result in misdiagnosis, mistreatment, and, sometimes, severe visual impairment. We identified a related disease entity, seen predominantly in young patients, of ocular surface inflammation associated with meibomitis, which we termed meibomitis-related keratoconjunctivitis. Its specific clinical features are similar to those observed in the above-mentioned diseases, and the inflammatory form of MGD was found to be closely involved in the ocular surface inflammation seen in those four diseases, based on our statistical evaluation. The diagnosis and management of meibomitis, an inflammatory form of MGD, is vital for the successful treatment of the induced ocular surface inflammation. We propose that the ocular surface and the adnexal meibomian glands should be considered as one unit, i.e., the "meibomian gland and ocular surface" (MOS), when encountered in the clinical setting. PMID:25881997

  9. Immunology of IgG4-related disease.

    PubMed

    Della-Torre, E; Lanzillotta, M; Doglioni, C

    2015-08-01

    Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that derives its name from the characteristic finding of abundant IgG4(+) plasma cells in affected tissues, as well as the presence of elevated serum IgG4 concentrations in many patients. In contrast to fibrotic disorders, such as systemic sclerosis or idiopathic pulmonary fibrosis in which the tissues fibrosis has remained largely intractable to treatment, many IgG4-RD patients appear to have a condition in which the collagen deposition is reversible. The mechanisms underlying this peculiar feature remain unknown, but the remarkable efficacy of B cell depletion in these patients supports an important pathogenic role of B cell/T cell collaboration. In particular, aberrant T helper type 2 (Th2)/regulatory T cells sustained by putative autoreactive B cells have been proposed to drive collagen deposition through the production of profibrotic cytokines, but definitive demonstrations of this hypothesis are lacking. Indeed, a number of unsolved questions need to be addressed in order to fully understand the pathogenesis of IgG4-RD. These include the identification of an antigenic trigger(s), the implications (if any) of IgG4 antibodies for pathophysiology and the precise immunological mechanisms leading to fibrosis. Recent investigations have also raised the possibility that innate immunity might precede adaptive immunity, thus further complicating the pathological scenario. Here, we aim to review the most recent insights on the immunology of IgG4-RD, focusing on the relative contribution of innate and adaptive immune responses to the full pathological phenotype of this fibrotic condition. Clinical, histological and therapeutic features are also addressed. PMID:25865251

  10. Isolated intrapancreatic IgG4-related sclerosing cholangitis

    PubMed Central

    Nakazawa, Takahiro; Ikeda, Yushi; Kawaguchi, Yoshiaki; Kitagawa, Hirohisa; Takada, Hiroki; Takeda, Yutaka; Makino, Isamu; Makino, Naohiko; Naitoh, Itaru; Tanaka, Atsushi

    2015-01-01

    Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is frequently associated with type 1 autoimmune pancreatitis (AIP). Association with AIP can be utilized in the diagnosis of IgG4-SC. However, some cases of IgG4-SC are isolated from AIP, which complicates the diagnosis. Most of the reported cases of isolated IgG4-SC displayed hilar biliary strictures, whereas isolated IgG4-SC with intrapancreatic biliary stricture is very rare. Recently, we have encountered 5 isolated intrapancreatic IgG4-SC cases that were not associated with AIP, three of which were pathologically investigated after surgical operation. They all were males with a mean age of 74.2 years. The pancreas was not enlarged in any of these cases. No irregular narrowing of the main pancreatic duct was found. Bile duct wall thickening in lesions without luminal stenosis was detected by abdominal computed tomography in all five cases, by endoscopic ultrasonography in two out of four cases and by intraductal ultrasonography in all three cases. In three cases, serum IgG4 levels were within the normal limits. The mean serum IgG4 level measured before surgery was 202.1 mg/dL (4 cases). Isolated intrapancreatic IgG4-SC is difficult to diagnose, especially if the IgG4 level remains normal. Thus, this type of IgG4-SC should be suspected in addition to cholangiocarcinoma and pancreatic cancer if stenosis of intrapancreatic bile duct is present. PMID:25632210

  11. IgG4-Related Disease: Imitating A Great Imitator

    PubMed Central

    Berenberg, Jeffrey; Tom, Linda; Gress, Francis

    2015-01-01

    Immunoglobulin G4-related disease (IgG4-RD) is a rare, but increasingly recognized, multi-organ fibro-inflammatory condition characterized by distinct pathologic and histologic features. The clinical variability and relative novelty of IgG4-RD make accurate diagnosis of the condition quite challenging. We report a case of a 71-year-old man presenting with hypertrophy of the facial glands and generalized lymphadenopathy who was previously diagnosed with sarcoidosis. We recognized that he had atypical epidemiologic characteristic for sarcoidosis and his prior work-up documented elevated serum IgG4 to > 300 mg/dL. Immunostaining of an axillary lymph node biopsy showed an IgG4+/IgG+ plasma cell ratio of > 40% and a plasma cell concentration of > 100 IgG4+ plasma cells per high powered field, findings consistent with the diagnosis of IgG4-RD. This case report is an example of how analysis of collective clinicopathologic data led to a diagnosis of IgG4-RD. The pathologic complexities which contribute to the elusive nature of IgG4-RD are also illustrated. PMID:26793411

  12. Magnetic resonance imaging evaluation of non ovarian adnexal lesions.

    PubMed

    Thawait, Shrey K; Batra, Kiran; Johnson, Stephen I; Torigian, Drew A; Chhabra, Avneesh; Zaheer, Atif

    2016-01-01

    Differentiation of nonovarian from ovarian lesions is a diagnostic challenge. MRI (Magnetic Resonance Imaging) of the pelvis provides excellent tissue characterization and high contrast resolution, allowing for detailed evaluation of adnexal lesions. Salient MRI characteristics of predominantly cystic lesions and predominantly solid adnexal lesions are presented along with epidemiology and clinical presentation. Due to its excellent soft tissue resolution, MRI may be able to characterize indeterminate adnexal masses and aid the radiologist to arrive at the correct diagnosis, thus positively affect patient management. PMID:26463742

  13. ACR Appropriateness Criteria clinically suspected adnexal mass.

    PubMed

    Harris, Robert D; Javitt, Marcia C; Glanc, Phyllis; Brown, Douglas L; Dubinsky, Theodore; Harisinghani, Mukesh G; Khati, Nadia J; Kim, Young Bae; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Podrasky, Ann E; Royal, Henry D; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2013-03-01

    Adnexal masses are a common problem clinically and imaging-wise, and transvaginal US (TVUS) is the first-line imaging modality for assessing them in the vast majority of patients. The findings of US, however, should be correlated with the history and laboratory tests, as well as any patient symptoms. Simple cysts are uniformly benign, and most warrant no further interrogation or treatment. Complex cysts carry more significant implications, and usually engender serial ultrasound(s), with a minority of cases warranting a pelvic MRI.Morphological analysis of adnexal masses with gray-scale US can help narrow the differential diagnosis. Spectral Doppler analysis has not proven useful in most well-performed studies. However, the use of color Doppler sonography adds significant contributions to differentiating between benign and malignant masses and is recommended in all cases of complex masses. Malignant masses generally demonstrate neovascularity, with abnormal branching vessel morphology. Optimal sonographic evaluation is achieved by using a combination of gray-scale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23358212

  14. Ocular Manifestations of Acquired Immunodeficiency Syndrome

    PubMed Central

    Kim, Young Shin; Sun, Hae Jung; Kim, Tae Hyong; Kang, Kui Dong

    2015-01-01

    Purpose To investigate the patterns and risk factors of the ocular manifestations of acquired immunodeficiency syndrome (AIDS) and their correlation with CD4+ count in the era of highly active antiretroviral therapy (HAART). Methods This retrospective study examined 127 AIDS patients who presented to Soonchunhyang University Hospital. Data were collected from patient interviews, clinical examinations, and laboratory investigations. Ophthalmologic examinations included the best-corrected visual acuity, intraocular pressure, anterior segment and adnexal examination, and dilated fundus examination. Results Of the 127 patients with AIDS, 118 were on HAART and 9 were not. The mean CD4+ count was 266.7 ± 209.1 cells/µL. There were ocular manifestations in 61 patients (48.0%). The incidence of anterior segment manifestations was higher than posterior segment manifestations at 28.3% and 19.7%, respectively. The mean CD4+ count was significantly (p < 0.05) lower in the patients with posterior versus anterior segment ocular manifestations. The most common ocular manifestation was retinal microvasculopathy (15.0%), followed by keratoconjunctivitis sicca (14.2%), conjunctival microvasculopathy (9.4%), cytomegalovirus retinitis (3.1%), herpes zoster ophthalmicus (2.4%), and blepharitis (1.6%). Retinal microvasculopathy and cytomegalovirus retinitis were common in patients with CD4+ counts <200 cells/µL, while keratoconjunctivitis sicca and conjunctival microvasculopathy were common in patients with CD4+ counts of 200 to 499 cells/µL. There was a significant (p < 0.05) association between ocular manifestation and CD4+ count or age. Conclusions The introduction of HAART has changed the landscape of ocular presentations in patients with AIDS. In this study, anterior segment and external ocular manifestations occurred more frequently than posterior segment manifestations. Also, the mean CD4+ count was significantly lower in patients with posterior segment ocular manifestations versus anterior segment ocular manifestations. We found that CD4+ count and age >35 years were independent risk factors for developing ocular manifestations. PMID:26240508

  15. 21 CFR 866.6050 - Ovarian adnexal mass assessment score test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ovarian adnexal mass assessment score test system... immunological Test Systems § 866.6050 Ovarian adnexal mass assessment score test system. (a) Identification. An...: Ovarian Adnexal Mass Assessment Score Test System.” For the availability of this guidance document,...

  16. 21 CFR 866.6050 - Ovarian adnexal mass assessment score test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ovarian adnexal mass assessment score test system... immunological Test Systems § 866.6050 Ovarian adnexal mass assessment score test system. (a) Identification. An...: Ovarian Adnexal Mass Assessment Score Test System.” For the availability of this guidance document,...

  17. 21 CFR 866.6050 - Ovarian adnexal mass assessment score test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ovarian adnexal mass assessment score test system... immunological Test Systems § 866.6050 Ovarian adnexal mass assessment score test system. (a) Identification. An...: Ovarian Adnexal Mass Assessment Score Test System.” For the availability of this guidance document,...

  18. Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature.

    PubMed

    Kheir, Wajiha J; Sheheitli, Huda; Abdul Fattah, Maamoun; Hamam, Rola N

    2015-01-01

    Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome. PMID:26106601

  19. Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature

    PubMed Central

    Kheir, Wajiha J.; Sheheitli, Huda; Abdul Fattah, Maamoun; Hamam, Rola N.

    2015-01-01

    Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome. PMID:26106601

  20. Perineural cysts resembling complex cystic adnexal masses on transvaginal sonography.

    PubMed

    Saboo, Sachin S; Di Salvo, Donald

    2013-01-01

    Perineural cysts may be discovered incidentally on pelvic sonography and can easily mimic more common gynecologic masses. We report the complex cystic adnexal mass like appearance of these incidentally noted cysts which mimicked malignancy on sonography in a postmenopausal female, with stage I breast cancer and vaginal spotting. PMID:22105304

  1. Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors

    PubMed Central

    Van Calster, B.; Van Hoorde, K.; Froyman, W.; Kaijser, J.; Wynants, L.; Landolfo, C.; Anthoulakis, C.; Vergote, I.; Bourne, T.; Timmerman, D.

    2015-01-01

    All gynecologists are faced with ovarian tumors on a regular basis, and the accurate preoperative diagnosis of these masses is important because appropriate management depends on the type of tumor. Recently, the International Ovarian Tumor Analysis (IOTA) consortium published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, the first risk model that differentiates between benign and four types of malignant ovarian tumors: borderline, stage I cancer, stage II-IV cancer, and secondary metastatic cancer. This approach is novel compared to existing tools that only differentiate between benign and malignant tumors, and therefore questions may arise on how ADNEX can be used in clinical practice. In the present paper, we first provide an in-depth discussion about the predictors used in ADNEX and the ability for risk prediction with different tumor histologies. Furthermore, we formulate suggestions about the selection and interpretation of risk cut-offs for patient stratification and choice of appropriate clinical management. This is illustrated with a few example patients. We cannot propose a generally applicable algorithm with fixed cut-offs, because (as with any risk model) this depends on the specific clinical setting in which the model will be used. Nevertheless, this paper provides a guidance on how the ADNEX model may be adopted into clinical practice. PMID:25897370

  2. Ocular prosthesis.

    PubMed

    Raizada, Kuldeep; Rani, Deepa

    2007-07-01

    Loss of an eye or a disfigured eye has a far-reaching impact on an individual's psyche'. Additionally it affects one's social and professional life. Cosmetic rehabilitation with custom made prosthetic devices gives such individuals professional and social acceptance and alleviates problems. This article aims at enhance awareness of the cosmetic benefits of custom designed ocular prosthesis. Ocularistry, the science of making ocular prosthesis, has undergone phenomenal growth in recent times. Ocularistry is fast evolving in India. "Ocularist" is the skilled individual involved in fabricating the ocular prosthesis. PMID:17320467

  3. Prevalence of simple adnexal cysts in postmenopausal women.

    PubMed

    Wolf, S I; Gosink, B B; Feldesman, M R; Lin, M C; Stuenkel, C A; Braly, P S; Pretorius, D H

    1991-07-01

    This prospective study was performed with ultrasound (US) to determine the prevalence of unilocular, nonseptated adnexal cysts ("simple cysts") in healthy postmenopausal women and the relationship between cyst occurrence and both hormone replacement and length of time since onset of menopause. Transabdominal and transvaginal US were performed on 149 volunteers aged 50 years or older. Patients were classified according to hormone regimens (no hormones, unopposed estrogen, continuous daily estrogen and progesterone, and sequential estrogen and progesterone) and time since onset of menopause (less than 5 years, 5-10 years, and greater than 10 years). Simple adnexal cysts were found in 22 women with the aid of transvaginal and/or transabdominal US, yielding a relative frequency of 14.8% +/- 5.7% and a prevalence of 14,800 patients with cysts per 100,000 patients. No statistical relationship was found between cyst frequency and type of hormone replacement or length of time since onset of menopause. PMID:2052725

  4. [Ocular trauma. Blunt ocular trauma].

    PubMed

    Saleh, M

    2012-06-01

    Ocular traumas represent a major public health problem with poorly understood ramifications at both the individual and community levels. Any of the ocular structures can be damaged in the case of closed globe injury. These lesions, often multiple, may appear immediately or in a delayed fashion. Classifications have been developed recently in order to better inform the patient of the visual prognosis. However, significant efforts are still needed, on the one hand, to assess and develop new therapies, and on the other hand, to implement effective policies to prevent ocular trauma. PMID:22463853

  5. [Ocular syphilis].

    PubMed

    Chiquet, C; Khayi, H; Puech, C; Tonini, M; Pavese, P; Aptel, F; Romanet, J-P

    2014-04-01

    Syphilis is a sexually transmitted disease caused by Treponema pallidum. Previously known as the "great imitator", this disease can have numerous and complex manifestations. The ophthalmologist should suspect the diagnosis in patients with uveitis or optic neuropathy and high-risk sexual behavior and/or another sexually transmitted disease (such as HIV) or those presenting with posterior placoid chorioretinitis or necrotising retinitis. Ocular involvement in acquired syphilis is rare, tending to occur during the secondary and tertiary stages of the disease. Syphilis may affect all the structures of the eye, but uveitis (accounting for 1-5% of the uveitis in a tertiary referral center) is the most common ocular finding. Granulomatous or non-granulomatous iridocyclitis (71%), panuveitis, posterior uveitis (8%) and keratouveitis (8%) are often described. In the secondary stage, the meninges and the central nervous system can be affected, sometimes with no symptoms, which justifies performing lumbar puncture in patients with uveitis and/or optic neuropathy. The diagnosis of ocular syphilis requires screening with a non-treponemal serology and confirmation with a treponemal-specific test. Parenterally administered penicillin G is considered first-line therapy for all stages of ocular syphilis. Systemic corticosteroids are an appropriate adjunct treatment for posterior uveitis, scleritis and optic neuritis if ocular inflammation is severe. Prolonged follow-up is necessary because of the possibility of relapse of the disease. With proper diagnosis and prompt antibiotic treatment, the majority of cases of ocular syphilis can be cured. PMID:24655791

  6. Mean Platelet Volume in Early Diagnosis of Adnexal Torsion

    PubMed Central

    Köleli, Işıl

    2015-01-01

    Background: Adnexal torsion (AT) is among the gynecological emergencies; more common in reproductive age, if diagnosed late, this can cause ovarian failure and infertility, but rarely thrombophlebitis and peritonitis. Despite these severe complications, preoperative diagnostic tests are not enough for early diagnosis. There are certain pieces of literature on the subject that reveal changes in mean platelet volume (MPV) values occur in inflammatory and ischemic diseases and that these changes have diagnostic and prognostic significance. However, there are no studies investigating this relationship with adnexal torsion. Aims: The aim of the study is to investigate the diagnostic and prognostic significance of the mean platelet volume value in the early diagnosis of patients with adnexal torsion. Study Design: Case-control study. Methods: Pre-operative demographic data, MPV, leukocyte count and neutrophils to lymphocytes (N/L) ratio in the blood samples of 51 patients, who were operated on preliminary adnexal torsion and diagnosed as adnexal torsion with a benign ovarian cyst (AT group) were retrospectively compared with those of 50 patients who were operated upon because of benign ovarian cysts and without torsion (control group) at this hospital between 2006 and 2014. Results: The mean MPV level was found to be 8.1 (7.1–10.7) fL in the AT group and 7.9 (6.6–10.2) fL in the control group; no statistically significant difference was found between the groups (p>0.05). Leukocyte count and N/L ratio in the AT group were, on average, 12×103/mm3 and 82% respectively and in control group; they were, on average, 7.2×103/mm3 and 59%, respectively. A statistically significant increase was found in the leukocyte count and N/L ratio of the AT group compared to the control group (p<0.001). The platelet count in the AT group was, on average, 253×103/mm3 and in the control group it was, on average, 280×103/mm3; no statistically significant difference was detected between these two groups (p>0.05). No correlation was detected between the MPV, platelet and leukocyte counts. The sensitivity of the leukocytosis to the AT cases was found to be 66.7%, and selectivity was 94%. Conclusion: The AT diagnostic and prognostic importance of MPV value has not been determined in this study. PMID:26740902

  7. Added Value of Using a CT Coronal Reformation to Diagnose Adnexal Torsion

    PubMed Central

    Jung, Sung Il; Park, Hee Sun; Yim, Younghee; Jeon, Hae Jeong; Yu, Mi Hye; Kim, Young Jun

    2015-01-01

    Objective To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion. Materials and Methods This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance. Results Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively). Conclusion Use of a coronal reformation with transverse CT images improves detection of adnexal torsion. PMID:26175583

  8. Optical coherence tomography imaging of ocular and periocular tumours

    PubMed Central

    Medina, Carlos A; Plesec, Thomas; Singh, Arun D

    2014-01-01

    Optical coherence tomography (OCT) has become pivotal in the practice of ophthalmology. Similar to other ophthalmic subspecialties, ophthalmic oncology has also incorporated OCT into practice. Anterior segment OCT (AS-OCT), ultra-high resolution OCT (UHR-OCT), spectral domain OCT (SD-OCT) and enhanced depth imaging OCT (EDI-OCT), have all been described to be helpful in the diagnosis, treatment planning and monitoring response of ocular and periocular tumours. Herein we discuss the role of OCT including the advantages and limitations of its use in the setting of common intraocular and adnexal tumours. PMID:24599420

  9. Ocular Pathology.

    PubMed

    Bauer, Bianca S

    2015-08-01

    Although not comprehensive of all ocular conditions in the equine species, this article concentrates on various ophthalmic conditions observed in the horse where laboratory diagnostics are recommended. The importance of laboratory diagnostic testing cannot be underestimated with equine ophthalmic disease. In many cases, laboratory diagnostics can aid in obtaining an early diagnosis and determining appropriate therapy, which in turn, can provide a better prognosis. In unfortunate cases where ocular disease results in a blind, painful eye necessitating enucleation, light microscopic evaluation is imperative to determine or confirm the cause of the blindness and provide a prognosis for the contralateral eye. PMID:26210955

  10. Large mucinous neoplasm of the appendix mimicking adnexal mass in a postmenopausal woman

    PubMed Central

    Akman, Levent; Hursitoglu, Behiye Seda; Hortu, ?smet; Sezer, Taylan; Oztekin, Kemal; Avsargil, Basak Dogan

    2014-01-01

    INTRODUCTION Appendiceal tumors are rare, late-diagnosed neoplasms that may not be differentiated from adnexal masses even by advanced imaging methods and other diagnostic procedures. They may be asymptomatic and remain undiagnosed until surgery. PRESENTATION OF CASE We report a case of 81-year-old postmenopausal woman presented with abdominal pain. A magnetic resonance imaging revealed right adnexal mass. Laparotomy was performed and detected a 12cmנ9cm mucinous tumoral mass arising in the appendix. An appendectomy and a right hemicolectomy with ileo-transverse anastomosis were performed. Histopathological examination was revealed appendiceal mucinous neoplasm with low malignancy potential. DISCUSSION Gastrointestinal tumors such as appendiceal tumors can mimicking adnexal mass. Therefore, appendiceal tumor kept in mind in a patient with diagnosed adnexal mass, especially patient had non-specific clinical symptoms, laboratory and radiologic findings. CONCLUSION Gastrointestinal tumors such as appendiceal tumors kept in mind in a patient with diagnosed adnexal mass. PMID:25498566

  11. Ocular phototherapy.

    PubMed

    Singh, A D

    2013-02-01

    Phototherapy can be translated to mean 'light or radiant energy-induced treatment.' Lasers have become the exclusive source of light or radiant energy for all applications of phototherapy. Depending on the wavelength, intensity, and duration of exposure, tissues can either absorb the energy (photocoagulation, thermotherapy, and photodynamic therapy (PDT)) or undergo ionization (photodisruption). For phototherapy to be effective, the energy has to be absorbed by tissues or more specifically by naturally occurring pigment (xanthophyll, haemoglobin, and melanin) within them. In tissues or tumours that lack natural pigment, dyes (verteporphin, Visudyne) with narrow absorption spectrum can be injected intravenously that act as focal absorbent of laser energy after they have preferentially localized within the tumour. Ocular phototherapy has broad applications in treatment of ocular tumours. Laser photocoagulation, thermotherapy, and PDT can be delivered with low rates of complications and with ease in the outpatient setting. Review of the current literature suggests excellent results when these treatments are applied for benign tumours, particularly for vascular tumours such as circumscribed choroidal haemangioma. For primary malignant tumours, such as choroidal melanoma, thermotherapy, and PDT do not offer local tumour control rates that are equivalent or higher than those achieved with plaque or proton radiation therapy. However, for secondary malignant tumours (choroidal metastases), thermotherapy and PDT can be applied as a palliative treatment. Greater experience is necessary to fully comprehend risks, comparative benefits, and complication of ocular phototherapy of ocular tumours. PMID:23238445

  12. Ocular phototherapy

    PubMed Central

    Singh, A D

    2013-01-01

    Phototherapy can be translated to mean light or radiant energy-induced treatment.' Lasers have become the exclusive source of light or radiant energy for all applications of phototherapy. Depending on the wavelength, intensity, and duration of exposure, tissues can either absorb the energy (photocoagulation, thermotherapy, and photodynamic therapy (PDT)) or undergo ionization (photodisruption). For phototherapy to be effective, the energy has to be absorbed by tissues or more specifically by naturally occurring pigment (xanthophyll, haemoglobin, and melanin) within them. In tissues or tumours that lack natural pigment, dyes (verteporphin, Visudyne) with narrow absorption spectrum can be injected intravenously that act as focal absorbent of laser energy after they have preferentially localized within the tumour. Ocular phototherapy has broad applications in treatment of ocular tumours. Laser photocoagulation, thermotherapy, and PDT can be delivered with low rates of complications and with ease in the outpatient setting. Review of the current literature suggests excellent results when these treatments are applied for benign tumours, particularly for vascular tumours such as circumscribed choroidal haemangioma. For primary malignant tumours, such as choroidal melanoma, thermotherapy, and PDT do not offer local tumour control rates that are equivalent or higher than those achieved with plaque or proton radiation therapy. However, for secondary malignant tumours (choroidal metastases), thermotherapy and PDT can be applied as a palliative treatment. Greater experience is necessary to fully comprehend risks, comparative benefits, and complication of ocular phototherapy of ocular tumours. PMID:23238445

  13. The cytology of molluscum contagiosum mimicking skin adnexal tumor

    PubMed Central

    Krishnamurthy, Jayashree; Nagappa, Divya Kota

    2010-01-01

    Molluscum contagiosum is a cutaneous viral infection presenting as multiple, umbilicated papules and vesicles. The cytology of molluscum contagiosum in an 11-year-old boy, which presented atypically as a solitary nodule over the right cheek, mimicking a skin adnexal tumor is reported here. Fine needle aspiration cytology plays a vital role in establishing the correct diagnosis of clinically unsuspected cases, and hence, the proper management of such lesions. The cytology of molluscum contagiosum is characterized by the presence of numerous large intracytoplasmic basophilic bodies that push the host nucleus to the periphery, giving a signet ring appearance to the superficial epidermal cells. PMID:21157556

  14. Simple adnexal cysts: the natural history in postmenopausal women.

    PubMed

    Levine, D; Gosink, B B; Wolf, S I; Feldesman, M R; Pretorius, D H

    1992-09-01

    Transabdominal and transvaginal ultrasound (US) examinations were performed in 184 asymptomatic postmenopausal volunteers to determine prospectively (a) the frequency and natural history of simple adnexal cysts in healthy postmenopausal women and (b) the relationship between cyst activity and both hormone replacement and length of time since menopause. Eighty-three simple adnexal cysts were found in 52 women. Thirty-two of 184 women (17%) had 37 cysts identified at initial examination; 46 new cysts appeared in 31 women (11 of whom previously had cysts). Forty-nine women with 72 cysts were reevaluated with subsequent US scanning over a period of 3-23 months. Thirty-eight of the 72 cysts (53%) disappeared completely, 20 (28%) remained constant in size, eight (11%) enlarged by 3 mm or more, two (3%) decreased in size by 3 mm or more, and four (6%) both increased and decreased in size on repeated examinations. No statistical relationship was found between presence of cysts or cyst activity with respect to the type of hormone replacement or length of time since menopause. PMID:1509047

  15. A Clinicopathological Study of Women with Adnexal Masses Presenting with Acute Symptoms

    PubMed Central

    Al-Shukri, M; Mathew, M; Al-Ghafri, W; Al-Kalbani, M; Al-Kharusi, L; Gowri, V

    2014-01-01

    Background: Abdominal pain is one of the most common presentations of adnexal pathology in gynecology. Early diagnosis and intervention is essential especially in adolescent girls and reproductive age group women to conserve reproductive function. Aim: The purpose of the following study is to assess the clinicopathologic outcome of women with adnexal masses presenting with acute pain. Subjects and Methods: A retrospective study of women with adnexal masses who had surgical intervention for acute symptoms from June 2007 to May 2012 was undertaken. During the study period, a total of 57 women were operated for adnexal masses as emergency. Results: Of the 57 women operated for adnexal masses as emergency, the most common pathology was teratoma 26% (15/57) followed by corpus luteal hemorrhage (16%) and endometriosis (14%). Laparoscopy was the initial surgical approach in just over 50% of patients, but surgery was completed laparoscopically only in about one-third of patients. Conservative surgery in the form of ovarian cystectomy was possible in 70% of patients. Conclusion: Complications of adnexal masses such as torsion and hemorrhage are common causes of acute abdominal pain. Timely diagnosis of the adnexal pathology and surgical intervention will help to preserve the reproductive outcome. Conservative surgery was possible in 70% of our study group. PMID:24761256

  16. [Significance of laparoscopy in gynaecological oncology: limitations for adnexal tumours].

    PubMed

    Wimberger, Pauline; Kimmig, Rainer

    2009-01-01

    In the last few decades, the impact and use of laparoscopy for benign adnexal tumours have markedly increased. However, the surgical resection of early-stage ovarian malignoma remains controversial. This review evaluates the importance of laparoscopy in surgery of adnexa and especially of malignant tumours. Certainly, morbidity after laparoscopy is lower, but there is a risk of possibly more restricted staging, rupture of the tumour and port metastases. Analysis showed that the standard treatment of ovarian malignant tumours is laparotomy via a vertical incision, because data on laparoscopy are scarce and prospective, randomized trials for early-stage ovarian cancer are still missing. Staging by laparoscopy is technically feasible, but so far there is no proof of safety. PMID:19525620

  17. Neutrophil to Lymphocyte ratio in the diagnosis of adnexal torsion

    PubMed Central

    Ercan, nder; Kst, Blent; Bakacak, Murat; Co?kun, Bora; Tohma, Ayta; Mavigk, Erkan

    2015-01-01

    Adnexal torsion (AT) is a condition in which there is sometimes difficulty in making a preoperative diagnosis since there are no routine laboratory markers and this condition is usually intraoperatively diagnosed. Many of the studies have indicated that the neutrophil-to-lymphocyte ratio (NLR) is a significant inflammatory marker in various diseases. In this study, we aimed to investigate the diagnostic efficacy of the NLR on the diagnosis of AT. Patients surgically treated for AT were analysed retrospectively. A total of 27 AT patients were included in the study (Group 1). Another 30 patients who were surgically treated for a unilateral ovarian mass and did not have torsion or malignity on the final histopathological examination were assigned to the control group (Group 2). White blood cells (WBCs), neutrophils, lymphocytes and the NLR were compared between groups. The mean WBC values for Groups 1 and 2 were 9.7 1.8 and 7.6 1.5 K/L (P < 0.001), respectively. The mean neutrophil values were also significantly higher in Group 1 (P < 0.001). However, the mean lymphocyte values were significantly higher in Group 2 (P < 0.001). Mean NLR was significantly higher in Group 1 (P < 0.001). Sensitivity and specificity of WBC > 8.8 were 83.3% and 74.1%, respectively. Sensitivity and specificity of NLR > 3 were 88.9% and 100%, respectively. Furthermore, the area under the ROC curve (AUC) was 0.933 for the NLR and 0.830 for WBC. With respect to the diagnosis of adnexal torsion, an NLR > 3 was identified as a more sensitive marker than the high WBC count. Therefore, an NLR > 3 seems to be a valuable marker in cases where it is difficult to diagnose AT. PMID:26629118

  18. Extramammary Paget's disease: evaluation of the adnexal status of 53 cases.

    PubMed

    Shiomi, Tatsushi; Yoshida, Yuichi; Yamamoto, Osamu; Umekita, Yoshihisa

    2015-06-01

    Extramammary Paget's disease (EMPD) is a distinct form of malignant skin neoplasm. The clinicopathological significance of cutaneous adnexal involvement in EMPD has not been investigated in detail. Surgical specimens were obtained from 53 patients with primary EMPD. Tumor involvement of cutaneous adnexal structures was evaluated using histological parameters. The degree of involvement was scored on a scale of 0-2: 0, no involvement; 1, involvement of the upper portion of the adnexa; 2, involvement of the lower portion of the adnexa. A score of 2 was regarded as significant. The presence of comedo necrosis was also examined. Adnexal involvement was identified in 46 cases (86.8%). Comedo necrosis was observed in 6 cases (11.3%). The proportions of each parameter in in situ cases were as follows: significant adnexal involvement (score 2) in 15/26 (57.7%), and comedo necrosis in 3/26 (11.5%). The corresponding proportions in cases with invasion were 21/27 (77.8%) and 3/27 (11.1%), respectively. No significant differences in adnexal involvement and comedo necrosis were detected between in situ EMPD and invasive EMPD (p>0.05). The current study suggests that the degree of adnexal involvement and the presence of comedo necrosis are not associated with tumor progression in EMPD. PMID:26247524

  19. Management of large cystic adnexal tumor by gasless laparoscopic-assisted surgery with wound retractor.

    PubMed

    Takeda, Akihiro; Sakai, Kotaro; Mitsui, Takashi; Nakamura, Hiromi

    2007-01-01

    We used a retrospective analysis to evaluate the efficacy of a wound retractor used in gasless laparoscopic-assisted surgery by the subcutaneous abdominal wall-lift method for the management of large cystic adnexal tumors. In the department of gynecology at a general hospital, 39 patients with large cystic adnexal tumors with an excised tissue weight including cystic contents exceeding 1000 g were treated by gasless laparoscopic-assisted surgery with a wound retractor from January 2001 through December 2006. Intervention was with a gasless laparoscopic-assisted adnexal surgery with a wound retractor. The median age of the patients was 51.5 years (range 16-79 years). The median weight of the excised tissue including cystic contents was 1857 g (range 1044-9454 g). The median blood loss was 30 mL (range 10-570 mL). The median surgical duration was 62 minutes (range 26-107 minutes). There were no major surgical complications. Histopathologic diagnosis of the excised tumor was mucinous cystadenoma, 18 cases; serous cystadenoma, 8 cases; mucinous cystadenocarcinoma of low-grade malignancy, 5 cases; dermoid cyst, 4 cases; paraovarian cyst, 2 cases; endometriotic cyst, 1 case; and clear cell adenocarcinoma, 1 case. Bilateral adnexal tumors were noted in 3 cases. We determined that gasless laparoscopic-assisted adnexal surgery with a wound retractor is an effective, minimally invasive procedure to treat large cystic adnexal tumors. PMID:17848329

  20. Histomorphological and Immunohistochemical Reappraisal of Cutaneous Adnexal Tumours: A Hospital Based Study

    PubMed Central

    Fatima, Uroos; Malaviya, Anil K.

    2016-01-01

    Background. Diagnosing adnexal tumours of the skin is a challenge due to their wide variety, infrequent occurrence in practice, and confusing morphological picture. Aims and Objectives. The present study aims to observe the spectrum of adnexal tumours at our institute and to evaluate them based on histomorphological, histochemical, and immunohistochemical methods either alone or in combination for proper identification and classification. Materials and Methods. A partly retrospective and partly prospective study was conducted on adnexal skin tumours over a period of 6 years. Relevant clinical profile was recorded. Histopathological examination was carried out and special stains were applied as and when required. Immunohistochemistry was performed where diagnosis with routine stains was not possible. Results. A total of 150 skin tumour biopsies were received. There were 87 keratotic tumours, 39 adnexal tumours, and 24 melanocytic tumours. Amongst the adnexal tumours, 51.3% eccrine, 30.8% follicular, and 17.9% sebaceous tumours were seen. In five cases, histological diagnosis was troublesome where immunohistochemistry helped in making final diagnosis. Limitations. The sample size is small. Conclusion. Histomorphology is confirmatory in majority of the adnexal tumours but few rare lesions that mimic internal malignancy require a panel of immunomarkers to rule out other possible differentials.

  1. Ocular vasculitis.

    PubMed

    Espinoza, Gabriela M; Desai, Ankit; Akduman, Levent

    2013-09-01

    Vasculitis is the inflammation of blood vessels that leads to loss of perfusion and ischemia with necrosis. When this occurs in the orbit, the consequences are typically very conspicuous and can be devastating with decreased quality of life and loss of vision. Systemic vasculitides are often related to ophthalmic disorders, which can serve as the first diagnostic manifestation of potentially life-threatening disease. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (e.g., granulomatosis with polyangiitis), Behcet's disease, rheumatoid arthritis, sarcoidosis, and systemic lupus erythematosus are a few of the diseases commonly associated with ocular vasculitis. Collaboration between ophthalmologists and rheumatologists is important in the successful diagnosis and treatment of patients with vasculitis. PMID:23888364

  2. Multidetector Computed Tomography for the Assessment of Adnexal Mass: Is Unenhanced CT Scan Necessary?

    PubMed Central

    Park, Hee Sun; Kim, Young Jun; Jeon, Hae Jeong

    2014-01-01

    Objective To compare the diagnostic performance and radiation dose between contrast-enhanced CT (ECT) alone, and combined unenhanced and contrast-enhanced CT (UE + ECT) for the assessment of adnexal mass. Materials and Methods This retrospective study was approved by the Institutional Review Board. A total of 146 consecutive patients (mean age, 41.1 years) who underwent preoperative unenhanced and contrast-enhanced multidetector CT of the pelvis and had adnexal masses found at surgery were included. Two readers independently evaluated the likelihood of adnexal malignancy on a 5-point scale on two different imaging datasets (ECT alone and UE + ECT). The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Radiation dose to patients was calculated by the volume CT dose index (CTDIvol) and the dose length products (DLP) on each dataset. Results Of the total 178 adnexal masses, 133 masses were benign and 45 masses were malignant. For both readers, there is no significant difference of AUC values between ECT alone and UE + ECT for the detection of adnexal malignancy (reader 1, 0.93 vs. 0.95; reader 2, 0.92 vs. 0.91) (p > 0.05). The mean CTDIvol (12.6 2.2 mGy) and DLP (641.2 137.2 mGy) of ECT alone was significantly lower than the mean CTDIvol (21.5 2.7 mGy) and DLP (923.6 158.8 mGy) of UE + ECT (p < 0.0001). Conclusion The use of unenhanced CT scan in addition to contrast-enhanced CT scan does not improve the detection of adnexal malignancy, but increases radiation exposure. PMID:24497795

  3. IgG4-related disease: current challenges and future prospects

    PubMed Central

    Lang, David; Zwerina, Jochen; Pieringer, Herwig

    2016-01-01

    Immunoglobulin G4-related disease (IgG4-RD) represents an immune-mediated fibroinflammatory condition with a characteristic histopathological appearance that can affect various organs. Although numerous single-organ manifestations have been described more than a century ago, its systemic nature and unique features were only discovered in the last 2 decades, when IgG4-RD emerged as a new entity of disease. IgG4-RD is usually considered a rare disease, but its true epidemiology has not yet been fully clarified. Also, despite recent advances in the identification of the underlying immunological processes, its pathophysiology is only incompletely understood till now. The diagnostic workup of IgG4-RD is complex and usually requires a combination of clinical examination, imaging, histological, and serological analyses. However, no finding alone is specific for IgG4-RD. Therefore, its diagnosis requires careful interpretation of examination results in context with the patient’s clinical appearance as well as the exclusion of a broad variety of differential diagnoses. The past years brought rapid advances concerning this novel disease entity: diagnostic criteria, further insights into the underlying immunological processes, new biomarkers, and novel therapeutic approaches were proposed and widened the knowledge in the field of IgG4-RD. Still, a greater number of questions remain unanswered, and many recent developments require further discussion and proof from clinical trials. This review should give an overview on current knowledge and future perspectives in epidemiology, pathophysiology, diagnosis, and therapy of IgG4-RD. PMID:26929632

  4. IgG4-Related Systemic Disease Can Be Easily Mistaken as a Uroepithelial Tumor

    PubMed Central

    Han, Song Yi; Lee, Seung Ik; Lee, Yeon Hee; Kim, Ae Jin; Lim, Hye Jin; Ro, Han; Chang, Jae Hyun; Lee, Hyun Hee; Chung, Wookyung

    2015-01-01

    Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized systemic syndrome characterized by elevated serum IgG4 concentrations and tumefaction or tissue infiltration by IgG4-positive plasma cells. We experienced a case of IgG4-RD involving multiple organs in a 64-year-old female who was referred for a suspected uroepithelial tumor. A mass biopsy confirmed dense lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. We discuss this case and review the literature to bring IgG4-RD to the attention to clinicians because it responds dramatically well to steroid therapy and should be kept in mind as a differential diagnosis to avoid unnecessary surgery. PMID:25914879

  5. First case of IgG4-related sclerosing cholangitis associated with autoimmune hemolytic anemia

    PubMed Central

    Masutani, Hironori; Okuwaki, Kosuke; Kida, Mitsuhiro; Yamauchi, Hiroshi; Imaizumi, Hiroshi; Miyazawa, Shiro; Iwai, Tomohisa; Takezawa, Miyoko; Koizumi, Wasaburo

    2014-01-01

    To our knowledge, patients with immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) associated with autoimmune hemolytic anemia (AIHA) have not been reported previously. Many patients with IgG4-SC have autoimmune pancreatitis (AIP) and respond to steroid treatment. However, isolated cases of IgG4-SC are difficult to diagnose. We describe our experience with a patient who had IgG4-SC without AIP in whom the presence of AIHA led to diagnosis. The patient was a 73-year-old man who was being treated for dementia. Liver dysfunction was diagnosed on blood tests at another hospital. Imaging studies suggested the presence of carcinoma of the hepatic hilus and primary sclerosing cholangitis, but a rapidly progressing anemia developed simultaneously. After the diagnosis of AIHA, steroid treatment was begun, and the biliary stricture improved. IgG4-SC without AIP was thus diagnosed. PMID:25024635

  6. IgG4-related disease in asbestos-related pleural disease.

    PubMed

    Onishi, Yasutaka; Nakahara, Yasuharu; Hirano, Katsuya; Sasaki, Shin; Kawamura, Tetsuji; Mochiduki, Yoshiro

    2016-03-01

    A 67-year-old man with a history of asbestos exposure and rounded atelectasis complained of cough and swelling in the left submandibular region. Computed tomography showed an increase in size of the right lower lung lobe lesion, which was recognized as the pre-existing rounded atelectasis, as well as swelling of the pancreas and submandibular glands. Biopsy from a submandibular gland and the pulmonary lesion led to a diagnosis of immunoglobulin G4-related disease (IgG4-RD). IgG4-RD is a recently recognized disease that was first reported as an autoimmune disease; however, some reports have indicated another pathogenesis of an allergic nature that is characterized by type 2 helper T cell (Th2) inflammation. Additionally, it is recognized that long-term exposure to asbestos can cause immune dysregulation. Here we present a case of IgG4-RD associated with asbestos-related pleural disease. Asbestos-induced immune dysregulation may be one etiology of IgG4-RD. PMID:26839697

  7. Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease.

    PubMed

    Raess, Philipp W; Habashi, Arlette; El Rassi, Edward; Milas, Mira; Sauer, David A; Troxell, Megan L

    2015-05-01

    Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathologic entity characterized by both IgG4+ plasma cell infiltration and fibrosis in one or more organs, prototypically pancreas or salivary/lacrimal glands. IgG4-RD in the thyroid (IgG4-RTD) is an area of active study, and the relationship between IgG4-RTD and Hashimoto thyroiditis is not fully delineated due to their overlapping histologic features. Retrospective review was performed of all thyroidectomy cases demonstrating lymphocytic inflammation at a single institution over a 4-year period. Approximately half (23/38) of patients had a clinical diagnosis of Hashimoto thyroiditis (HT). Nine of the 38 patients had increased absolute and relative numbers of IgG4+ plasma cells. Patients with a clinical diagnosis of HT had increased lymphoplasmacytic inflammation, but the relative proportion of IgG4+ plasma cells was not increased compared to patients without HT. There was no correlation between IgG4 levels and the amount of fibrosis in patients with or without HT. Patients identified as having the fibrosing variant of HT were not more likely to have increased levels of IgG4+ plasma cells than those without. There is significant morphologic and immunohistochemical overlap between HT and IgG4-RTD. Future studies to identify specific characteristics of IgG4-RTD involving the thyroid are necessary to accurately define this entity. PMID:25898816

  8. IgG4-related disease of the ileocecal region mimicking malignancy: A case report

    PubMed Central

    Hiyoshi, Yukiharu; Oki, Eiji; Zaitsu, Yoko; Ando, Koji; Ito, Shuhei; Saeki, Hiroshi; Morita, Masaru; Yamamoto, Hidetaka; Baba, Hideo; Maehara, Yoshihiko

    2014-01-01

    INTRODUCTION Immunoglobulin G4-related disease (IgG4-RD) is a systemic disease characterized by chronic fibrosing inflammation with abundant IgG4-positive plasma cells, and responds well to steroids. Previous reports of IgG4-RD have focused on pancreatic and extrapancreatic including the gastrointestinal tract, however, the colonic IgG4-RD is rare. PRESENTATION OF CASE We herein report the case of a 74-year-old female with edematous wall thickening of the terminal ileum to the lower ascending colon confirmed by several preoperative imaging studies, who underwent right hemi-colectomy for suspected malignant lymphoma. The resected specimen showed an irregular wall thickness with subserosal sclerosis, and the lesion was 10 cm in length from the terminal ileum to the ascending colon. The patient was diagnosed with IgG4-RD by pathological examinations, which demonstrated an increased number of IgG4-positive plasma cells (150/HPF), and an elevated IgG4/IgG ratio (50%). DISCUSSION Gastrointestinal IgG4-RD appears to be difficult to diagnose prior to surgical resection because of its rarity, and the similarity of its features to malignancy. The measurement of the serum IgG4 levels, immunohistochemical examination of biopsy specimens and use of several imaging modalities might help us to diagnose the disease without surgical resection, and this disease can generally be treated with steroid therapy. However, surgical resection for IgG4-RD may still be also necessary for patients with concerns regarding malignancy or with intractable gastrointestinal obstruction caused by this disease. CONCLUSION Gastrointestinal IgG4-RD often mimics malignancy, and we should therefore consider this disease in the differential diagnosis of colonic lesions in order to optimize the treatment. PMID:25194601

  9. IgG4- related disease: an orphan disease with many faces

    PubMed Central

    2014-01-01

    Immunoglobulin G4- related disease (IgG4-RD) is a rare systemic fibro-inflammatory disorder (ORPHA284264). Although patients have been described more than 100years ago, the systemic nature of this disease has been recognized in the 21st century only. Type 1 autoimmune pancreatitis is the most frequent manifestation of IgG4-RD. However, IgG4-RD can affect any organ such as salivary glands, orbits, retroperitoneum and many others. Recent research enabled a clear clinical and histopathological description of IgG4-RD. Typically, lymphoplasmacellular inflammation, storiform fibrosis and obliterative phlebitis are found in IgG4-RD biopsies and the tissue invading plasma cells largely produce IgG4. Elevated serum IgG4 levels are found in many but not all patients. Consequently, diagnostic criteria for IgG4-RD have been proposed recently. Treatment is largely based on clinical experience and retrospective case series. Glucocorticoids are the mainstay of therapy, although adjunctive immunosuppressive agents are used in relapsing patients. This review summarizes current knowledge on clinical manifestations, pathophysiology and treatment of IgG4-RD. PMID:25026959

  10. IgG4-Related Disease: Dataset of 235 Consecutive Patients

    PubMed Central

    Inoue, Dai; Yoshida, Kotaro; Yoneda, Norihide; Ozaki, Kumi; Matsubara, Takashi; Nagai, Keiichi; Okumura, Kenichirou; Toshima, Fumihito; Toyama, Jun; Minami, Tetsuya; Matsui, Osamu; Gabata, Toshifumi; Zen, Yoh

    2015-01-01

    Abstract Immunoglobulin G4-related disease (IgG4-RD) is a recently discovered systemic condition, in which various organ manifestations are linked by a similar histological appearance. Our knowledge of this condition is still fragmented, as most studies have examined only a few dozen patients or focused on a particular organ manifestation. This study was conducted to learn the demography and patient characteristics of IgG4-RD using a large cohort. A total of 235 consecutive patients with IgG4-RD, diagnosed in 8 general hospitals in the same medical district, were identified by searching the institutions radiology database. Inclusion criteria were histology-proven IgG4-RD according to the Pathology Consensus Statement and/or definitive type 1 autoimmune pancreatitis meeting the International Consensus Diagnostic Criteria. Clinical notes and images of selected patients were retrospectively reviewed. All patients were adults (M/F?=?4/1). The median age was 67 years (range 3586). Nine tenths were diagnosed in their 50s to 70s. Among 486 manifestations identified in total, the most common was pancreatitis diagnosed in 142 patients (60%), followed by sialadenitis (34%), tubulointerstitial nephritis (23%), dacryoadenitis (23%), and periaortitis (20%). The majority of patients (95%) had at least 1 of the 5 most common manifestations. Male and female patients differed in their organ manifestations (periaortitis more common in males and sialodacryoadenitis more common in females). Serum IgG4 (normal ?135?mg/dL) was elevated to >135?mg/dL in 208 patients (88%) and >270?mg/dL in 167 (71%). The IgG4 value was significantly higher in patients with multiorgan involvement than in those with a single manifestation (median 629?mg/dL vs 299?mg/dL, P?10% in 194 (89%). Corticosteroids were effective, but the relapse rate was estimated to be 24% in the study period (median 37 months). During the follow-up, 15 malignant diseases were diagnosed in 13 patients (6%). This figure is similar to the incidence (12.9 cancers) expected from the Japanese nationwide study for cancer epidemiology (standardized incidence ratio 1.16). In conclusion, this reliable dataset could improve the characterization of IgG4-RD, particularly its unique demography and the frequency of each organ manifestation. PMID:25881845

  11. Coronary periarteritis in a patient with multi-organ IgG4-related disease

    PubMed Central

    Guo, Yueyang; Ansdell, David; Brouha, Sharon; Yen, Andrew

    2015-01-01

    Immunoglobulin G4-related disease is a recently described systemic clinicopathological entity characterized by immunoglobulin G4-producing plasmacytic infiltration of tissue and frequently by elevated serum immunoglobulin G4 concentration. Manifestations of this disease have been documented in nearly all organs and locations, but coronary artery involvement is not widely recognized. We report the coronary findings of a patient with multi-organ immunoglobulin G4-related disease. Non-electrocardiogram-gated computed tomography of the chest demonstrated nodular and rind-like periarterial soft tissue thickening along the proximal coronary artery segments with improvement following steroid therapy. PMID:25926916

  12. 21 CFR 866.6050 - Ovarian adnexal mass assessment score test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ovarian adnexal mass assessment score test system. 866.6050 Section 866.6050 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES IMMUNOLOGY AND MICROBIOLOGY DEVICES Tumor Associated...

  13. Diagnostic value of ultrasound indicators of neoplastic risk in preoperative differentiation of adnexal masses

    PubMed Central

    Bachanek, Micha?; Trojanowski, Seweryn; Cendrowski, Krzysztof; Sawicki, W?odzimierz

    2013-01-01

    Aim To assess the diagnostic value of the risk of malignancy indices and simple ultrasound- based rules in preoperative differentiation of adnexal masses. Material and methods Retrospective examination of 87 patients admitted to hospital due to adnexal tumors. The lesions were evaluated on the basis of international ultrasound classification of ovarian tumors and four risk of malignancy indices were calculated based on ultrasound examination, concentration of CA 125 and menopausal status. Results The patients were aged between 17 and 79, the mean age was 44.5 (standard deviation SD=16.6). Most of the patients (60.91%) were before their menopause. The sensitivity of the simple ultrasound-based rules in the diagnosis of malignancies equaled 64.71% and the specificity constituted 90.00%. A significant statistical difference in the presence of the malignant process was demonstrated in relation to age, menopausal status, CA 125 concentration and analyzed ultrasound score. All indices were characterized by similar sensitivity and specificity. The highest specificity and predictive value of malignant lesions out of the assessed ones was demonstrated by the risk of malignancy index proposed by Yamamoto. The risk of malignancy index according to Jacobs, however, showed the highest predictive value in the case of non-malignant lesions. Conclusions The multiparametric ultrasound examination may facilitate the selection of patients with adnexal tumors to provide them with an appropriate treatment observation, laparotomy and laparoscopy. These parameters constitute a simple ambulatory method of determining the character of adnexal masses before recommending appropriate treatment.

  14. 76 FR 16292 - Medical Devices; Immunology and Microbiology Devices; Classification of Ovarian Adnexal Mass...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... HUMAN SERVICES Food and Drug Administration 21 CFR Part 866 Medical Devices; Immunology and Microbiology Devices; Classification of Ovarian Adnexal Mass Assessment Score Test System AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY: The Food and Drug Administration (FDA) is classifying...

  15. 76 FR 16350 - Medical Devices; Ovarian Adnexal Mass Assessment Score Test System; Labeling; Black Box Restrictions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... HUMAN SERVICES Food and Drug Administration 21 CFR Part 866 Medical Devices; Ovarian Adnexal Mass Assessment Score Test System; Labeling; Black Box Restrictions AGENCY: Food and Drug Administration, HHS. ACTION: Proposed rule. SUMMARY: The Food and Drug Administration (FDA) is proposing to amend...

  16. Cluster Bomb Ocular Injuries

    PubMed Central

    Mansour, Ahmad M.; Hamade, Haya; Ghaddar, Ayman; Mokadem, Ahmad Samih; El Hajj Ali, Mohamad; Awwad, Shady

    2012-01-01

    Purpose: To present the visual outcomes and ocular sequelae of victims of cluster bombs. Materials and Methods: This retrospective, multicenter case series of ocular injury due to cluster bombs was conducted for 3 years after the war in South Lebanon (July 2006). Data were gathered from the reports to the Information Management System for Mine Action. Results: There were 308 victims of clusters bombs; 36 individuals were killed, of which 2 received ocular lacerations and; 272 individuals were injured with 18 receiving ocular injury. These 18 surviving individuals were assessed by the authors. Ocular injury occurred in 6.5% (20/308) of cluster bomb victims. Trauma to multiple organs occurred in 12 of 18 cases (67%) with ocular injury. Ocular findings included corneal or scleral lacerations (16 eyes), corneal foreign bodies (9 eyes), corneal decompensation (2 eyes), ruptured cataract (6 eyes), and intravitreal foreign bodies (10 eyes). The corneas of one patient had extreme attenuation of the endothelium. Conclusions: Ocular injury occurred in 6.5% of cluster bomb victims and 67% of the patients with ocular injury sustained trauma to multiple organs. Visual morbidity in civilians is an additional reason for a global ban on the use of cluster bombs. PMID:22346132

  17. Ultrasound Image Discrimination between Benign and Malignant Adnexal Masses Based on a Neural Network Approach.

    PubMed

    Aramendía-Vidaurreta, Verónica; Cabeza, Rafael; Villanueva, Arantxa; Navallas, Javier; Alcázar, Juan Luis

    2016-03-01

    The discrimination between benign and malignant adnexal masses in ultrasound images represents one of the most challenging problems in gynecologic practice. In the study described here, a new method for automatic discrimination of adnexal masses based on a neural networks approach was tested. The proposed method first calculates seven different types of characteristics (local binary pattern, fractal dimension, entropy, invariant moments, gray level co-occurrence matrix, law texture energy and Gabor wavelet) from ultrasound images of the ovary, from which several features are extracted and collected together with the clinical patient age. The proposed technique was validated using 106 benign and 39 malignant images obtained from 145 patients, corresponding to its probability of appearance in general population. On evaluation of the classifier, an accuracy of 98.78%, sensitivity of 98.50%, specificity of 98.90% and area under the curve of 0.997 were calculated. PMID:26715189

  18. Laparoendoscopic Single-Site Surgery for the Treatment of Benign Adnexal Disease: A Prospective Trial

    PubMed Central

    Fagotti, Anna; Fanfani, Francesco; Rossitto, Cristiano; Marocco, Francesco; Gallotta, Valerio; Romano, Federico; Scambia, Giovanni

    2010-01-01

    Background. To validate feasibility, efficacy, and safeness of laparoscopic treatment of benign adnexal diseases through a single transumbilical access (LESS) in a prospective series of patients. Methods. A prospective clinical trial including 30 women has been conducted at the Division of Gynecology of Catholic University of Sacred Hearth of Rome. Patients underwent different laparoscopic procedures by LESS utilizing a multiport trocar and conventional straight laparoscopic instrumentation. Intra and perioperative outcome has been reported. Results. Ten mono/bilateral adnexectomies and 20 cystectomies have been performed by LESS approach. Laparoscopic procedures were completed through a single access in 28 cases (93.4%). No major intra- or postoperative complications were observed. Mean hospital stay was 1.3 days. Conclusions. LESS approach is feasible to treat benign adnexal disease with a very low conversion rate and no early or late complications. More clinical data are needed to confirm these advantages compared to standard laparoscopic technique. PMID:20169051

  19. Laparoendoscopic single-site surgery for the treatment of benign adnexal disease: a prospective trial.

    PubMed

    Fagotti, Anna; Fanfani, Francesco; Rossitto, Cristiano; Marocco, Francesco; Gallotta, Valerio; Romano, Federico; Scambia, Giovanni

    2010-01-01

    Background. To validate feasibility, efficacy, and safeness of laparoscopic treatment of benign adnexal diseases through a single transumbilical access (LESS) in a prospective series of patients. Methods. A prospective clinical trial including 30 women has been conducted at the Division of Gynecology of Catholic University of Sacred Hearth of Rome. Patients underwent different laparoscopic procedures by LESS utilizing a multiport trocar and conventional straight laparoscopic instrumentation. Intra and perioperative outcome has been reported. Results. Ten mono/bilateral adnexectomies and 20 cystectomies have been performed by LESS approach. Laparoscopic procedures were completed through a single access in 28 cases (93.4%). No major intra- or postoperative complications were observed. Mean hospital stay was 1.3 days. Conclusions. LESS approach is feasible to treat benign adnexal disease with a very low conversion rate and no early or late complications. More clinical data are needed to confirm these advantages compared to standard laparoscopic technique. PMID:20169051

  20. Laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy

    PubMed Central

    Minig, Lucas; Otao, Lucas; Cruz, Pilar; Patrono, Mara Guadalupe; Botazzi, Cecilia; Zapardiel, Ignacio

    2016-01-01

    OBJECTIVE: To evaluate the feasibility and safety of laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy. STUDY DESIGN: An observational study of a prospective collection of data of all pregnant women who underwent laparoscopic surgery for adnexal masses during the first trimester of pregnancy between January 1999 and November 2012 at the Obstetrics and Gynecology Department of the Italian Hospital of Buenos Aires, Buenos Aires, Argentina was performed. RESULTS: A total of 13 women were included. The median (range) gestational age at the moment of surgical procedure was 7 weeks (range: 5-12 weeks). The main indication of surgery was cyst torsion in four cases (30.7%) and rupture of ovarian cysts in four cases (30.7%). Other indications included persistent ovarian cyst in three patients (23%) and heterotopic pregnancy in two cases (15.3%). Neither surgical complications nor spontaneous abortions occurred in any of the cases and the post-operative period was uneventful in all the cases. No cases of intrauterine growth retardation, preterm delivery, congenital defects, or neonatal complications were registered. CONCLUSION: The treatment of complicated adnexal masses by laparoscopic surgery during the first trimester of pregnancy appears to be a safe procedure both for the mother and for the foetus. Additional research on a larger number of cases is still needed to support these conclusions.

  1. Ultrasound follow up of an adnexal mass has the potential to save lives.

    PubMed

    Ormsby, Eleanor L; Pavlik, Edward J; van Nagell, John R

    2015-11-01

    Ovarian cancer is among the most dreaded cancers since it is often found at a late stage where the opportunity for extended survival is poor. Ultrasound has been utilized in several ovarian cancer screening trials in asymptomatic women in order to detect ovarian cancer at early stages where survival rates are high. Efforts to improve screening for ovarian cancer are ongoing. While ovarian cancer screening in asymptomatic women is not recommended for clinical application currently, the care of women with adnexal masses found by ultrasound in clinical practice can benefit from close evaluation of the evidence obtained from large prospective ovarian cancer screening trials and by relating this evidence to recent advances in the understanding of different types of ovarian cancer. Post-menopausal women who have an adnexal mass discovered by ultrasound have a much higher risk of developing ovarian cancer than women with normal ultrasound. The preponderance of reported evidence indicates that ultrasound monitoring of an adnexal mass is safe, cost effective and can achieve an improved positive predictive value in detecting ovarian cancer when ovarian abnormalities resolve during surveillance. Proposals to arbitrarily discontinue ultrasound monitoring can negatively impact patient care and generate medical-legal actions, especially because there is no evidence to support safe discontinuation. In this review, we outline a rationale for continuing ultrasound surveillance of ovarian abnormalities. PMID:26116103

  2. Targeting the adnexal epithelium: an unusual case of syringometaplasia in a patient on vemurafenib.

    PubMed

    Yu, JiaDe; Ravikumar, Sitara; Plaza, Jose A; Troy, James L; Schieke, Stefan M

    2015-05-01

    Cutaneous adverse events (cAEs) are reported in 90% of all patients on selective BRAF inhibitors and contribute significantly to patient morbidity. Two weeks after initiating vemurafenib for metastatic melanoma, our patient developed a pruritic eruption with numerous, 1-2 mm pink hyperkeratotic follicular papules over his trunk and upper extremities. A biopsy demonstrated squamous metaplasia of the eccrine ducts with irregular hyperplasia of hair follicles sparing the interfollicular epidermis. Diffuse adnexal metaplasia is a novel and unusual cutaneous response to vemurafenib. The patient was started on acitretin 10 mg daily with improvement of the eruption after 4 weeks. We report an unusual cAE of vemurafenib selectively targeting the adnexal epithelium with relative sparing of the interfollicular epidermis. Interval improvement was noted after 4 weeks of acitretin, which is an effective therapeutic option for patients with cAEs involving squamous hyperplasia secondary to vemurafenib. Our case illustrates the particular sensitivity of the adnexal epithelium for vemurafenib-induced dysfunction in proliferation and differentiation, providing the basis for common cAEs observed on this medication. PMID:25839889

  3. Surgical approach to appendiceal mucocele mimicking an adnexal complex mass: case report.

    PubMed

    Scaffa, C; Di Bella, O; Tartaglia, E; Rotondi, M; Lup, F; Messalli, E M

    2007-01-01

    Mucocele of the vermiform appendix is a rare disease of the appendix caused by mucoid substance retention in its lumen, due to obstruction or hyperproduction due to appendiceal retention cysts, mucosal hyperplasia, mucinous cystadenomas and cystadenocarcinomas. Therefore, also appendiceal malignancy can be the underlying cause, making accurate preoperative diagnosis imperative, even if this disease is often asymptomatic and an early diagnosis still remains very difficult on imaging studies. In women, appendiceal mucoceles can sometimes present on clinical and instrumental findings as a right adnexal mass mimicking an ovarian neoplasm. A rare case of appendiceal mucocele in a 36-year-old women with a right-sided painful pelvic mass is presented. The mucocele was misdiagnosed as a cystic complex mass of the right adnexa both clinically and ultrasonographically. Serum levels of CEA and CA19-9 were increased. Explorative laparoscopy was performed revealing an enlarged vermiform appendix with the uterus and adnexa macroscopically normal, and no signs of intraperitoneal metastasis or adnexal torsion. Laparotomic appendectomy followed. Histological examination revealed a mucinous cystadenoma of the vermiform appendix. This clinical entity of appendiceal mucocele should always be considered by gynaecologists as well as gastroenterologists in the differential diagnosis of patients presenting a right-sided adnexal mass on ultrasound in order to choose the best surgical approach. PMID:18179147

  4. Ocular paintball injuries.

    PubMed

    Fineman, M S

    2001-06-01

    Paintball sport-related ocular injuries represent an increasing problem as the popularity of the sport increases and the number of participants grows. Although eye protective devices designed specifically for paintball sports are extremely effective in preventing such injuries, the failure to properly wear these devices has resulted in an alarming number of severe ocular injuries. Recent trends have indicated that an increasing percentage of paintball sport-related ocular injuries have occurred in unsupervised, noncommercial settings (i.e., backyard games) where the use of eye protective devices is not required. Paintball industry standards for eye protection have recently been developed and should be implemented for all participants. PMID:11389344

  5. p40 exhibits better specificity than p63 in distinguishing primary skin adnexal carcinomas from cutaneous metastases.

    PubMed

    Lee, Jonathan J; Mochel, Mark C; Piris, Adriano; Boussahmain, Chakib; Mahalingam, Meera; Hoang, Mai P

    2014-05-01

    The histopathologic distinction between primary adnexal carcinomas and metastatic adenocarcinoma to the skin from sites such as the breast, lung, and others often presents a diagnostic dilemma. Current markers of diagnostic utility include p63 and cytokeratin 5/6; however, their expression has been demonstrated in 11% to 22% and 27% of cutaneous metastases, respectively. Furthermore, the immunoreactivity of p40 and GATA3 in various cutaneous adnexal carcinomas has not been previously reported. In the present study, we compared the expression of p40, p63, cytokeratin 5/6, and GATA3 in a total of 143 cases, including 67 primary adnexal carcinomas and 76 cutaneous metastases. p40, p63, cytokeratin 5/6, and GATA3 expression was observed in 80%, 84%, 86%, and 47% of primary adnexal carcinoma, respectively, and in 8%, 17%, 26%, and 40% of cutaneous metastases, respectively. ?(2) Analysis revealed statistically significant P values (<.0001) for p40, p63, and cytokeratin 5/6 in distinguishing primary adnexal carcinoma from cutaneous metastases. In summary, while p63 and cytokeratin 5/6 have similar sensitivity (84% and 86%, respectively) in detecting primary adnexal carcinomas, p40 appeared to be the most specific marker (92%) with the best positive predictive value (90%). Since breast and lung are the most common sites of origin for cutaneous metastases, p40 is the best distinguishing marker in these settings. None of the four studied markers (p40, p63, cytokeratin 5/6, and GATA3) are helpful in distinguishing between primary adnexal carcinomas from cutaneous metastases of salivary gland or bladder malignancies. PMID:24746214

  6. Ocular manifestation of Ichthyosis

    PubMed Central

    Al-Amry, Mohammad A.

    2015-01-01

    Purpose Ichthyosis is a rare dermato-ocular disease. This study evaluates the presenting ocular signs, symptoms, complications and prognosis of ichthyosis in a case series from Saudi Arabia. Methods A retrospective chart review was performed for 11 patients with ichthyosis who presented to King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, over the last 20years. Results The most common presenting ocular diagnosis was ectropion of both the lids. Two patients developed corneal perforation with poor prognosis. Most of the patients underwent skin grafting to repair eyelid ectropion. The visual prognosis was excellent because timely surgical interventions were performed. Hence the rate of corneal complications such as perforation was low. Conclusion The most ocular presentation of ichthyosis is ectropion of both the upper and lower lids. Despite good visual prognosis, there were some devastating corneal complications such as perforation with unpredictable outcomes.

  7. Ocular immune privilege

    PubMed Central

    Taylor, AW

    2015-01-01

    It has been over 60 years since the phrase immune privilege was used by Sir Peter Medawar to describe the lack of an immune response against allografts placed into the ocular microenvironment. Since then, we have come to understand that the mechanisms of ocular immune privilege include unique anatomical features of a blood barrier and a lack of direct lymphatic drainage. Also, we know that the ocular microenvironment is rich with immunosuppressive molecules that influence the activity of immune cells. Moreover, the placement of foreign antigen into the ocular microenvironment can induce a systemic form of tolerance to the foreign antigen called anterior chamber-associated immune deviation (ACAID). Many soluble immunomodulators are found in aqueous humour, and are a mixture of growth factors, cytokines, neuropeptides, and soluble receptors. This is a continuously growing list. The mechanisms of ocular immune privilege induce apoptosis, promote the production of anti-inflammatory cytokines, and mediate the activation of antigen-specific regulatory immunity. These mechanisms of immune privilege also attempt to impose themselves upon immunity within the uveitic eye. The adaptation of several anatomical and biochemical mechanisms to establish an immune privileged microenvironment within the eye makes the eye immunologically unique. It is a tissue site where we may learn how immunity is regulated in inflammation and at rest. Success in translating the lessons of ocular immune privilege to other tissues has the potential to drastically change the therapy and clinical outcomes of autoimmune diseases and allograft survival. PMID:19136922

  8. Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses.

    PubMed

    Suh-Burgmann, Elizabeth; Kinney, Walter

    2015-12-01

    The management of women with asymptomatic adnexal masses should aim to balance potential benefit with potential harm. While masses with highly worrisome features or other signs of malignancy should be referred for surgery, the vast majority of masses have an indeterminate or benign appearance and are candidates for observation. Evidence supports the use of initial short-term serial ultrasound in distinguishing between benign and malignant masses. However, benefit from prolonged, potentially life-long monitoring of stable masses has not been demonstrated. Since the goal of monitoring an adnexal mass is to observe for worrisome growth or increasing complexity as an indicator of malignancy, if the mass remains stable, the likelihood of malignancy and therefore, the potential benefit of observation wanes with time. The recognition that Type 2 high grade serous cancers, which are responsible for the majority of deaths from ovarian cancer, arise from fallopian tube rather than ovarian precursors, further diminishes the likelihood that monitoring a stable ovarian mass will lead to early diagnosis of high grade disease. While some Type 1 cancers may develop from ovarian precursors, the available data suggest that any measurable benefit of monitoring known lesions for detection of these cancers is realized within the first year of observation. The argument in favor of indefinite, potentially life-long monitoring of stable masses also fails to adequately account for the risks of perpetual imaging, which include the risk of incidental findings, an increased likelihood of unnecessary surgery, patient anxiety and cost. It is not always better to order a test than not order a test. Given the absence of evidence of benefit, observation of stable small adnexal masses should be limited in duration in order to minimize potential harms. PMID:26363476

  9. Large Mucocele of the Appendix at Laparoscopy Presenting as an Adnexal Mass in a Postmenopausal Woman: A Case Report

    PubMed Central

    Paladino, Elvira; Bellantone, Maria; Sesti, Francesco; Piccione, Emilio; Pietropolli, Adalgisa

    2014-01-01

    A 79-year-old female was referred to our Gynecologic Department presenting with a pelvic magnetic resonance imaging (MRI), showing an adnexal mass, later confirmed at the pelvic examination. The patient's routine laboratory tests were normal. A sonographic examination was performed with inconclusive results. Although the ultrasonography excluded the presence of vascularization and malignant degeneration, the adnexal localization appeared to be dubious. The laparoscopy and the subsequent histologic examination revealed the presence of a mucocele of the appendix. The following case report focuses the attention on a misdiagnosis of appendiceal mucocele. The misdiagnosis caused no negative impact on the treatment that in this case was adequate and successful. PMID:24804128

  10. Large mucocele of the appendix at laparoscopy presenting as an adnexal mass in a postmenopausal woman: a case report.

    PubMed

    Paladino, Elvira; Bellantone, Maria; Conway, Francesca; Sesti, Francesco; Piccione, Emilio; Pietropolli, Adalgisa

    2014-01-01

    A 79-year-old female was referred to our Gynecologic Department presenting with a pelvic magnetic resonance imaging (MRI), showing an adnexal mass, later confirmed at the pelvic examination. The patient's routine laboratory tests were normal. A sonographic examination was performed with inconclusive results. Although the ultrasonography excluded the presence of vascularization and malignant degeneration, the adnexal localization appeared to be dubious. The laparoscopy and the subsequent histologic examination revealed the presence of a mucocele of the appendix. The following case report focuses the attention on a misdiagnosis of appendiceal mucocele. The misdiagnosis caused no negative impact on the treatment that in this case was adequate and successful. PMID:24804128

  11. Comparative Effectiveness of Robotically Assisted Compared With Laparoscopic Adnexal Surgery for Benign Gynecologic Disease

    PubMed Central

    Wright, Jason D.; Kostolias, Alessandra; Ananth, Cande V.; Burke, William M.; Tergas, Ana I.; Prendergast, Eri; Ramsey, Scott D.; Neugut, Alfred I.; Hershman, Dawn L.

    2014-01-01

    Objective To perform a population-based analysis to compare the complications and cost of laparoscopic and robotically assisted adnexal surgery. Methods A nationwide database was utilized to analyze the use and outcomes of robotically assisted adnexal surgery from 20092012. Multivariable mixed effects regression models were developed to examine predictors of use of robotic surgery. After propensity score matching, complications and cost were compared between robotically assisted and laparoscopic surgery. Results 87,514 women were identified. From 2009 to 2012, performance of robotic-assisted oophorectomy increased from 3.5% (95% CI, 3.23.8%) to 15.0% (95% CI, 14.415.6%), while robotically assisted cystectomy rose from 2.4% (95% CI, 2.02.7%) to 12.9% (95% CI, 12.213.5%). The overall complication rate was 7.1% (95% CI, 4.010.2%) for robotically assisted vs. 6.0% (95% CI, 2.99.1%) for laparoscopic oophorectomy (OR=1.20; 95% CI, 1.001.45) (P=0.052). Robotic-assisted oophorectomy was associated with a higher rate of intraoperative complications (3.4% vs. 2.1%, OR=1.60; 95% CI, 1.212.13). The overall complication rate was 3.7% (95% CI ?0.88.2%) after robotically assisted versus 2.7% (95% CI, ?1.87.2%) for laparoscopic cystectomy (OR=1.38; 95% CI, 0.951.99). The intraoperative complication rate was higher for robotically assisted cystectomy (2.0% vs. 0.9%, OR=2.40; 95% CI, 1.314.38). Compared to laparoscopy, robotically assisted oophorectomy was associated with $2504 (95% CI, $2356$2652) increased total costs and robotically assisted cystectomy $3310 (95% CI, $3082$3581) higher costs. Conclusion Use of robotically assisted adnexal surgery increased rapidly. Compared to laparoscopic surgery, robotically assisted adnexal surgery is associated with substantially greater costs and a small, but statistically significant, increase in intraoperative complications. PMID:25437715

  12. Preoperative Evaluation of Risk of Ovarian Malignancy Algorithm Index in Prediction of Malignancy of Adnexal Masses

    PubMed Central

    Farzaneh, Farah; Honarvar, Zahra; Yaraghi, Mansoore; Yaseri, Mehdi; Arab, Maliheh; Hosseini, Maryamsadat; Ashrafgangoi, Tahereh

    2014-01-01

    Background: Differentiation between benign and malignant ovarian neoplasms is essential to create a system for patient referrals. Objectives: The aim of the present prospective trial was to analyze the value of the risk of ovarian malignancy algorithm (ROMA) in prediction of adnexal masses malignancy in pre- and post-menopause women before operation. Materials and Methods: Preoperative serum samples were tested for CA125 and HE4 using fully automated methods (Abbott architect) and gained best cutoff. The ROMA index was analyzed in 99 patients (including 68 pre-menopause and 31 menopause) with adnexal masses referred to Imam Hossein Hospital/Tehran/Iran and had been scheduled for operation. The pathological results showed 43 cases (22 menopause) with malignant adnexal masses and 56 cases (9 menopauses) with benign adnexal masses. Demographical data, clinical symptoms and the ROMA index were separately analyzed and contrasted in benign and malignant in both menopause and pre-menopause patients. Results: The only significant difference was the older age of the malignant group vs. benign group (P = 0.001) regarding demographic findings. As concerns the clinical symptoms, presence of abdominal discomfort in pre-diagnosis period was the only significant parameter in malignant group (P = 0.001). Additionally, data analysis of patients as a total group showed that specificity (96.4%), positive predictive value (PPV) (94.1%), area under the curve (AUC) (0.907), and diagnostic accuracy (DA) (86.9%) of the ROMA were higher than HE4 (91.1%, 85.7%, 0.857 and 81.8%. respectively) and CA125 (87.9%, 67.3%, 0.828 and 75.8%, respectively) alone. Besides, negative predictive value (NPV) (86.4%) and sensitivity (86.1%) of CA125 were higher than HE4 (79.7% and 69.8%, respectively). In contrast, specificity of HE4 (91.1%) was higher than CA125 (67.9%). Data analysis of patients as two groups (pre and post menopause groups) showed the same results. Conclusions: Specificity, DA and AUC of the ROMA were higher than HE4 and CA125 taken separately. PMID:25068046

  13. Primary pelvic hydatid cyst an unusual cause of cystic adnexal image (mass).

    PubMed

    Ait Benkaddour, Y; Benkaddour, Yassir Ait; Mansouri, M Z; Rabbani, K; Jalal, H; Aboulfalh, A; Abbassi, H

    2011-06-01

    Hydatid cyst is a parasitic human infection which is endemic in North Africa. It is more frequently localized in the liver and the lung. Involvement of others sites is usually secondary to these primary localizations. We report 2 exceptional cases of primary pelvic hydatid cyst diagnosed respectively in a 37-year-old and in a 48-year-old women. These cases will focus on the different characteristics of the infection, and the benefit of including epidemiologic arguments in using the diagnostical approach of adnexal masses. PMID:22590903

  14. Ocular involvement of brucellosis.

    PubMed

    Bazzazi, Nooshin; Yavarikia, Alireza; Keramat, Fariba

    2013-01-01

    A 29-year-old male diagnosed with brucellosis a week earlier was referred to the ophthalmology clinic with visual complaints. On examination, visual acuity was 20/25, he had conjunctival injection on slit lamp examination. There was also bilateral optic disk swelling plus retinal hyperemia (optic disc hyperemia and vascular tortuosity) and intraretinal hemorrhage on funduscopy. The patient was admitted and treated with cotrimoxazole, rifampin, doxycycline and prednisolone for 2 months. Ocular manifestations subsided gradually within 6 months after treatment. Brucellosis can affect the eye and lead to serious ocular complications. Early diagnosis and prompt treatment should be considered in endemic areas. PMID:23580863

  15. Homocysteine in ocular diseases.

    PubMed

    Ajith, Thekkuttuparambil Ananthanarayanan; Ranimenon

    2015-10-23

    Homocysteine (Hcy) is a derived sulfur-containing and non-proteinogenic amino acid. The metabolism of Hcy occurs either through the remethylation to methionine or transsulfuration to cysteine. Studies have identified hyperhomocysteinemia (HHcy) as one of the possible risk factors for a multitude of diseases including vascular, neurodegenerative and ocular diseases. Association of HHcy with eye diseases such as retinopathy, pseudoexfoliative glaucoma maculopathy, cataract, optic atrophy and retinal vessel atherosclerosis is established. The molecular mechanism underlying these ocular diseases has been reported as impaired vascular endothelial function, apoptosis of retinal ganglion cells, extracellular matrix alterations, decreased lysyl oxidase activity and oxidative stress. The formed homocysteine-thiolactone in HHcy has stronger cytotoxicity and pro-inflammatory properties which can induce lens opacification and optic nerve damage. The metabolism of Hcy requires enzymes with vitamins such as folic acid, vitamins B12 and B6. Despite the mixed conclusion of various studies regarding the level of these vitamins in elder people, studies recommended the treatment with folate and B12 to reduce Hcy levels in subjects with or without any defect in the enzymes involved in its metabolism. The levels of Hcy, folate, B6 as well as B12 should be measured early in patients with visual impairment that would aid to screen patients for life-threatening disorders related with HHcy. Elder patients may supplement with these vitamins in order to attenuate the ocular damages. This article discusses the association of Hcy in ocular diseases and the possible mechanism in the pathogenesis. PMID:26343924

  16. Pattern of ocular trauma.

    PubMed

    Hossain, M M; Mohiuddin, A A; Akhanda, A H; Hossain, M I; Islam, M F; Akonjee, A R; Ali, M

    2011-07-01

    This prospective observational study was conducted in the department of Ophthalmology Mymensingh Medical College Hospital during the period of November, 2009 to October, 2010. Two hundred & fifty (250) patients of both sexes and all ages with ocular trauma were selected randomly for this study. A detailed history of patients, duration of trauma, relation of trauma with work, visual status prior to injury, any surgery prior to injury & patients were alcoholic or not were taken. Male patients were 190(76%) and female patients were 60(24%). Majority of patients were 11-20 years group (39.2%). Most of patients (40%) attended into hospital within 60 hours of ocular trauma. Accidental occupational trauma were more common (51.2%) and assault injury were less common (12.8%). Greater number of ocular trauma was caused by sharp objects (59.2%) and less number of ocular trauma was caused by chemical injuries (2.4%). Open globe injuries were more common (62%) than closed globe injury (38%). Visual acuity on admission between 6/60 to PL comprises highest number (64%) and also on discharge between 6/60 to PL comprises highest number of cases (50%). Most of the patients came from poor socioeconomic group (60%). PMID:21804497

  17. The Value of Ultrasound Monitoring of Adnexal Masses for Early Detection of Ovarian Cancer

    PubMed Central

    Suh-Burgmann, Elizabeth; Kinney, Walter

    2016-01-01

    Although ultrasound has so far been found to be ineffective as a screening tool for ovarian cancer, it is commonly used as a means of evaluating or following ovarian or adnexal masses once they are detected. We review the use of serial ultrasound for the management of adnexal masses and propose an approach to monitoring based on an understanding of the overall risk of cancer among the population in question and an assessment of how the potential benefit of monitoring compares with potential risk. In our approach, masses that are symptomatic, large (>10 cm), associated with an elevated CA 125 level or overt signs of malignancy, or that are determined to have a worrisome appearance by stringent ultrasound criteria should be evaluated surgically. Women with masses that have none of these characteristics should be offered monitoring. Short-term initial ultrasound monitoring carries significant potential benefit in terms of aiding detection of early malignancy and avoidance of unnecessary surgery. However, if a mass remains stable but persistent, the potential benefit of ongoing monitoring wanes with time, whereas the potential harms, in terms of patient anxiety, cost, and the risk of incidental findings and unnecessary surgery increase. Therefore, monitoring of stable lesions should be limited in duration in order to limit potential harms from overtreatment and overdiagnosis. PMID:26904503

  18. UNEXPECTED OVARIAN MALIGNANCY FOUND AFTER LAPAROSCOPIC SURGERY IN PATIENTS WITH ADNEXAL MASSES A SINGLE INSTITUTIONAL EXPERIENCE

    PubMed Central

    SAITO, SHIGEKO; KAJIYAMA, HIROAKI; MIWA, YOKO; MIZUNO, MIKA; KIKKAWA, FUMITAKA; TANAKA, SHIHO; OKAMOTO, TOMOMITSU

    2014-01-01

    ABSTRACT Laparoscopy has become the standard surgery for the treatment of benign ovarian tumors. The aim of this study was to evaluate the appropriateness of laparoscopy for ovarian tumors, including those with malignant potential. A total of 487 patients with adnexal masses underwent laparoscopic surgery in Social Insurance Chukyo Hospital from January 2000 to December 2012.We reviewed 471 cases that fulfilled the criteria set for this study, and examined 10 cases with unexpected ovarian malignancy to analyze their preoperative diagnosis, second surgery, postoperative chemotherapy, and prognosis. The ages of the 471 patients ranged from 13 to 50 years, with a median of 31. Nulliparous patients numbered 321(68.1%).Of all, 436 patients mostly consisted of those with endometrioma, benign ovarian neoplasm or functional cyst. In all, we histologically identified 10 women with malignancy: 6 with borderline ovarian tumors (BOT), 2 with ovarian cancer, and 2 with histologically rare tumors (immature teratoma and granulosa cell tumor). All patients with BOT were diagnosed with a mucinous histology. Two patients underwent both second radical surgery (hysterectomy and contra- or bilateral salpingo-oophorectomy) and chemotherapies that consisted of CBDCA and PTX or DTX. Thus, 2 patients underwent staging procedures, but the remaining 8 cases did not. None of them had evidence of recurrences. With accurate staging and careful postoperative follow-up, laparoscopic surgery could be a feasible initial operation for patients with adnexal masses including early-stage ovarian malignancy. PMID:25129994

  19. Use of an internal reference in semi-quantitative dynamic contrast-enhanced MRI (DCE MRI) of indeterminate adnexal masses

    PubMed Central

    Benardin, L; Booth, T C; Miquel, M E; Dilks, P; Sahdev, A; Rockall, A G

    2014-01-01

    Objective: Semi-quantitative dynamic contrast-enhanced MRI (DCE MRI) has proven useful in discriminating benign from borderline/malignant adnexal lesions. Our aim was to assess if the use of a lesion-to-internal-reference ratio improved the performance in characterizing adnexal masses and which internal reference was suitable. Methods: Semi-quantitative DCE MRI images of 71 indeterminate adnexal lesions were retrospectively reviewed. A region of interest was manually drawn onto the enhancing solid component, psoas muscle and normal outer myometrium. The DCE parameters were evaluated, and the lesion-to-internal-reference ratios were calculated. Results: When the wash in rate of the lesion was higher than that of the myometrium, 97% specificity and 12% sensitivity for borderline/malignancy was reached. When the maximum relative enhancement and maximum absolute enhancement (SImax) of the lesion was less than those of the psoas, 100% specificity for benignity was achieved. The highest area under the curve (AUC) (0.807) was achieved using a SImax lesionmyometrium ratio. A slightly lower AUC (0.799) was achieved using a SImax lesionpsoas ratio, but the psoas muscle was more frequently measurable in the same slice as the lesion ROI. Although the AUC was higher, when using ratios instead of individual DCE values, this was not significantly different. Conclusion: DCE MRI has added diagnostic value in the assessment of adnexal lesions, and the use of internal references enables high specificity for malignancy and benignity. Lesioninternal-reference ratios have no added diagnostic value over DCE values alone. Advances in knowledge: Both psoas muscle and myometrium are suitable internal references in the DCE assessment of adnexal lesions enabling high specificity for malignancy and benignity. PMID:25237836

  20. Ocular delivery of macromolecules

    PubMed Central

    Kim, Yoo-Chun; Chiang, Bryce; Wu, Xianggen; Prausnitz, Mark R.

    2014-01-01

    Biopharmaceuticals are making increasing impact on medicine, including treatment of indications in the eye. Macromolecular drugs are typically given by physician-administered invasive delivery methods, because non--invasive ocular delivery methods, such as eye drops, and systemic delivery, have low bioavailability and/or poor ocular targeting. There is a need to improve delivery of biopharmaceuticals to enable less-invasive delivery routes, less-frequent dosing through controlled-release drug delivery and improved drug targeting within the eye to increase efficacy and reduce side effects. This review discusses the barriers to drug delivery via various ophthalmic routes of administration in the context of macromolecule delivery and discusses efforts to develop controlled-release systems for delivery of biopharmaceuticals to the eye. The growing number of macromolecular therapies in the eye needs improved drug delivery methods that increase drug efficacy, safety and patient compliance. PMID:24998941

  1. Human ocular anatomy.

    PubMed

    Kels, Barry D; Grzybowski, Andrzej; Grant-Kels, Jane M

    2015-01-01

    We review the normal anatomy of the human globe, eyelids, and lacrimal system. This contribution explores both the form and function of numerous anatomic features of the human ocular system, which are vital to a comprehensive understanding of the pathophysiology of many oculocutaneous diseases. The review concludes with a reference glossary of selective ophthalmologic terms that are relevant to a thorough understanding of many oculocutaneous disease processes. PMID:25704934

  2. The clinical spectrum of ocular bobbing and ocular dipping.

    PubMed Central

    Mehler, M F

    1988-01-01

    The term "ocular bobbing" defines a distinctive class of abnormal spontaneous vertical eye movements which occur in a variety of clinicopathological settings. Four cardinal forms, which correspond to the predicted permutations of the two characteristic clinical variables, initial vertical excursion and phasic velocity, have now been described. Reverse ocular dipping, with directional reversal and phasic inversion from typical ocular bobbing, is the last link in this functional tetrad and is newly presented. The four pathological forms share several basic phenomenological features but exhibit clinical and aetiological diversity and significant differences in prognosis. An analysis of the clinical spectrum of disorders subsumed under the general heading of "ocular bobbing" is presented. PMID:3404172

  3. Tumefactive intramural gossypiboma of the urinary bladder mimicking an invasive adnexal malignancy

    PubMed Central

    Jain, Shivi; Verma, Ashish; Jain, Madhu; Trivedi, Sameer; Shukla, Ram C; Srivastava, Arvind

    2015-01-01

    A surgical swab retained in the body after surgery is known as Gossypiboma. The purpose of this report is to highlight an intramural vesical gossypiboma mimicking an invasive adnexal malignancy. A 28-year-old multiparous, with open-tubal ligation three years ago, presented with painless hematuria and a nontender mass on vaginal examination. USG suggested pelvic endometriosis infiltrating into the bladder and cystoscopy showed no intraluminal extension of the mass. Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) misdiagnosed it as invasive malignancy of the fallopian tube. Exploratory laparotomy found it to be an intramural vesical gossypiboma. A pelvic gossypiboma infiltrating into the wall of the urinary bladder may easily be misinterpreted as an invasive pelvic malignancy on imaging and may make one consider unwarranted radical surgery. PMID:25969644

  4. Adnexal Incarceration in a Posterior Pelvic Peritoneal Defect Mimics Ovarian Torsion.

    PubMed

    Jackson, Amanda M; Hope, Erica R; Phippen, Neil T

    2015-01-01

    Surgery for suspected ovarian torsion sometimes reveals unexpected sources of pelvic pain, such as internal hernias, adhesions, or anatomic defects. A 23-year-old nulligravida with Alagille syndrome was taken to the operating room with suspected ovarian torsion. Intraoperatively, the right adnexa bulged out of a right-sided, posterior peritoneal cleft that incarcerated most of the enlarged ovary. No ovarian torsion was identified. The left adnexa appeared to be normal; however, it dwelled within a left-sided posterior peritoneal cleft. The bilateral posterior peritoneal defects that housed the adnexa were likely of congenital etiology. Although adnexal incarceration is a rare finding at surgery for suspected ovarian torsion, it should be part of the differential diagnosis when evaluating acute pelvic pain. PMID:26044591

  5. Developing photoacoustic ocular imaging system

    NASA Astrophysics Data System (ADS)

    Ye, Shuoqi; Wu, Ning; Ren, Qiushi; Li, Changhui

    2013-03-01

    Ocular imaging plays a key role for the diagnosis of various ocular diseases. In this work, we have developed an ocular imaging system based on the photoacoustic tomography. This system has successfully imaged the entire eye of a mouse, from its iris to the retina region, and the imaging is label-free and non-invasively. The resolution of this system reaches several micron meters, allowing the study of microstructures in various ocular tissues. Our system has the potential to be a powerful non-invasive imaging method for the ophthalmology.

  6. Adnexal Torsion

    MedlinePLUS

    ... ve probably been infected with the mosquito-borne Zika virus should not have... More News News HealthDay More U.S. Women Delivering Babies at Home or Birth Centers WEDNESDAY, March 23, 2016 (HealthDay News) -- More women in the United States are choosing to deliver their babies at home ...

  7. IgG4-related disease: description of a case with pulmonary lesions, mediastinal lymphadenopathies and rapidly progressive renal failure.

    PubMed

    Fernndez Lorente, Loreto; lvarez, Dolores Lpez; Lpez, Virginia Garca; Kollros, Vesna Abujder; Ariza, Aurelio; Glvez, Alejandro; Bonet, Josep

    2015-01-01

    This is a case report of a 73-year-old man with new-onset acute renal failure while being investigated for pulmonary infiltrates and mediastinal lymphadenopathies. Urine tests showed tubular range proteinuria with no microhaematuria. Immunology tests showed elevated serum IgG and hypocomplementaemia (classical pathway activation). Renal biopsy and clinical-pathological correlation were crucial in this case, reinforcing their important role in the final diagnosis of acute kidney injury. PMID:26300516

  8. Serum BAFF and APRIL levels in patients with IgG4-related disease and their clinical significance

    PubMed Central

    2012-01-01

    Introduction B cell-activating factor of the tumor necrosis factor family (BAFF) and a proliferation-inducing ligand (APRIL) play a crucial role in B cell development, survival, and antibody production. Here we analyzed the serum levels of BAFF and APRIL and their respective clinical associations in patients with an immunoglobulin (Ig) G4-related disease (IgG4-RD). Methods We measured serum levels of BAFF and APRIL in patients with IgG4-RD, primary Sjgren's syndrome (pSS), and healthy individuals. Serum BAFF and APRIL levels in IgG4-RD were assessed for correlations with serological parameters, including Ig, particularly IgG4, and the number of affected organs. Serum BAFF and APRIL levels in IgG4-RD were monitored during glucocorticoid (GC) therapy. Results Serum BAFF and APRIL levels in patients with IgG4-RD were significantly higher (P < 0.01) than in healthy individuals. The BAFF levels of patients with IgG4-RD were comparable to those of patients with pSS. Although clinical parameters, such as serum IgG4 and the number of affected organs, were not correlated with the levels of BAFF, serum APRIL levels were inversely correlated with serum IgG4 levels (r = -0.626, P < 0.05). While serum BAFF levels decreased following GC therapy, serum APRIL levels increased during follow-up. Conclusion These results indicate that BAFF and APRIL might be useful markers for predicting disease activity in IgG4-RD. Further studies are needed to elucidate the role of BAFF and APRIL in the pathogenesis of IgG4-RD. PMID:22531553

  9. Ocular herpes simplex

    PubMed Central

    2008-01-01

    Introduction Ocular infection with herpes simplex virus (HSV) is usually acquired early in life, with 50% of people from higher and 80% from lower socioeconomic groups in the USA having antibodies by the age of 30 years. Attacks usually resolve spontaneously within 1?2 weeks, but 50% of people will experience a recurrence within 10 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with epithelial keratitis? What are the effects of treatments in people with stomal keratitis? What are the effects of interventions to prevent recurrence of ocular herpes simplex? What are the effects of interventions to prevent recurrence of ocular herpes simplex in people with corneal grafts? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found seven systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding oral aciclovir to topical corticosteroids plus topical antiviral treatment; adding topical corticosteroids to topical antiviral treatment; antiviral agents (topical); debridement; interferons (topical); and oral aciclovir. PMID:19445742

  10. Ocular BB injuries.

    PubMed

    Sternberg, P; de Juan, E; Green, W R; Hirst, L W; Sommer, A

    1984-10-01

    Data from the United States Consumer Product Safety Commission indicate that air-powered guns were responsible for 22,800 injuries treated in emergency rooms during 1981, of which 1255 were eye injuries. From 1970 to 1981, 32 patients have undergone surgical intervention at the Wilmer Eye Institute for airgun-related eye injuries. Of the 22 patients with penetrating injuries from the pellets, 19 eyes were enucleated; final vision in the three remaining eyes was worse than 5/200. Of seven patients with nonpenetrating injuries, six had final vision of 20/40 or better. All three patients with penetrating injuries from shattered spectacle lenses had final vision of 20/40 or better. Histopathologic examination of the enucleated specimens demonstrated severe disruption of intraocular contents, particularly posteriorly. Despite the potential ocular dangers of airguns, only 11 states have enacted legislation that regulates their sale or use. BB injuries represent a devastating form of ocular trauma which can be prevented by adoption and enforcement of appropriate legislation. PMID:6514290

  11. Ocular Gene Therapy.

    PubMed

    Campbell, J Peter; McFarland, Trevor J; Stout, J Timothy

    2016-01-01

    Ocular gene therapy involves the introduction of an exogenous gene product to a host's cellular and genetic machinery for endogenous production of a desired gene product. The eye represents an ideal target organ due to its easy visibility and accessibility, and several trials have demonstrated proof-of-principle safety and efficacy in a subtype of Leber's congenital amaurosis. There are numerous ongoing clinical trials exploring gene therapy in other retinal diseases. In autosomal recessively inherited retinal degenerations, the introduced gene product replaces a known genetically deficient gene product and provides restoration of function. In other disease states, such as neovascular age-related macular degeneration, the delivered gene product modulates existing proteins within a cell, such as vascular endothelial growth factor, for a desired therapeutic effect. This latter approach may have broader applications in other diseases such as diabetes and other retinal vascular diseases that are as yet unrealized. This review summarizes the current state of clinical research in ocular gene therapy focusing on those diseases in which the technology has reached clinical trials. PMID:26502313

  12. Ocular tuberculosis: current perspectives

    PubMed Central

    Shakarchi, Faiz I

    2015-01-01

    The World Health Organization currently estimates that nearly two billion people, or one-third of the world’s population, are infected by tuberculosis, and that roughly 10% of the infected people are symptomatic. Tuberculosis affects the lungs in 80% of patients, while in the remaining 20% the disease may affect other organs, including the eye. Uveitis can be seen concurrently with tuberculosis, but a direct association is difficult to prove. Ocular tuberculosis is usually not associated with clinical evidence of pulmonary tuberculosis, as up to 60% of extrapulmonary tuberculosis patients may not have pulmonary disease. The diagnosis of tuberculous uveitis is often problematic and in nearly all reported cases, the diagnosis was only presumptive. Tuberculous uveitis is a great mimicker of various uveitis entities and it can be considered in the differential diagnosis of any type of intraocular inflammation. It is still unknown if ocular manifestations result from a direct mycobacterium infection or hypersensitivity reaction and this is reflected on the management of tuberculous uveitis. Prevalence of tuberculosis as an etiology of uveitis may reach up to 10% in endemic areas. Tuberculous uveitis is a vision-threatening disease that inevitably leads to blindness if not properly diagnosed and treated. The aim of this review is to illustrate the various clinical features and management of presumed tuberculous uveitis. The current review focuses on the diagnostic criteria, significance of tuberculin skin test, and use of systemic corticosteroids in the management of tuberculous uveitis as recommended in recent publications. PMID:26648690

  13. Ocular surface reconstruction update.

    PubMed

    Shimmura, Shigeto; Tsubota, Kazuo

    2002-08-01

    Ocular surface reconstruction (OSR) is now a standard procedure in the treatment of severe ocular surface disorders. The past few years have revealed the long-term results of patients who were operated on during the early stages of OSR development, and we now have a more realistic view of the benefits and limits of the procedure. On the other hand, further understanding of the physiologic role played by the amniotic membrane (AM) has opened doors to further refined techniques in treating these patients. This review will introduce some of the major contributions made during the past years in the advancement of OSR. Clinically, we are at a stage of reviewing the pros and cons of the various transplantation techniques. Identification of factors crucial for a successful OSR procedure will further improve surgical results. Basic researchers are on the verge of identifying the so-called limbal stem cells, and further understanding of AM physiology will lead the way to tissue engineering techniques as another alternative in OSR surgery. PMID:12165702

  14. Inhibition of autophagy in peripheral blood mononuclear cells by vaginal fluid from women with a malignant adnexal mass.

    PubMed

    Orfanelli, Theofano; Doulaveris, Georgios; Holcomb, Kevin; Jeong, Jiyeon M; Sisti, Giovanni; Kanninen, Tomi T; Caputo, Thomas A; Gupta, Divya; Witkin, Steven S

    2015-12-15

    Inhibition of autophagy is a characteristic of ovarian cancer. We determined whether inhibition of autophagy by vaginal fluid could provide a non-invasive test for cancer risk stratification in women presenting with an adnexal mass. Vaginal fluid supernatants from 90 women undergoing evaluation for a suspicious adnexal mass were incubated with peripheral blood mononuclear cells (PBMCs) obtained from healthy women under conditions that induce autophagy. Rapamycin, an autophagy inducer, was added to some cultures. After 48 hr the cells were collected, lysed and assayed by ELISA for intracellular p62 concentration. p62 is a cytoplasmic protein that is consumed during autophagy induction. Its concentration is inversely proportional to the extent of autophagy induction. Clinical information including pathological diagnoses was obtained after completion of laboratory studies. Mean p62 levels were 9.4 ng/ml in the 21 women with a subsequent malignant diagnosis, 4.5 ng/ml in the eight women with a borderline tumor diagnosis and 3.6 ng/ml in the 61 women with benign disease (p?adnexal masses. PMID:26132572

  15. IgG4-producing marginal zone B-cell lymphoma.

    PubMed

    Sato, Yasuharu; Takata, Katsuyoshi; Ichimura, Kouichi; Tanaka, Takehiro; Morito, Toshiaki; Tamura, Maiko; Yoshino, Tadashi

    2008-11-01

    IgG4-related disease is a recently proposed clinical entity with several unique clinicopathological features. A chronic inflammatory state with marked fibrosis, which can often be mistaken for malignancy, especially by clinical imaging analyses, unifies these features. Little is known about lymphomagenesis in the context of IgG4-related disease, we recently first reported the ocular adnexal marginal zone B-cell lymphomas arising from IgG4-related disease. To the best of our knowledge, no existing study has ever established the neoplastic potential of IgG4-producing cells. In the present report, we describe the first IgG4-producing lymphoma. The patient was a 72-year-old male who was being followed for an asbestos-related pleural plaque. During follow-up, computed tomography revealed bilateral renal masses and multiple swollen retroperitoneal lymph nodes. A retroperitoneal lymph node biopsy was performed. Histologically, the interfollicular areas were expanded by medium to large plasmacytoid cells. These plasmacytoid cells showed nuclear pleomorphism and had prominent Russell bodies. Immunohistochemistry and double immunofluorescence staining of these cells revealed IgG4 positivity and monotypic lambda-light chain predominance. A portion of these cells were partially positive for CD20, negative for CD3, and somewhat faintly positive for CD138. In addition, serum IgG4 was elevated. Southern blot analysis of the lymph node specimen detected immunoglobulin heavy chain gene rearrangement. The present study indicates that, not only can malignant lymphomas occur in the setting of IgG4-related disease, but IgG4-producing cells can also be neoplastic. PMID:18839275

  16. Ocular leech infestation.

    PubMed

    Lee, Yueh-Chang; Chiu, Cheng-Jen

    2015-01-01

    This case report describes a female toddler with manifestations of ocular leech infestation. A 2-year-old girl was brought to our outpatient clinic with a complaint of irritable crying after being taken to a stream in Hualien 1 day previous, where she played in the water. The parents noticed that she rubbed her right eye a lot. Upon examination, the girl had good fix and follow in either eye. Slit-lamp examination showed conjunctival injection with a moving dark black-brown foreign body partly attached in the lower conjunctiva. After applying topical anesthetics, the leech, measuring 1 cm in length, was extracted under a microscope. The patient began using topical antibiotic and corticosteroid agents. By 1 week after extraction, the patient had no obvious symptoms or signs, except for a limited subconjunctival hemorrhage, and no corneal/scleral involvement was observed. PMID:25784786

  17. Photorefractor ocular screening system

    NASA Technical Reports Server (NTRS)

    Richardson, John R. (Inventor); Kerr, Joseph H. (Inventor)

    1987-01-01

    A method and apparatus for detecting human eye defects, particularly detection of refractive error is presented. Eye reflex is recorded on color film when the eyes are exposed to a flash of light. The photographs are compared with predetermined standards to detect eye defects. The base structure of the ocular screening system is a folding interconnect structure, comprising hinged sections. Attached to one end of the structure is a head positioning station which comprises vertical support, a head positioning bracket having one end attached to the top of the support, and two head positioning lamps to verify precise head positioning. At the opposite end of the interconnect structure is a camera station with camera, electronic flash unit, and blinking fixation lamp, for photographing the eyes of persons being evaluated.

  18. Ocular Screening System

    NASA Technical Reports Server (NTRS)

    1987-01-01

    Used to detect eye problems in children through analysis of retinal reflexes, the system incorporates image processing techniques. VISISCREEN's photorefractor is basically a 35 millimeter camera with a telephoto lens and an electronic flash. By making a color photograph, the system can test the human eye for refractive error and obstruction in the cornea or lens. Ocular alignment problems are detected by imaging both eyes simultaneously. Electronic flash sends light into the eyes and the light is reflected from the retina back to the camera lens. Photorefractor analyzes the retinal reflexes generated by the subject's response to the flash and produces an image of the subject's eyes in which the pupils are variously colored. The nature of a defect, where such exists, is identifiable by atrained observer's visual examination.

  19. Sports related ocular injuries

    PubMed Central

    Mishra, Avinash; Verma, Ashok K.

    2012-01-01

    Every year > 600,000 sports and recreation related eye injuries occur, out of which roughly 13,500 of these result in permanent loss of sight. Up to 90% of these sports related eye injuries are preventable by using adequate eye protection equipment. Protective eyewear is made of polycarbonate, a highly impact-resistant plastic which is now easily available as prescription and non-prescription eyewear and all players should be encouraged to use them. The medical officers by educating their patients regarding the risks of eye injuries in various sports and the confirmed benefits of using protective equipment have the potential to prevent injury to over thousands of eyes every year. The medical fraternity can also play a very important role in educating the coaches, parents, and children and thus put an end to unnecessary blindness and vision loss from sports related ocular injuries, therefore ensuring a lifetime of healthy vision. PMID:24532883

  20. Ocular manifestations of cancer.

    PubMed

    De Potter, P

    1998-12-01

    Cancer may affect the eye and orbit by a direct effect of metastatic neoplastic infiltration or compression or by circulating antibodies involving paraneoplastic retinal degeneration. Metastatic tumor to the uvea is the most common form of an intraocular malignant process. The choroid is the most common site for uveal metastasis; metastases to the ciliary body, iris, retina, optic disc, and vitreous are rare. Approximately one third of patients have no history of primary cancer at the time of ocular diagnosis. Breast and lung carcinomas for women and lung and gastrointestinal carcinomas for men most commonly metastasize to the eye and orbit. The short-term prognosis for vision is usually good but the systemic prognosis is poor. The visual paraneoplastic syndromes encompass several distinct clinical and pathologic entities including carcinoma-associated retinopathy, melanoma-associated retinopathy, and bilateral diffuse melanocytic uveal proliferation. The first affects photoreceptors, the second is thought to affect bipolar cell function, and the third targets the uveal tract. Identification of circulating antibodies against retinal proteins (recoverin, 23-kD retinal protein; 46-kD and 60-kD retinal proteins) serves to recognize the paraneoplastic nature of the patient's symptoms, which frequently develop before the cancer is diagnosed. No therapy exists to stop the inexorable progressive loss of vision. Metastasis to the eye and orbit and paraneoplastic disorders represent a very bad prognostic sign. Recognition of their visual symptoms and ocular findings should alert the ophthalmologist to the possibility of cancer and systemic evaluation should be pursued. PMID:10387328

  1. Ocular effects of adrenomedullin.

    PubMed

    Taniguchi, T; Kawase, K; Gu, Z B; Kimura, M; Okano, Y; Kawakami, H; Tsuji, A; Kitazawa, Y

    1999-11-01

    The purpose of this study was to determine the expression and effects of adrenomedullin (AM), a novel vasodilator peptide, in the eye. Expression of AM mRNA was examined in the rat iris-ciliary body using reverse transcription-polymerase chain reaction (RT-PCR). In rabbits, intraocular pressure (IOP) was measured periodically after intravitreal injection (20 microl) of AM (10(-7)-10(-4)m) into one eye. In separate groups of rabbits, 30 min after intravitreal injection of either AM-(22-52) (10(-3)m), a specific AM receptor antagonist, or CGRP-(8-37) (10(-3)m), a CGRP1 receptor antagonist, into one eye, AM (10(-6)m) was injected into both eyes, and IOP was measured. Using different rabbits, aqueous protein and cAMP concentrations were determined 6 hr after injection of AM. Expression of AM mRNA was detected in the rat iris-ciliary body. In rabbits, intravitreally administered AM (10(-6)-10(-4)m) profoundly lowered IOP, and the maximum effect was observed at 4-8 h. The ocular hypotensive effect of AM was dose-dependent (10(-7)-10(-4)m). Pretreatment with CGRP-(8-37) did not significantly inhibit the ocular hypotensive effect of AM (10(-6)m), whereas pretreatment with AM-(22-52) completely abolished it. AM (10(-6)m) did not significantly affect aqueous protein concentration. The higher dose of AM (10(-5)m) induced a significant increase in aqueous protein, which was not associated with an increase in the aqueous cAMP content and was significantly inhibited by AM-(22-52) and CGRP-(8-37). These results demonstrate that AM is expressed in the iris-ciliary body and decreases IOP mainly via specific AM receptors, and suggest that AM may play a role in controlling IOP. PMID:10548466

  2. Ocular complications of diabetes mellitus

    PubMed Central

    Sayin, Nihat; Kara, Necip; Pekel, Gökhan

    2015-01-01

    Diabetes mellitus (DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and is becoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world’s most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases. PMID:25685281

  3. Ocular neuromyotonia after radiation therapy

    SciTech Connect

    Lessell, S.; Lessell, I.M.; Rizzo, J.F. III

    1986-12-15

    Ocular neuromyotonia is a paroxysmal monocular deviation that results from spasm of eye muscles secondary to spontaneous discharges from third, fourth, or sixth nerve axons. We observed this rare disorder in four patients who had been treated with radiation for tumors in the region of the sella turcica and cavernous sinus. Based on these cases and four others identified in the literature it would appear that radiation predisposes to a cranial neuropathy in which ocular neuromyotonia may be the major manifestation. Radiation appears to be the most common cause of ocular neuromyotonia.

  4. Ocular myasthenia gravis: A review

    PubMed Central

    Nair, Akshay Gopinathan; Patil-Chhablani, Preeti; Venkatramani, Devendra V; Gandhi, Rashmin Anilkumar

    2014-01-01

    Myasthenia gravis (MG) is a disease that affects the neuro-muscular junction resulting in classical symptoms of variable muscle weakness and fatigability. It is called the great masquerader owing to its varied clinical presentations. Very often, a patient of MG may present to the ophthalmologist given that a large proportion of patients with systemic myasthenia have ocular involvement either at presentation or during the later course of the disease. The treatment of ocular MG involves both the neurologist and ophthalmologist. Thus, the aim of this review was to highlight the current diagnosis, investigations, and treatment of ocular MG. PMID:25449931

  5. Ocular Blood Flow Autoregulation Mechanisms and Methods

    PubMed Central

    Luo, Xue; Shen, Yu-meng; Jiang, Meng-nan; Lou, Xiang-feng; Shen, Yin

    2015-01-01

    The main function of ocular blood flow is to supply sufficient oxygen and nutrients to the eye. Local blood vessels resistance regulates overall blood distribution to the eye and can vary rapidly over time depending on ocular need. Under normal conditions, the relation between blood flow and perfusion pressure in the eye is autoregulated. Basically, autoregulation is a capacity to maintain a relatively constant level of blood flow in the presence of changes in ocular perfusion pressure and varied metabolic demand. In addition, ocular blood flow dysregulation has been demonstrated as an independent risk factor to many ocular diseases. For instance, ocular perfusion pressure plays key role in the progression of retinopathy such as glaucoma and diabetic retinopathy. In this review, different direct and indirect techniques to measure ocular blood flow and the effect of myogenic and neurogenic mechanisms on ocular blood flow are discussed. Moreover, ocular blood flow regulation in ocular disease will be described. PMID:26576295

  6. Female adnexal tumor of probable Wolffian origin (FATWO) with recurrence 3 years postsurgery.

    PubMed

    Syriac, Susanna; Durie, Nicole; Kesterson, Joshua; Lele, Shashrikant; Mhawech-Fauceglia, Paulette

    2011-05-01

    This is the case report of a 38-year-old woman who presented with a mass of the right broad ligament that was diagnosed as a female adnexal tumor of probable Wollfian origin (FATWO). The patient was treated with a simple mass excision. Three years after the excision, the patient presented with uterine bleeding. A total abdominal hysterectomy was advised. Intraoperative histologic consultation showed a poorly differentiated tumor on the surface of the left ovary. After extensive immunohistochemistry analysis and after reviewing the histology slides from the primary tumor, the final diagnosis was concluded to be recurrent FATWO on the surface of the ovary. C-kit immunohistochemistry was found to be strongly positive. Polymerase chain reaction amplification of C-kit genes on exons 9, 11, 13, and 17 and of PDGFR gene on exons 12 and 18 showed no mutational changes. Owing to the limited options in treating recurrent disease and the lack of prognostic factors for recurrence or metastasis, the patient was started on 400 mg of imatinib mesylate therapy for 6 months. In addition, the patient is undergoing continuous follow-up by computed tomographic imaging every 6 months. As chemotherapy and radiation therapy for recurrent or metastatic FATWO are most often unsuccessful, a molecular targeted therapy, such as tyrosine kinase inhibitor, could be considered. However, collective data are needed from multiple centers to determine its effectiveness in these patients. PMID:21464731

  7. Single-Incision Single-Instrument Adnexal Surgery in Pediatric Patients

    PubMed Central

    Loux, Tara; Falk, Gavin A.; Gaffley, Michaela; Ortega, Stephanie; Ramos, Carmen; Malvezzi, Leopoldo; Knight, Colin G.; Burnweit, Cathy

    2015-01-01

    Introduction. Pediatric surgeons often practice pediatric gynecology. The single-incision single-instrument (SISI) technique used for appendectomy is applicable in gynecologic surgery. Methods. We retrospectively analyzed the records of patients undergoing pelvic surgery from 2008 to 2013. SISI utilized a 12?mm transumbilical trocar and an operating endoscope. The adnexa can be detorsed intracorporeally or extracorporealized via the umbilicus for lesion removal. Results. We performed 271 ovarian or paraovarian surgeries in 258 patients. In 147 (54%), the initial approach was SISI; 75 cases (51%) were completed in patients aged from 1 day to 19.9 years and weighing 4.7 to 117?kg. Conversion to standard laparoscopy was due to contralateral oophoropexy, solid mass, inability to mobilize the adnexa, large mass, bleeding, adhesions, or better visualization. When SISI surgery was converted to Pfannenstiel, the principal reason was a solid mass. SISI surgery was significantly shorter than standard laparoscopy. There were no major complications and the overall cohort had an 11% minor complication rate. Conclusion. SISI adnexal surgery is safe, quick, inexpensive, and effective in pediatric patients. SISI was successful in over half the patients in whom it was attempted and offers a scarless result. If unsuccessful, the majority of cases can be completed with standard multiport laparoscopy. PMID:26557994

  8. Pediatric ocular injuries in Lesotho.

    PubMed

    Gordon, Y J; Mokete, M

    1982-11-01

    One hundred and ten children were evaluated in a prospective study in Lesotho to determine the pattern of pediatric ocular injuries in a developing African country. The pattern was found to be the same as that of developed countries regarding increased incidence in boys, frequency of accidental, self-inflicted and assault injuries, and high incidence of corneal lacerations, traumatic cataracts, hyphemas, and lid lacerations. The pattern differed from developed countries in the absence of injuries due to arrows, airgun pellets (BBs), fireworks, toys and chemical burns, the absence of orbital fractures, intra-ocular metallic foreign bodies, and rarity of retinal detachment, and the generally poor visual results following perforating ocular injuries. An information campaign is advocated in Lesotho to aid in the prevention of pediatric ocular injuries. PMID:7151660

  9. Ocular Tropism of Respiratory Viruses

    PubMed Central

    Rota, Paul A.; Tumpey, Terrence M.

    2013-01-01

    SUMMARY Respiratory viruses (including adenovirus, influenza virus, respiratory syncytial virus, coronavirus, and rhinovirus) cause a broad spectrum of disease in humans, ranging from mild influenza-like symptoms to acute respiratory failure. While species D adenoviruses and subtype H7 influenza viruses are known to possess an ocular tropism, documented human ocular disease has been reported following infection with all principal respiratory viruses. In this review, we describe the anatomical proximity and cellular receptor distribution between ocular and respiratory tissues. All major respiratory viruses and their association with human ocular disease are discussed. Research utilizing in vitro and in vivo models to study the ability of respiratory viruses to use the eye as a portal of entry as well as a primary site of virus replication is highlighted. Identification of shared receptor-binding preferences, host responses, and laboratory modeling protocols among these viruses provides a needed bridge between clinical and laboratory studies of virus tropism. PMID:23471620

  10. Genetics Home Reference: Ocular albinism

    MedlinePLUS

    ... structures that produce and store a pigment called melanin. Melanin is the substance that gives skin, hair, and ... ocular albinism? albinism ; cell ; chromosome ; gene ; inherited ; involuntary ; melanin ; mutation ; nystagmus ; photophobia ; pigment ; pigmentation ; protein ; retina ; sensitivity ; ...

  11. Ocular tropism of respiratory viruses.

    PubMed

    Belser, Jessica A; Rota, Paul A; Tumpey, Terrence M

    2013-03-01

    Respiratory viruses (including adenovirus, influenza virus, respiratory syncytial virus, coronavirus, and rhinovirus) cause a broad spectrum of disease in humans, ranging from mild influenza-like symptoms to acute respiratory failure. While species D adenoviruses and subtype H7 influenza viruses are known to possess an ocular tropism, documented human ocular disease has been reported following infection with all principal respiratory viruses. In this review, we describe the anatomical proximity and cellular receptor distribution between ocular and respiratory tissues. All major respiratory viruses and their association with human ocular disease are discussed. Research utilizing in vitro and in vivo models to study the ability of respiratory viruses to use the eye as a portal of entry as well as a primary site of virus replication is highlighted. Identification of shared receptor-binding preferences, host responses, and laboratory modeling protocols among these viruses provides a needed bridge between clinical and laboratory studies of virus tropism. PMID:23471620

  12. Rabies: ocular pathology.

    PubMed Central

    Haltia, M; Tarkkanen, A; Kivel, T

    1989-01-01

    Ocular pathology in the first European case of human bat-borne rabies is described. The patient was a 30-year-old bat scientist who seven weeks after bat bite developed neurological symptoms and died 23 days later. Rabies virus antigens were detected in brain smears. After extensive virological studies the virus turned out to be a rabies-related virus, closely resembling the Duvenhage virus isolated from bats in South Africa in 1980. By light microscopy focal chronic inflammatory infiltration of the ciliary body and of the choroid was found. PAS-positive exudate was seen in the subretinal and in the outer plexiform layers of the retina, and retinal veins showed endothelial damage and perivascular inflammation. Many of the retinal ganglion cells were destroyed. The presence of rabies-related viral antigen in the retinal ganglion cells was shown by positive cytoplasmic immunofluorescence, though electron microscopy failed to identify definite viral structures in the retina. By immunohistochemistry glial fibrillary acidic protein was observed in the Mller's cells, which are normally negative for this antigen but express it as a reactive change when the retina is damaged. Synaptophysin, a constituent of presynaptic vesicles of normal retinal neurons, was not detected in the retina. Images PMID:2920157

  13. Primary alveolar rhabdomyosarcoma of fallopian tube masquerading as a unilateral adnexal mass: A case report and literature review.

    PubMed

    Shahin, Nisreen Abu; Alqaisy, Amin; Zheng, Wenxin

    2015-01-01

    Rhabdomyosarcoma (RMS) is a high-grade sarcoma that predominantly affects children, and rarely, the adult population. RMS demonstrates three major histologic variants: Embryonal, alveolar, and pleomorphic. A limited number of documented pure RMS cases of the gynecologic organs in adult women are found in the literature. Of these reports, the fallopian tube (FT) is reported as the primary site in only three cases, those included one of embryonal and two of the pleomorphic histologic variants. Herein, we report the first case of alveolar RMS arising in the FT of an adult woman and presenting as a unilateral adnexal mass. PMID:26549082

  14. GATA3 Expression in Normal Skin and in Benign and Malignant Epidermal and Cutaneous Adnexal Neoplasms.

    PubMed

    Mertens, Richard B; de Peralta-Venturina, Mariza N; Balzer, Bonnie L; Frishberg, David P

    2015-12-01

    Initial investigations reported GATA3 to be a sensitive and relatively specific marker for mammary and urothelial carcinomas. Recently, GATA3 expression has been described in several other epithelial tumors. However, there has been only limited investigation of GATA3 expression in cutaneous epithelial tumors. The objective of this study was to examine the immunohistochemical expression of GATA3 in a wide variety of cutaneous epithelial neoplasms. GATA3 expression was evaluated in 99 benign and 63 malignant cutaneous epithelial tumors. GATA3 was consistently and usually strongly expressed in clear cell acanthoma, trichofolliculoma, trichoepithelioma, trichilemmoma, sebaceous adenoma, sebaceoma, apocrine hidrocystoma, apocrine tubular papillary adenoma, hidradenoma papilliferum, and syringocystadenoma papilliferum. Hidradenomas exhibited variable positive staining. Most poromas, syringomas, chondroid syringomas, cylindromas, and spiradenomas were negative or only focally and weakly positive. Focal staining was present in all pilomatrixomas. Thirteen of 14 basal cell carcinomas, 21 of 24 squamous carcinomas, and all 6 sebaceous carcinomas exhibited positive staining. The 1 apocrine carcinoma, both mucinous carcinomas, and 2 of 3 microcystic adnexal carcinomas also exhibited positive staining, whereas the 1 eccrine porocarcinoma and the 1 adenoid cystic carcinoma were negative. One of 11 Merkel cell carcinomas exhibited focal weak staining. Our findings demonstrate that GATA3 is expressed in a wide variety of benign and malignant cutaneous epithelial neoplasms. In addition to carcinomas of breast and urothelial origin and other more recently described GATA3-positive tumors, the differential diagnosis of a metastatic tumor of unknown primary origin that expresses GATA3 should also include a carcinoma of cutaneous epithelial origin. PMID:26595821

  15. Radiotherapy for ocular tumours.

    PubMed

    Stannard, C; Sauerwein, W; Maree, G; Lecuona, K

    2013-02-01

    Ocular tumours present a therapeutic challenge because of the sensitive tissues involved and the necessity to destroy the tumour while minimising visual loss. Radiotherapy (RT) is one of several modalites used apart from surgery, laser, cryotherapy, and chemotherapy. Both external beam RT (EBRT) and brachytherapy are used. Tumours of the bulbar conjunctiva, squamous carcinoma and malignant melanoma, can be treated with a radioactive plaque: strontium-90, ruthenium-106 (Ru-106), or iodine-125 (I-125), after excision. If the tumour involves the fornix or tarsal conjunctiva, proton therapy can treat the conjunctiva and spare most of the eye. Alternatively, an I-125 interstitial implant can be used with shielding of the cornea and lens. Conjunctival mucosal-associated lymphoid tissue lymphoma can be treated with an anterior electron field with lens shielding and 25-30 Gray (Gy) in 2?Gy fractions. Discrete retinoblastoma (RB), too large for cryotherapy or thermolaser, or recurrent after these modalities, can be treated with plaque therapy, I-125, or Ru-106. For large RB, multiple tumours, or vitreous seeds the whole eye can be treated with an I-125 applicator, sparing the bony orbit, or with EBRT, under anaesthetic, using X-rays or proton therapy with vacuum contact lenses to fix the eyes in the required position. Post-enucleated orbits at risk for recurrent RB can be treated with an I-125 implant with shielding to reduce the dose to the bony orbit. Uveal malignant melanomas can be treated with plaque or proton therapy with excellent local control. Preservation of vision will depend on the initial size and location of the tumour. PMID:23174750

  16. X-Linked ocular albinism; Nettleship-Falls ocular albinism.

    PubMed

    Booth, Alexandria V; Soldano, Anthony C; Levine, Jonathan; Pomeranz, Miriam

    2008-01-01

    A 39-year-old man with foveal hypoplasia, nystagmus, and decreased visual acuity was found to have multiple, cutaneous, hypopigmented macules. Macromelanosomes were demonstrated in normal skin on histopathologic examination. The patient's constellation of findings along with a strong X-linked inheritance pattern in family members led to the diagnosis of X-linked ocular albinism, which is an uncommon condition that is characterized by congenital nystagmus, iris translucency, hypopigmentation of the ocular fundus, strabismus, foveal hypoplasia, photophobia, and impaired vision. PMID:18627740

  17. [Ocular immune reconstitution inflammatory syndrome].

    PubMed

    Ma, N; Ye, J J

    2016-02-11

    Immune reconstitution inflammatory syndrome (IRIS) is a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes or emerging diseases or even dead after the initiation of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected individuals in a period of recovery of immune function. Ocular immune reconstitution inflammatory syndrome is mainly caused by cytomegalovirus which performing a series of ocular inflammation accompanied with the increase of CD4+ T lymphocytes, such as cytomegalovirus retinitis, after HAART. With HAART widely used, the patients of IRIS gradually increased. But the clinical presentations of IRIS were various because of different pathogens. This review summarized the clinical manifestations, risk factors, diagnosis and treatment of ocular IRIS.(Chin J Ophthalmol, 2016, 51: 150-153). PMID:26906710

  18. Cerebellum and Ocular Motor Control

    PubMed Central

    Kheradmand, Amir; Zee, David S.

    2011-01-01

    An intact cerebellum is a prerequisite for optimal ocular motor performance. The cerebellum fine-tunes each of the subtypes of eye movements so they work together to bring and maintain images of objects of interest on the fovea. Here we review the major aspects of the contribution of the cerebellum to ocular motor control. The approach will be based on structuralfunctional correlation, combining the effects of lesions and the results from physiologic studies, with the emphasis on the cerebellar regions known to be most closely related to ocular motor function: (1) the flocculus/paraflocculus for high-frequency (brief) vestibular responses, sustained pursuit eye movements, and gaze holding, (2) the nodulus/ventral uvula for low-frequency (sustained) vestibular responses, and (3) the dorsal oculomotor vermis and its target in the posterior portion of the fastigial nucleus (the fastigial oculomotor region) for saccades and pursuit initiation. PMID:21909334

  19. Ocular Immune Privilege and Transplantation

    PubMed Central

    Taylor, Andrew W.

    2016-01-01

    Allografts are afforded a level of protection from rejection within immune-privileged tissues. Immune-privileged tissues involve mechanisms that suppress inflammation and promote immune tolerance. There are anatomical features, soluble factors, membrane-associated proteins, and alternative antigen-presenting cells (APC) that contribute to allograft survival in the immune-privileged tissue. This review presents the current understanding of how the mechanism of ocular immune privilege promotes tolerogenic activity by APC, and T cells in response to the placement of foreign antigen within the ocular microenvironment. Discussed will be the unique anatomical, cellular, and molecular mechanisms that lessen the chance for graft destroying immune responses within the eye. As more is understood about the molecular mechanisms of ocular immune privilege greater is the potential for using these molecular mechanisms in therapies to prevent allograft rejection. PMID:26904026

  20. The Ocular Surface Chemical Burns

    PubMed Central

    Baradaran-Rafii, Alireza; Djalilian, Ali R.

    2014-01-01

    Ocular chemical burns are common and serious ocular emergencies that require immediate and intensive evaluation and care. The victims of such incidents are usually young, and therefore loss of vision and disfigurement could dramatically affect their lives. The clinical course can be divided into immediate, acute, early, and late reparative phases. The degree of limbal, corneal, and conjunctival involvement at the time of injury is critically associated with prognosis. The treatment starts with simple but vision saving steps and is continued with complicated surgical procedures later in the course of the disease. The goal of treatment is to restore the normal ocular surface anatomy and function. Limbal stem cell transplantation, amniotic membrane transplantation, and ultimately keratoprosthesis may be indicated depending on the patients' needs. PMID:25105018

  1. Air bags and ocular injuries.

    PubMed Central

    Stein, J D; Jaeger, E A; Jeffers, J B

    1999-01-01

    PURPOSE: This investigation retrospectively examined ocular injuries associated with air bag deployment to gain a better appreciation of potential risk factors in motor vehicle accidents. National statistics regarding the efficacy of air bags were reviewed. METHODS: Review of the literature from 1991 to 1998 identified 44 articles describing 97 patients with air-bag-induced ocular injuries. Variables extracted from each case were age, sex, height, position in the car, eye wear, vehicle impact speed, visual acuity, and specific ocular injuries. RESULTS: Corneal abrasions occurred in 49% of occupants, hyphemas in 43%, vitreous or retinal hemorrhages in 25%, and retinal tears or detachments in 15%. The globe was ruptured in 10 patients. Patients involved in higher-speed accidents (over 30 mph) sustained a greater percentage of vitreous or retinal hemorrhages and traumatic cataracts, while those at slower speeds were more prone to retinal tears or detachments. In a subset of 14 patients with serious ocular injuries, the impact speed of 11 patients was recorded at 30 mph or less. Slower speed may be a risk factor for some ocular injuries. Occupant height was not a significant factor. National statistics confirm that air bags reduce fatalities in motor vehicle accidents. However, children sitting in the front seat without a seat belt and infants in passenger-side rear-facing car seats are at risk for fatal injury. CONCLUSION: Air bags combined with seat belts are an effective means of reducing injury and death in adults during motor vehicle accidents. However, this study has documented a wide variety of ocular injuries associated with air bag deployment. It is hoped that researchers can develop modifications that continue to save lives while minimizing additional harm. Images FIGURE 1 FIGURE 2A FIGURE 2B FIGURE 2C FIGURE 2D FIGURE 3A FIGURE 3B FIGURE 4 FIGURE 5 FIGURE 7 FIGURE 8 PMID:10703118

  2. 21 CFR 886.1040 - Ocular esthesiometer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ocular esthesiometer. 886.1040 Section 886.1040 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1040 Ocular esthesiometer. (a) Identification. An ocular esthesiometer is a device, such as...

  3. Algorithmic approach to solid adnexal masses and their mimics: utilization of anatomic relationships and imaging features to facilitate diagnosis.

    PubMed

    Reiter, Michael J; Schwope, Ryan B; Lisanti, Christopher J

    2014-12-01

    Solid adnexal masses, while less common than their cystic counterparts, may present a challenge for radiologists given the wide range of histologic entities that occur in this region. Pelvic masses, especially when large, can seem overwhelming at first but application of an algorithmic approach allows for more confident assessment. This approach focuses first on the use of anatomic relationships and interactions of various pelvic structures to localize the mass' origin. For instance, the directionality of ureteral displacement can suggest if a mass is intra or extraperitoneal. Then, key discriminating imaging features, such as the presence of fat, hypervascularity, or low T2 signal on magnetic resonance imaging (MRI) can be applied to further narrow the list of diagnostic possibilities. Entities such as leiomyomas, nerve sheath tumors, congenital uterine anomalies, and vascular abnormalities (ovarian torsion or iliac vessel aneurysm) in particular are often accurately characterized with sonography and/or MRI. For solid adnexal masses in which a definitive diagnosis by imaging is not reached, information germane to clinicians regarding further management can still be provided, principally with regard to surgical vs. nonsurgical treatment. PMID:24852312

  4. Ocular Fibroblast Diversity: Implications for Inflammation and Ocular Wound Healing

    PubMed Central

    Xi, Xia; McMillan, David H.; Lehmann, Geniece M.; Sime, Patricia J.; Libby, Richard T.; Huxlin, Krystel R.; Feldon, Steven E.

    2011-01-01

    Purpose. Various ocular and orbital tissues differ in their manifestations of inflammation, although the reasons for this are unclear. Such differences may be due to behaviors exhibited by resident cell types, including fibroblasts. Fibroblasts mediate immune function and produce inflammatory mediators. Chronic stimulation of ocular fibroblasts can lead to prolonged inflammation and, in turn, to impaired vision and blindness. Interleukin (IL)-1?, which is produced by various cells during inflammation, is a potent activator of fibroblasts and inducer of the expression of inflammatory mediators. The hypothesis for this study was that that human fibroblasts derived from distinct ocular tissues differ in their responses to IL-1? and that variations in the IL-1 signaling pathway account for these differences. Methods. Human fibroblasts were isolated from the lacrimal gland, cornea, and Tenon's capsule and treated with IL-1? in vitro. Cytokine and prostaglandin (PG)E2 production were measured by ELISA and EIA. Cyclooxygenase (Cox)-2 expression was detected by Western blot. Components of the IL-1 signaling pathway were detected by flow cytometry, ELISA, Western blot, and immunofluorescence. Results. Cytokine and PGE2 production and Cox-2 expression were greatest in corneal fibroblasts. VEGF production was greatest in Tenon's capsule fibroblasts. Variations in IL-1 receptor and receptor antagonist expression, I?B? degradation and p65 nuclear translocation, however, did not account for these differences, but overexpression of the NF-?B member RelB dampened Cox-2 expression in all three fibroblast types. Conclusions. The results highlight the inherent differences between ocular fibroblast strains and provide crucial insight into novel, tissue-specific treatments for ocular inflammation and disease, such as RelB overexpression. PMID:21571679

  5. Ocular hypotensive effects of medifoxamine.

    PubMed Central

    Saleh, S; Turner, P

    1992-01-01

    Medifoxamine is a novel monoamine re-uptake inhibiting antidepressive drug which preferentially inhibits dopamine reuptake. In human volunteer studies it has been found to reduce significantly intraocular pressure after single oral doses of 300-1000 mg, and to produce a small but statistically significant miosis. Its maximal ocular hypotensive action was less than that of oral timolol 20 mg. PMID:1389953

  6. ROP surgery and ocular circulation

    PubMed Central

    van Heuven, WAJ; Kiel, JW

    2015-01-01

    Purpose Visual results following vitreoretinal surgery for stages 4 and 5 retinopathy of prematurity are often disappointing, even when anatomic results are good. This poses the question whether the surgery or the post-operative care causes the optic atrophy. A hypothesis is proposed that ocular perfusion pressure (mean blood pressure minus intraocular pressure) during or after surgery may be too low to provide adequate ocular blood flow. Methods This report analyses the published results of retinopathy of prematurity surgery, the techniques used, as well as data about blood pressure and intraocular pressure in premature infants. Results Mean blood pressure in conscious premature infants is low and labile; it falls further under anaesthesia. Pre-operative intraocular pressure in retinopathy of prematurity patients is unknown, but intraocular pressure during vitrectomy is elevated, and likely elevated postoperatively. Conclusions Conditions during and after vitreoretinal surgery for retinopathy of prematurity are conducive to low ocular perfusion pressure and consequent ischaemia of the retina and optic nerve, which can contribute to poor visual results. Improved monitoring and control of ocular perfusion pressure is warranted. PMID:18356931

  7. Ocular Toxoplasmosis: Lessons from Brazil

    Technology Transfer Automated Retrieval System (TEKTRAN)

    • A new attention to post-natally acquired infections. Previously, most attention was focused on infection during pregnancy, and the risk of congenital disease, with the feeling that infection in older individuals was benign, without a substantial risk of disease morbidity, such as ocular involvemen...

  8. Ocular findings in alopecia areata.

    PubMed

    Ergin, Can; Acar, Mutlu; Kaya Ak??, Havva; Gnl, Mzeyyen; Grdal, Canan

    2015-11-01

    Alopecia areata is a T cell mediated disease with which many disorders may be associated. There are few studies reporting ocular findings in alopecia areata. The aim of the study is to assess tear function and ocular surface pathologies in alopecia areata. Thirty-two patients with alopecia areata and 20 age- and sex-matched healthy controls were enrolled in the study. Ocular surface disease index questionnaire, Schirmer, tear break-up time, and corneal staining stage tests were done. The data was analyzed using SPSS 10.0 software. One-way variance analysis and Chi-square tests were used as tests of significance. The patient group had significantly higher ocular surface disease index questionnaire and corneal staining stage test scores and lower tear break-up time test scores compared with the control group (P < 0.05). Dry eye disease (DED) was diagnosed in 27 (84%) of 32 alopecia areata patients and in only 3 (15%) of 20 controls, and there was a significant difference between the groups (P < 0.01). T cell mediated autoimmunity has a prominent role in the etiopathogenesis of alopecia areata and dry eye disease. We think that inflammatory mechanisms causing alopecia areata may trigger dry eye disease or vice versa. All patients with AA should be referred to an ophthalmologist for the evaluation of DED and other possible eye pathologies. PMID:26147700

  9. Ocular manifestations of HIV infection.

    PubMed Central

    Jabs, D A

    1995-01-01

    OBJECTIVE: To evaluate the frequency of ocular complications and the clinical outcomes of these complications in patients with various stages of HIV infection. METHODS: Retrospective review of all HIV-infected patients seen in an AIDS ophthalmology clinic from November 1983 through December 31, 1992. RESULTS: Eleven-hundred sixty-three patients were seen for ophthalmologic evaluation. Of these, 781 had the acquired immune deficiency syndrome (AIDS), 226 had symptomatic HIV infection (AIDs-related complex [ARC]), and 156 had asymptomatic HIV infection. Non-infectious HIV retinopathy was the most common ocular complication, affecting 50% of the patients with AIDS, 34% of the patients with ARC, and 3% of the patients with asymptomatic HIV infection. Cytomegalovirus (CMV) retinitis was the most common opportunistic ocular infection, affecting 37% of the patients with AIDS. Other opportunistic ocular infections, including ocular toxoplasmosis, varicella zoster virus retinitis, and Pneumocystis choroidopathy were all much less common, each occurring in < or = 1% of the patients with AIDS. Treatment of CMV retinitis with either foscarnet or ganciclovir was successful in initially controlling the retinitis. However, relapse represented a significant problem and required frequent re-inductions. As a consequence of the retinal damage associated with relapse, loss of visual acuity occurred. The median time to a visual acuity of 20/200 or worse for all eyes with CMV retinitis was 13.4 months, and the median time to a visual acuity of 20/200 or worse in the better eye was 21.1 months. At last follow-up, 75% of the patients had a final visual acuity of 20/40 or better in at least one eye. Retinal detachments were a frequent ophthalmologic complication of CMV retinitis with a cumulative probability of a retinal detachment in at least one eye of 57% at 12 months after the diagnosis of CMV retinitis. Herpes zoster ophthalmicus developed in 3% of the overall series and was seen in all stages of HIV infection. Fifty-six percent of the cases of ocular toxoplasmosis had simultaneous toxoplasmic cerebritis. Ocular toxoplasmosis responded to standard anti-microbial therapy. Varicella zoster virus retinitis, when manifested by the acute retinal necrosis (ARN) syndrome, responded to intravenous acyclovir therapy. Conversely, in a limited number of patients with the progressive outer retinal necrosis syndrome, the disease responded poorly to intravenous acyclovir therapy, but appeared to respond to combination foscarnet and acyclovir therapy. Neuro-ophthalmic lesions were present in 6% of the patients with AIDS. The most common cause of a neuro-ophthalmic lesion was cryptococcal meningitis, and 25% of the patients with cryptococcal meningitis developed a neuro-ophthalmic complication. CONCLUSIONS: Ocular manifestations are common in patients with AIDS. CMV retinitis represented a major vision-threatening problem in these patients. While available therapy was successful in initially controlling the retinitis, the phenomenon of relapse resulted in some degree of long-term visual loss. Preservation of the patient's visual acuity in at least one eye was generally successful. Other opportunistic ocular infections were substantially less common than CMV retinitis but require aggressive therapy. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 PMID:8719695

  10. Ocular surface foreign bodies: novel findings mimicking ocular malignant melanoma

    PubMed Central

    Maudgil, A; Wagner, B E; Rundle, P; Rennie, I G; Mudhar, H S

    2014-01-01

    Purpose Malignant melanoma of the eye is an uncommon condition that is important to recognise. We describe three cases in which ocular foreign bodies have masqueraded as ocular malignant melanoma. Methods Interventional case reports. Results Case 1 describes diathermy-induced carbon particle implantation, during plaque therapy for the treatment of uveal melanoma, mimicking recurrence with extra-scleral invasion. Case 2 shows a foreign body called mullite' mimicking conjunctival melanoma. Case 3 demonstrates a conjunctival foreign body called illite' that mimicked a limbal melanocytic lesion, clinically thought to be either melanocytoma or melanoma. Conclusion This report highlights the importance of careful history taking, examination, and appropriate biopsy in cases of suspected malignant melanoma, to prevent unnecessary and potentially radical treatment. PMID:25104745

  11. Recent Advances in Topical Ocular Drug Delivery.

    PubMed

    Yellepeddi, Venkata Kashyap; Palakurthi, Srinath

    2016-03-01

    Topical ocular drug delivery has been considered to be an ideal route of administration for treatment of ocular diseases related to the anterior segment of the eye. However, topical ocular delivery is a challenging task because of barriers such as nasolacrimal drainage, corneal epithelium, blood-ocular barriers, and metabolism in the eye. Approaches to improve ocular bioavailability include physical approaches such as formulations of drugs as solutions (Zymaxid(™)), suspensions (Zigran(®)), gels (Akten(®)) and chemical approaches such as prodrugs (Xalatan(™)), chemical delivery systems, and soft drugs. The purpose of this review article is to summarize recent advances in topical drug delivery to the anterior segment of the eye. Functional transporters in the corneal epithelium were also discussed as they provide prospects in topical ocular delivery. In addition to conventional delivery systems, novel delivery systems involving nanocarriers were also investigated for topical ocular delivery. Furthermore, due to increased interest, gene therapy applications of topical ocular delivery of genes to the anterior segment of the eye were also discussed. Research in topical ocular delivery is active for more than 50 years and proven to be advantageous for the treatment of many ocular diseases. However, there is scope for innovation in topical drug delivery to develop delivery systems with a high patient safety profile and compliance for effective clinical usefulness. PMID:26666398

  12. Psychoneuroimmunology: application to ocular diseases.

    PubMed

    Ventura, Lori M

    2009-06-01

    Psychoneuroimmunology (PNI) is a relatively new discipline within the field of neuroscience which researches the relationship between emotional states, the central and peripheral nervous systems, and the endocrine and immune systems. Negative psychological states, such as stress, anxiety, and depression, may alter immune system regulation and modulation of peripheral cytokines. A plethora of PNI studies have shown that increased psychological stress and depression are associated with an alteration of immune functioning and worsened health outcomes for many conditions. To date, application of PNI methodology has not been reported for ocular diseases. This article provides an historical perspective on the origins of the rift between the emotional and spiritual from physical aspects of disease. A review of how stress is mediated through sympathetic adrenomedullary and hypothalamic pituitary axis activation with shifts in immunity is provided. The literature which supports spirituality in healing is presented. Finally, ocular diseases which would be most amenable to a PNI approach are discussed. PMID:19672468

  13. Ocular effects of radiofrequency energy.

    PubMed

    Elder, J A

    2003-01-01

    Radiofrequency (RF) energy has been reported to cause a variety of ocular effects, primarily cataracts but also effects on the retina, cornea, and other ocular systems. Cataracts have been observed in experimental animals when one eye was exposed to a localized, very high RF field and the other eye was the unexposed control. The results show that 2450 MHz exposures for >or=30 min at power densities causing extremely high dose rates (>or=150 W/kg) and temperatures (>or=41 degrees C) in or near the lens caused cataracts in the rabbit eye. However, cataracts were not observed in the monkey eye exposed to similar exposure conditions, reflecting the different patterns of energy absorption (SAR, specific absorption rate) distribution, due to their different facial structure. Since the monkey head is similar in structure to the human head, the nonhuman primate study showed that the incident power density levels causing cataracts in rabbits and other laboratory animals cannot be directly extrapolated to primates, including human beings. It is reasonable to assume that an SAR that would induce temperatures >or=41 degrees C in or near the lens in the human eye would produce cataracts by the same mechanism (heating) that caused cataracts in the rabbit lens; however, such an exposure would greatly exceed the currently allowable limits for human exposure and would be expected to cause unacceptable effects in other parts of the eye and face. Other ocular effects including corneal lesions, retinal effects, and changes in vascular permeability, have been observed after localized exposure of the eye of laboratory animals to both continuous wave (CW) and pulsed wave (PW) exposures, but the inconsistencies in these results, the failure to independently confirm corneal lesions after CW exposure, the failure to independently confirm retinal effects after PW exposure, and the absence of functional changes in vision are reasons why these ocular effects are not useful in defining an adverse effect level for RF exposure. While cataracts develop after localized exposure of the eye at SARs >or= 150 W/kg, whole body exposure at much lower levels (14-42 W/kg) is lethal to rabbits. Two studies reported cataracts in this animal after 30 daily exposures at SARs at the upper end of the lethal range, e.g., 38-42 W/kg; however, long term exposure of rabbits (23 h/day, 6 months) at 1.5 W/kg (17 W/kg in the rabbit head) did not cause cataracts or other ocular effects. A long term (1-4 years) investigation of monkeys exposed at high SARs (20 and 40 W/kg to the monkey face) found no cataracts or other ocular effects or change in visual capability. The results of these long term studies support the conclusion that clinically significant ocular effects, including cataracts, have not been confirmed in human populations exposed for long periods of time to low level RF energy. The results of four recent human studies show that there is no clear evidence of an association between RF exposure and ocular cancer. PMID:14628311

  14. [Ocular manisfestations of systemic disease].

    PubMed

    Kristin, N; Ulbig, M

    2006-01-12

    In many cases, patients with systemic diseases may present with a variety of ocular manifestations. The most common of these are "red eye" or a visual disturbance."Red eye" may be the first symptom of a condition from the group of rheumatic diseases and urgently mandates an ophthalmological investigation. Visual disorders occur, for example, in an underlying diabetic condition or arterial hypertension. Patients with arterial hypertension and/or diabetics must consult an ophthalmologist at regular intervals. Not only the underlying disease itself, but also its treatment can give rise to ocular complications. Patients on certain drugs - such as chloroquine or ethambutol should be referred for an ophthalmological examination at regular intervals. PMID:16610413

  15. Recent Overview of Ocular Patents

    PubMed Central

    Gaudana, Ripal J.; Gokulgandhi, Mitan R.; Boddu, Sai H.S.; Mitra, Ashim K.

    2015-01-01

    Ocular drug therapy has always been considered as a major challenge in the field of drug delivery. The presence of blood ocular barriers and efflux pumps has imposed a great concern as well. Various vision threatening disorders require a long term therapy of drug molecules, especially for the diseases that affect the posterior segment. Pharmaceutical companies and other research institutes have adopted a multidisciplinary approach to meet the current challenges which is evidenced by the trends seen in the published and filed U.S. patents. Various strategies have been employed to achieve long term sustained and targeted delivery for both the anterior and the posterior segments of the ocular diseases. These strategies include formulating drugs into implant, micro or nanoparticulate systems and hydrogel-based systems. Transporter targeted approach has also allowed scientists to deliver drugs to both the segments of the eye. Recent developments such as delivery of drugs utilizing ultrasound, iontophoresis and microneedle based devices have been promising. Gene-based therapeutics has opened a new avenue for vision threatening disorders. In all, the current developments in the entire field have been very exciting for finding out new strategies to treat vision threatening disorders. PMID:22493994

  16. Prodrug Strategies in Ocular Drug Delivery

    PubMed Central

    Barot, Megha; Bagui, Mahuya; Gokulgandhi, Mitan R.; Mitra, Ashim K.

    2015-01-01

    Poor bioavailability of topically instilled drug is the major concern in the field of ocular drug delivery. Efflux transporters, static and dynamic ocular barriers often possess rate limiting factors for ocular drug therapy. Different formulation strategies like suspension, ointment, gels, nanoparticles, implants, dendrimers and liposomes have been employed in order to improve drug permeation and retention by evading rate limiting factors at the site of absorption. Chemical modification such as prodrug targeting various nutrient transporters (amino acids, peptide and vitamin) has evolved a great deal ofintereSt to improve ocular drug delivery. In this review, we have discussed various prodrug strategies which have been widely applied for enhancing therapeutic efficacy of ophthalmic drugs. The purpose of this review is to provide an update on the utilization of prodrug concept in ocular drug delivery. In addition, this review will highlight ongoing academic and industrial research and development in terms of ocular prodrug design and delivery. PMID:22530907

  17. Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies

    PubMed Central

    Kaijser, J.

    2015-01-01

    Whilst the outcomes for patients with ovarian cancer clearly benefit from centralised, comprehensive care in dedicated cancer centres, unfortunately the majority of patients still do not receive appropriate specialist treatment. Any improvement in the accuracy of current triaging and referral pathways whether using new imaging tests or biomarkers would therefore be of value in order to optimise the appropriate selection of patients for such care. An analysis of current evidence shows that such tests are now available, but still await recognition, acceptance and widespread adoption. It is therefore to be hoped that present guidance relating to the classification of ovarian masses will soon become more “evidence-based”. These promising tests include the International Ovarian Tumour Analysis (IOTA) LR2 model and ultrasound-based Simple Rules (SR). Based on a comprehensive recent meta-analysis both currently offer the optimal “evidence-based” approach to discriminating between cancer and benign conditions in women with adnexal tumours needing surgery. LR2 and SR are reliable tests having been shown to maintain a high sensitivity for cancer after independent external and temporal validation by the IOTA group in the hands of examiners with various levels of ultrasound expertise. They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI). The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area. ADNEX is a novel test that enables the more specific subtyping of adnexal cancers (i.e. borderline, stage 1 invasive, stage II-IV invasive, and secondary metastatic malignant tumours) and shares similar levels of accuracy to IOTA LR2 and SR for basic discrimination between cancer and benign disease. The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist clinicians to select patients with adnexal masses that are suitable for expectant management, and that will work in all health care settings (i.e. primary vs secondary vs tertiary care). These important themes will likely control the future agenda of the IOTA project. PMID:25897371

  18. Cyclophosphamide for ocular inflammatory diseases

    PubMed Central

    Pujari, Siddharth S.; Kempen, John H.; Newcomb, Craig W.; Gangaputra, Sapna; Daniel, Ebenezer; Suhler, Eric B.; Thorne, Jennifer E.; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Foster, C. Stephen

    2009-01-01

    Purpose To evaluate the outcomes of cyclophosphamide therapy for non-infectious ocular inflammation. Design Retrospective cohort study Participants Two hundred fifteen patients with non-infectious ocular inflammation observed from initiation of cyclophosphamide. Methods Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at four centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation and reasons for discontinuation were obtained by medical record review of every visit. Main Outcome Measures Control of inflammation, corticosteroid-sparing effects, discontinuation of therapy. Results The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%) or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval (CI): 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI: 68.3%-83.7%) within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by six and 12 months respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI: 0.24 -0.41), and the estimated proportion with remission at or prior to 2 years was 63.1% (95% CI: 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within one year because of side effects-usually of a reversible nature. Conclusions Our data suggest that cyclophosphamide is effective for the majority of patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg of prednisone or less, although a year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in the majority of patients who were able to tolerate therapy. In order to titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide appears beneficial for severe ocular inflammation cases where the potentially vision-saving benefits outweigh the substantial potential side effects of therapy, or when indicated for associated systemic inflammatory diseases. PMID:19969366

  19. Ocular preparations: the formulation approach.

    PubMed

    Kaur, Indu Pal; Kanwar, Meenakshi

    2002-05-01

    The main aim of pharmacotherapeutics is the attainment of an effective drug concentration at the intended site of action for a sufficient period of time to elicit the response. A major problem being faced in ocular therapeutics is the attainment of an optimal concentration at the site of action. Poor bioavailability of drugs from ocular dosage forms is mainly due to the tear production, non-productive absorption, transient residence time, and impermeability of corneal epithelium. This article reviews: (1) the barriers that decrease the bioavailability of an ophthalmic drug; (2) the objectives to be considered in producing optimal formulations; and (3) the approaches being used to improve the corneal penetration of a drug molecule and delay its elimination from the eye. The focus of this review is on the recent developments in topical ocular drug delivery systems, the rationale for their use, their drug release mechanism, and the characteristic advantages and limitations of each system. In addition, the review attempts to give various analytical procedures including the animal models and other models required for bioavailability and pharmacokinetic studies. The latter can aid in the design and predictive evaluation of newer delivery systems. The dosage forms are divided into the ones which affect the precorneal parameters, and those that provide a controlled and continuous delivery to the pre- and intraocular tissues. The systems discussed include: (a) the commonly used dosage forms such as gels, viscosity imparting agents, ointments, and aqueous suspensions; (b) the newer concept of penetration enhancers, phase transition systems, use of cyclodextrins to increase solubility of various drugs, vesicular systems, and chemical delivery systems such as the prodrugs; (c) the developed and under-development controlled/continuous drug delivery systems including ocular inserts, collagen shields, ocular films, disposable contact lenses, and other new ophthalmic drug delivery systems; and (d) the newer trends directed towards a combination of drug delivery technologies for improving the therapeutic response of a non-efficacious drug. The fruitful resolution of the above-mentioned technological suggestions can result in a superior dosage form for both topical and intraocular ophthalmic application. PMID:12098838

  20. Tumors of the ocular surface: A review

    PubMed Central

    Honavar, Santosh G; Manjandavida, Fairooz P

    2015-01-01

    Tumors of the Ocular Surface clinically manifest with a very wide spectrum and include several forms of epithelial, stromal, caruncular, and secondary tumors. As a group, these tumors are seen commonly in the clinical practice of a comprehensive ophthalmologist, cornea specialist, and an ocular oncologist. This review is aimed to discuss the common tumors of the ocular surface and emphasize on their clinical diagnosis and appropriate management. PMID:25971163

  1. Ocular involvement in cutaneous connective tissue disease.

    PubMed

    Santoro, Frank A; Huang, John

    2016-01-01

    Connective tissue disorders commonly involve multiple organ systems including the skin and eye. The pathogenesis of many of these disorders affects the microvasculature in these organs. Redness, dryness, pain, and vision loss might be signs of ocular disease in a patient with connective tissue disease. Ocular involvement can potentially lead to blindness and indicate systemic involvement. Dermatologists should be aware of potential ocular involvement in cutaneous connective tissue disorders, and their recognition should prompt ophthalmologic evaluation. PMID:26903181

  2. [Glaucoma medications, preservatives and the ocular surface.

    PubMed

    Aptel, F; Labbé, A; Baudouin, C; Bron, A; Lachkar, Y; Sellem, E; Renard, J-P; Nordmann, J-P; Rouland, J-F; Denis, P

    2014-10-14

    Several clinical and experimental studies have demonstrated that ocular surface disease is common in glaucoma patients receiving chronic glaucoma drops, and that the preservatives in these drops play a major role in the occurrence of ocular surface disease. These ocular surface changes may induce both symptoms reported by the patients and anterior segment clinical signs, and should be systematically assessed by history and exam in all glaucoma patients. In these patients with ocular surface disease, reducing the amount of preservatives administered to the eye should be strived for, rather than adding additional eye drops to alleviate or mask the side effects of the glaucoma drops. PMID:25440185

  3. Ocular manifestations of infectious skin diseases.

    PubMed

    Sadowska-Przytocka, Anna; Czarnecka-Operacz, Magdalena; Jenerowicz, Dorota; Grzybowski, Andrzej

    2016-01-01

    Ocular complications of infectious skin diseases are a common occurrence. Managing the inflamed or infected eye in the emergency setting presents a diagnostic and therapeutic challenge to the emergency physician. Infectious agents may affect any part of the eye. Ocular findings may be the first sign of many infectious diseases, such as, for example, gonorrhea or chlamydia infection. Understanding the various forms of ocular involvement in these conditions is important, because untreated ophthalmic involvement can lead to severe vision loss. This review focuses on the significant ocular manifestations of the most common infectious diseases, including bacterial, viral, fungal, and parasitic infections, that both ophthalmologists and dermatologists may encounter. PMID:26903179

  4. Ocular drug delivery systems: An overview

    PubMed Central

    Patel, Ashaben; Cholkar, Kishore; Agrahari, Vibhuti; Mitra, Ashim K

    2014-01-01

    The major challenge faced by todays pharmacologist and formulation scientist is ocular drug delivery. Topical eye drop is the most convenient and patient compliant route of drug administration, especially for the treatment of anterior segment diseases. Delivery of drugs to the targeted ocular tissues is restricted by various precorneal, dynamic and static ocular barriers. Also, therapeutic drug levels are not maintained for longer duration in target tissues. In the past two decades, ocular drug delivery research acceleratedly advanced towards developing a novel, safe and patient compliant formulation and drug delivery devices/techniques, which may surpass these barriers and maintain drug levels in tissues. Anterior segment drug delivery advances are witnessed by modulation of conventional topical solutions with permeation and viscosity enhancers. Also, it includes development of conventional topical formulations such as suspensions, emulsions and ointments. Various nanoformulations have also been introduced for anterior segment ocular drug delivery. On the other hand, for posterior ocular delivery, research has been immensely focused towards development of drug releasing devices and nanoformulations for treating chronic vitreoretinal diseases. These novel devices and/or formulations may help to surpass ocular barriers and associated side effects with conventional topical drops. Also, these novel devices and/or formulations are easy to formulate, no/negligibly irritating, possess high precorneal residence time, sustain the drug release, and enhance ocular bioavailability of therapeutics. An update of current research advancement in ocular drug delivery necessitates and helps drug delivery scientists to modulate their think process and develop novel and safe drug delivery strategies. Current review intends to summarize the existing conventional formulations for ocular delivery and their advancements followed by current nanotechnology based formulation developments. Also, recent developments with other ocular drug delivery strategies employing in situ gels, implants, contact lens and microneedles have been discussed. PMID:25590022

  5. Drug-induced ocular disorders.

    PubMed

    Li, Junping; Tripathi, Ramesh C; Tripathi, Brenda J

    2008-01-01

    While beneficial therapeutically, almost all medications have untoward effects on various body tissues and functions, including the eye in which organ toxic reactions are readily detectable. Every part of the eye and all ocular functions could be affected adversely. In this review, we describe the most commonly recognized drug-induced ocular disorders, their specific clinical features, the medications that can cause the problem, the differential diagnosis and possible mechanisms of action, as well as guidelines for the management of the adverse reactions. The eyelids are most frequently involved in drug toxicity that commonly manifests as inflammation, hypersensitivity reaction or dermatitis. Drug-induced keratoconjunctival disorders present mainly as conjunctival hyperaemia (red eye), with or without superficial corneal involvement. Frequently, drug preservatives in topical ocular medications induce these adverse effects. Treatment of blepharospasm with Botox may lead to drooping of the eyelids and corneal exposure. Intraoperative floppy iris syndrome is a drug-induced reaction in patients treated with tamsulosin and who undergo cataract surgery. Certain sulfa-based drugs can cause swelling of the ciliary body and lead to the development of angle-closure glaucoma. In addition, adrenergic agents, certain beta(2)-adrenergic agonists and anticholinergic agents may induce pupillary dilation and precipitate angle-closure glaucoma in susceptible patients. Glucocorticoids administered systemically, topically or intravitreally are known to increase intraocular pressure, which can lead to the development of open-angle glaucoma in susceptible patients. This painless form of glaucoma has also been associated with the use of the anticancer agents docetaxel and paclitaxel. The toxic effects of systemic and topically applied drugs may manifest as cloudiness of the lens. Long-term use of glucocorticoids produces a characteristic posterior subcapsular cataract and, although the opacities may remain stationary or progress, they rarely regress upon drug withdrawal. Systemic administration of phenothiazines or busulfan induce cataractous changes in the anterior or posterior cortex, respectively. Many systemic drugs reach the retina through the vascular supply. Aminoquinolines induce a characteristic bull's eye maculopathy. Phenothiazines bind to melanin granules and can cause a severe phototoxic retinopathy. Typical tamoxifen retinopathy manifests as crystalline deposits in the inner retina. Some patients treated with retinoids have decreased night vision and abnormal dark-adaptation. Patients on long-term treatment with linezolid may develop an optic neuropathy (swollen or pale optic disc), symmetric painless decrease of visual acuity and colour vision, and bilateral visual field defects. A probable link exists between amiodarone and a bilateral optic neuropathy that is very similar to nonarteritic ischaemic optic neuropathy (NAION). The most common adverse effects of cGMP-specific phosphodiesterase type 5 inhibitors (erectile dysfunction drugs) are changes in colour perception, blurry vision and increased light sensitivity; recently these drugs have been also implicated in the development of NAION. A bilateral, retrobulbar optic neuropathy that manifests as loss of visual acuity or colour vision and visual field defect is associated with the use of ethambutol. Many different kinds of medications can cause similar ocular adverse reactions. Conversely, a single medication may affect more than one ocular structure and cause multiple, clinically recognizable disorders. Clinicians should be mindful of drug-induced ocular disorders, whether or not listed in product package inserts, and, if in doubt, consult with an ophthalmologist. PMID:18217789

  6. Anomalous phosphenes in ocular protontherapy

    NASA Astrophysics Data System (ADS)

    Khan, E.; Maréchal, F.; Dendale, R.; Mabit, C.; Calugaru, V.; Desjardin, L.; Narici, L.

    2010-04-01

    We have undertaken a clinical ground study of proton-induced light flashes (phosphenes). Patients treated at the Institut Curie - Centre de Protonthérapie in Orsay, France, received radiation therapy to cure ocular and skull-base cancers. Sixty percent of the patients treated for choroidal melanomas using 73 MeV protons report anomalous phosphenes. Delivering a radiation dose on the retina only is not sufficient to trigger the light flash. The present study may be the first indication of phosphenes triggered by protons of few tens of MeV.

  7. Ocular injuries from automobile batteries.

    PubMed

    Holekamp, T L

    1977-01-01

    The incidence of eye injuries related to automobile batteries has sharply increased, currently comprising nearly 1% of all unscheduled eye visits to one medical center. A series of 93 cases obtained over 81/2 years was reviewed and follow-up information obtained. While two thirds of the injuries were relatively minor, 10% (9) of the patients sustained permanent ocular damage or required hospitalization. All of the severe injuries and the majority of the other injuries were caused by battery explosions. Not only should the inherent danger of the lead-acid storage battery be reduced, but the public must be alerted to the hazard. PMID:929798

  8. Ocular complications of Wegener's granulomatosis.

    PubMed

    Bullen, C L; Liesegang, T J; McDonald, T J; DeRemee, R A

    1983-03-01

    140 patients with biopsy-proven Wegener's granulomatosis were examined during a 16-year period at the Mayo Clinic. Forty patients had diverse and explosive ophthalmic involvement, including conjunctivitis, episcleritis, scleritis, corneal ulceration, uveitis, retinal vasculitis, optic neuropathy, orbital mass, orbital cellulitis, and obstruction of the nasolacrimal duct. The multiple ophthalmic and systemic complications in these 40 patients and the importance of establishing the pathologic diagnosis are discussed. Treatment with corticosteroids and immunosuppressive agents has dramatically improved the prognosis, although substantial mortality (four patients died of Wegener's granulomatosis) and ocular morbidity (three eyes were enucleated) are still associated with this disease. PMID:6602963

  9. Ocular complications of bungee jumping

    PubMed Central

    Hassan, H Mohammed J; Mariatos, Georgios; Papanikolaou, Theocharis; Ranganath, Akshatha; Hassan, Hala

    2012-01-01

    Aim In this paper, we will try to highlight the importance of various investigations and their crucial role in identifying whether the defect is structural or functional. Case history A 24-year-old woman presented with ocular complications after bungee jumping. Subsequently, although all ophthalmic signs resolved, she complained of decreased vision in her left eye. Conclusion Initial ophthalmic injury was detected by optical coherence tomography scan showing a neurosensory detachment of the fovea. This was not initially detected on slit-lamp examination or fluorescein angiography. On later examination, although the optical coherence tomography scan showed no structural damage, electrodiagnostic tests showed a functional defect at the fovea. PMID:23055687

  10. Raman Spectroscopy of Ocular Tissue

    NASA Astrophysics Data System (ADS)

    Ermakov, Igor V.; Sharifzadeh, Mohsen; Gellermann, Warner

    The optically transparent nature of the human eye has motivated numerous Raman studies aimed at the non-invasive optical probing of ocular tissue components critical to healthy vision. Investigations include the qualitative and quantitative detection of tissue-specific molecular constituents, compositional changes occurring with development of ocular pathology, and the detection and tracking of ocular drugs and nutritional supplements. Motivated by a better understanding of the molecular mechanisms leading to cataract formation in the aging human lens, a great deal of work has centered on the Raman detection of proteins and water content in the lens. Several protein groups and the hydroxyl response are readily detectable. Changes of protein compositions can be studied in excised noncataractous tissue versus aged tissue preparations as well as in tissue samples with artificially induced cataracts. Most of these studies are carried out in vitro using suitable animal models and conventional Raman techniques. Tissue water content plays an important role in optimum light transmission of the outermost transparent ocular structure, the cornea. Using confocal Raman spectroscopy techniques, it has been possible to non-invasively measure the water to protein ratio as a measure of hydration status and to track drug-induced changes of the hydration levels in the rabbit cornea at various depths. The aqueous humor, normally supplying nutrients to cornea and lens, has an advantageous anterior location for Raman studies. Increasing efforts are pursued to non-invasively detect the presence of glucose and therapeutic concentrations of antibiotic drugs in this medium. In retinal tissue, Raman spectroscopy proves to be an important tool for research into the causes of macular degeneration, the leading cause of irreversible vision disorders and blindness in the elderly. It has been possible to detect the spectral features of advanced glycation and advanced lipooxydation end products in excised tissue samples and synthetic preparations and thus to identify potential biomarkers for the onset of this disease. Using resonance Raman detection techniques, the concentration and spatial distribution of macular pigment, a protective compound, can be detected in the living human retina Useable in clinical settings for patient screening, the technology is suitable to investigate correlations between pigment concentration levels and risk for macular degeneration and to monitor increases in pigment levels occurring as a result of dietary intervention strategies.

  11. 21 CFR 886.1040 - Ocular esthesiometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ocular esthesiometer. 886.1040 Section 886.1040 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1040 Ocular esthesiometer. (a)...

  12. 21 CFR 886.1040 - Ocular esthesiometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ocular esthesiometer. 886.1040 Section 886.1040 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1040 Ocular esthesiometer. (a)...

  13. 21 CFR 886.1040 - Ocular esthesiometer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ocular esthesiometer. 886.1040 Section 886.1040 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1040 Ocular esthesiometer. (a)...

  14. 21 CFR 886.1040 - Ocular esthesiometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ocular esthesiometer. 886.1040 Section 886.1040 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1040 Ocular esthesiometer. (a)...

  15. Human ocular angiostrongyliasis: a literature review.

    PubMed

    Diao, Zongli; Wang, Jing; Qi, Haiyu; Li, Xiaoli; Zheng, Xiaoyan; Yin, Chenghong

    2011-04-01

    Human ocular angiostrongyliasis caused by Angiostrongylus cantonensis infection in the eye is a very rare condition. Until now, there has been no comprehensive analysis of this disease. We searched and analysed the references found on the Internet that refer to human ocular angiostrongyliasis and reviewed the aetiology, clinical manifestations, diagnosis, epidemiology and treatment of the condition. Twenty-six references were found reporting 35 patients from 10 countries that were diagnosed with human ocular angiostrongyliasis. People are usually infected by eating raw or undercooked intermediate hosts of the parasite such as snails or contaminated vegetables. The most common symptom was visual loss. Although several treatments have been used, ocular angiostrongyliasis can still result in permanent visual impairment and may even cause blindness. As the eye is the site of infection and direct visualization is possible, ocular examination is crucial for diagnosis. The therapeutic success depended on early and complete surgical removal. PMID:21296846

  16. Custom Ocular Prosthesis: A Palliative Approach

    PubMed Central

    Thakkar, Prachi; Patel, JR; Sethuraman, Rajesh; Nirmal, Narendra

    2012-01-01

    The goal of palliative care is the achievement of the best quality of life for patients and their families. Eyes are generally the first features of the face to be noticed. Loss of an eye is a traumatic event which has a crippling effect on the psychology of the patient. Several ocular and orbital disorders require surgical intervention that may result in ocular defects. An ocular prosthesis is fabricated to restore the structure, function, and cosmetics of the defects created by such conditions. Although an implant eye prosthesis has a superior outcome, due to economic factors it may not be a feasible option for all patients. Therefore, a custom-made ocular prosthesis is a good alternative. This case report presents a palliative treatment for a patient with an enucleated eye by fabricating a custom ocular prosthesis which improved his psychological, physical, social, functional, emotional and spiritual needs. PMID:22837616

  17. Ocular biomarkers of Alzheimer's disease.

    PubMed

    Heaton, George R; Davis, Benjamin M; Turner, Lisa A; Cordeiro, Maria F

    2015-01-01

    Alzheimer's disease (AD) is a devastating neurodegenerative disease characterised clinically by a progressive decline in executive functions, memory and cognition. Classic neuropathological hallmarks of AD include intracellular hyper-phosphorylated tau protein which forms neurofibrillary tangles (NFT), and extracellular deposits of amyloid β (Aβ) protein, the primary constituent of senile plaques (SP). The gradual process of pathogenic amyloid accumulation is thought to occur 10-20 years prior to symptomatic manifestation. Advance detection of these deposits therefore offers a highly promising avenue for prodromal AD diagnosis. Currently, the most sophisticated method of 'probable AD' diagnosis is via neuroimaging or cerebral spinal fluid (CSF) biomarker analysis. Whilst these methods have reported a high degree of diagnostic specificity and accuracy, they fall significantly short in terms of practicality; they are often highly invasive, expensive or unsuitable for large-scale population screening. In recent years, ocular screening has received substantial attention from the scientific community due to its potential for non-invasive and inexpensive central nervous system (CNS) imaging. In this appraisal we build upon our previous reviews detailing ocular structural and functional changes in AD (Retinal manifestations of Alzheimer's disease, Alzheimer's disease and Retinal Neurodegeneration) and consider their use as biomarkers. In addition, we present an overview of current advances in the use of fluorescent reporters to detect AD pathology through non-invasive retinal imaging. PMID:25788142

  18. Ocular manifestations of frontonasal dysplasia.

    PubMed

    Roarty, J D; Pron, G E; Siegel-Bartelt, J; Posnick, J C; Buncic, J R

    1994-01-01

    The ophthalmologic findings associated with frontonasal dysplasia have not been defined previously in a large series of untreated children. We reviewed the ophthalmic manifestations of a series of patients with frontonasal dysplasia who were seen as part of their craniofacial evaluation. All had undergone a complete ophthalmologic examination before any manipulation of either the orbits or the soft tissues of the orbital contents. From 1986 to 1991, 23 patients with frontonasal dysplasia were seen; ophthalmologic abnormalities were found in 20 (87 percent). Abnormalities included significant refractive errors, strabismus, nystagmus, and eyelid ptosis. Three patients had amblyopia, a treatable cause of visual loss, from strabismus or anisometropia. Ten eyes in seven patients (30 percent) had severe structural anomalies, such as optic nerve hypoplasia, optic nerve colobomas, microphthalmia, cataract, corneal dermoid, or inflammatory retinopathy, that resulted in an acuity of 20/100 or worse. The high incidence of ocular abnormalities indicates that early assessment by an ophthalmologist should be part of the initial evaluation of patients with frontonasal dysplasia to detect treatable visual or ocular problems. PMID:8278482

  19. Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion

    PubMed Central

    Topu, Hasan Onur; ?skender, Can Tekin; Ceran, Ufuk; Kaymak, Oktay; Timur, Hakan; Uygur, Dilek; Dan??man, Nuri

    2015-01-01

    We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women. PMID:26854140

  20. Human ocular Thelaziasis in Karnataka

    PubMed Central

    Krishnachary, Prabhakar S; Shankarappa, Vijaykumar G; Rajarathnam, Rajendra; Shanthappa, Mahesh

    2014-01-01

    Thelaziasis is an Arthropod-born disease of the eye and adnexa caused by Thelazia callipaeda, a nematode parasite transmitted by drosophilid flies to carnivores and humans. Because of its distribution mainly confined to South Asian countries and Russia, it is commonly known as Oriental Eye worm. It is often under-reported and not been given its due clinical importance. We report first case of human Thelaziasis from Hassan District, Karnataka. Five creamy-white, translucent worms were removed from the conjunctival sac of a 74-year-old male patient. Based on morphological characters, the worms were identified as nematodes belonging to the genus Thelazia and speciation was confirmed by CDC, Atlanta as callipaeda. Rarity of the disease and its ability to cause both extra and intraocular manifestations leading to ocular morbidity is the reason for presenting this case. From the available data, this is the first case report from Karnataka, India. PMID:25116781

  1. Ocular manifestations of drug and alcohol abuse

    PubMed Central

    Peragallo, Jason; Biousse, Valrie; Newman, Nancy J.

    2015-01-01

    Purpose of review To review commonly encountered adverse ocular effects of illicit drug use. Recent findings Drug and alcohol abuse can produce a variety of ocular and neuro-ophthalmic side effects. Novel, so-called designer, drugs of abuse can lead to unusual ocular disorders. Legal substances, when used in manners for which they have not been prescribed, can also have devastating ophthalmic consequences. Summary In this review we will systematically evaluate each part of the visual pathways and discuss how individual drugs may affect them. PMID:24100364

  2. [Penetrating ocular trauma with intraocular foreign body].

    PubMed

    Musat, O; Ochinciuc, Uliana; Gutu, Tatiana; Cristescu, T R; Coman, Corina

    2012-01-01

    We present the case of a 65 years old pacient which was admitted for the sudden decrease of visual acuity in the left eye, accompanied by ocular pain and conjunctival hiperemia, simptoms appeared after an ocular trauma. After the clinical and paraclinical examination we determined the diagnosis of OS: Penetrating ocular trauma with retention of a foreign body; posttraumatic cataract. Surgical treatement was warrented and we performed OS : Facoemulsification + PFK implant in sulcus + 23 Ga posterior vitrectomy + peeling of the posterior hyaloid membrane + extraction of the foreign body + LASER endofotocoagulation + transscleral cryotherapy + SF6 gas injection. The post-operatory evolution was favorable. PMID:22888689

  3. Gender Disparities in Ocular Inflammatory Disorders*

    PubMed Central

    Sen, Hatice Nida; Davis, Janet; Ucar, Didar; Fox, Austin; Chan, Chi Chao; Goldstein, Debra A.

    2014-01-01

    Ocular inflammatory disorders disproportionately affect women, and the majority of affected women are of childbearing age. The role of sex or reproductive hormones has been proposed in many other inflammatory or autoimmune disorders, and findings from non-ocular autoimmune diseases suggest a complex interaction between sex hormones, genetic factors and the immune system. However, despite the age and sex bias, factors that influence this disparity are complicated and unclear. This review aims to evaluate the gender disparities in prevalence, incidence and severity of the most common infectious and non-infectious ocular inflammatory disorders. PMID:24987987

  4. Sudden cardiac death due to coronary artery involvement by IgG4-related disease: a rare, serious complication of a rare disease.

    PubMed

    Patel, Nimesh R; Anzalone, Mary L; Buja, L Maximilian; Elghetany, M Tarek

    2014-06-01

    Immunoglobulin G4-related disease (IgG4-RD) is a systemic disorder characterized by multiorgan fibrosis with IgG4-producing plasma cells, increased IgG4 serum concentration, and responsiveness to steroid therapy. Involvement of the pancreas, salivary glands, orbit, aorta, and other sites has been well documented in the literature; however, there have been limited reports of cases involving the coronary arteries. We report the case of a 53-year-old Hispanic man who was brought to the emergency center and diagnosed with sudden cardiac death. Autopsy was subsequently performed, revealing multiorgan involvement by IgG4-RD, including involvement of the coronary arteries. The inflammation and fibrosis, in combination with concomitant atherosclerotic disease, resulted in severe stenosis of the coronary arteries. Two of the coronary arteries were further occluded by thrombosis. These factors led to cardiac hypoperfusion, myocardial infarction and, ultimately, sudden cardiac death. Fatal involvement of the coronary arteries has not been previously reported, raising a new concern for a severe complication of IgG4-RD. PMID:24878025

  5. Ocular prosthetics: use of a tissue conditioner material to modify a stock ocular prosthesis.

    PubMed

    Ow, R K; Amrith, S

    1997-08-01

    The custom-made ocular prosthesis contributes to enhanced tissue health of the anophthalmic socket. For this purpose, an acrylic resin ocular prosthesis may be modified, by using an appropriate dental impression material and being adapted closely to the anophthalmic socket. The modeling impression material is subsequently replaced by acrylic resin. This article describes the application of a viscoelastic tissue conditioner material, as an impression medium for prosthetic modification of an ocular prosthesis. The tissue conditioner material exhibits favorable tissue compatibility, adhesion to acrylic resin, and detailed surface registration. These advantages facilitate the clinical procedure and evaluation of modifications made to the ocular prosthesis. PMID:9260142

  6. Options for management of intra ocular tumors

    PubMed Central

    Lingam, Gopal

    2015-01-01

    The management of intra ocular tumors has undergone a sea change from the era of enucleation or external beam radiation. With the advent of new chemotherapy protocols, globe and vision salvage have become possible in a majority of cases of retinoblastoma. This article is an overview of the various modalities available for the management of intra ocular tumors and their indications. Chemotherapy has been covered elsewhere in this series of articles on ocular oncology. Photocoagulation and cryopexy are easily administered modalities of treatment for small tumors and totally within the ophthalmologist's domain. Slightly larger tumors are treatable with brachytherapy. The susceptibility of the tumors to chemotherapy and radiation decide the choice of treatment and the dosage. Management of intra ocular tumors very often needs a multidisciplinary approach including ophthalmologist, oncologist, radiation physicist, and radiotherapist. PMID:25971164

  7. Ocular radioimmunoscintigraphy: sensitivity and practical considerations

    SciTech Connect

    Bomanji, J.; Nimmon, C.C.; Hungerford, J.L.; Solanki, K.; Granowska, M.; Britton, K.E.

    1988-06-01

    Ocular radioimmunoscintigraphy was performed in 20 patients using /sup 99m/Tc-labeled monoclonal antibody 225.28S, F(ab')2 fragments. Radioimmunoscintigraphy was positive in 13 patients and the diagnosis of ocular melanoma was confirmed by enucleation of the eye or clinical follow-up. Scintigraphy was positive in one patient with lymph node metastasis from an ocular melanoma. In six patients immunoscintigraphy was negative. Using this technique a sensitivity of 92.8% was achieved for detecting ocular melanomas. Single photon emission tomography helped to separate the lesions situated in the nasal quadrant of the eye from the adjacent nasopharyngeal activity. With appropriate imaging techniques small tumors of the order of 3 x 5 x 3 mm could be detected clearly.

  8. Ocular manifestations in systemic lupus erythematosus.

    PubMed

    Silpa-Archa, Sukhum; Lee, Joan J; Foster, C Stephen

    2016-01-01

    Systemic lupus erythematosus (SLE) can involve many parts of the eye, including the eyelid, ocular adnexa, sclera, cornea, uvea, retina and optic nerve. Ocular manifestations of SLE are common and may lead to permanent blindness from the underlying disease or therapeutic side effects. Keratoconjunctivitis sicca is the most common manifestation. However, vision loss may result from involvement of the retina, choroid and optic nerve. Ocular symptoms are correlated to systemic disease activity and can present as an initial manifestation of SLE. The established treatment includes prompt systemic corticosteroids, steroid-sparing immunosuppressive drugs and biological agents. Local ocular therapies are options with promising efficacy. The early recognition of disease and treatment provides reduction of visual morbidity and mortality. PMID:25904124

  9. Ocular Complications of Inflammatory Bowel Disease

    PubMed Central

    Mady, Rana; Grover, Will; Butrus, Salim

    2015-01-01

    Though inflammatory bowel disease (IBD) has a specific predilection for the intestinal tract, it is a systemic inflammatory disorder affecting multiple organs, including the eye. Ocular complications directly related to IBD are categorized as primary and secondary. Primary complications are usually temporally associated with IBD exacerbations and tend to resolve with systemic treatment of the intestinal inflammation. These include keratopathy, episcleritis, and scleritis. Secondary complications arise from primary complications. Examples include cataract formation due to treatment with corticosteroids, scleromalacia due to scleritis, and dry eye due to hypovitaminosis A following gut resection. Some ocular manifestations of IBD can lead to significant visual morbidity and temporally associated complications can also be a herald of disease control. Furthermore, ocular manifestations of IBD can occasionally manifest before the usual intestinal manifestations, leading to an earlier diagnosis. Thus, it is important to understand the clinical presentation of possible ocular manifestations in order to initiate appropriate treatment and to help prevent significant visual morbidity. PMID:25879056

  10. Viral ocular manifestations: a broad overview.

    PubMed

    Newman, Howard; Gooding, Caroline

    2013-09-01

    The viruses able to affect the eye are taxonomically diverse, ranging from double-stranded DNA viruses, to single stranded RNA viruses, to retroviruses. Any part of the eye may be affected, frequently producing blepharitis, conjunctivitis, keratitis, uveitis, cataract and retinitis. The more common ocular viral infections include the Herpesviruses such as HSV-1, VZV and CMV. The HIV pandemic is placing a serious burden on ophthalmology clinics, particularly in sub-Saharan Africa as the number of viral ocular diseases is increasing. In particular, CMV retinitis is becoming more prevalent where antiretroviral therapy is not available and is replaced by immune-recovery uveitis where antiretrovirals are given. This review aims to improve knowledge of the common viral ocular diseases, their diagnosis and management, as well as the fairly uncommon viral ocular diseases that may also cause considerable morbidity. PMID:23797960

  11. Ocular Malformations with Presumable Intraocular Calcification.

    PubMed

    Tengtrisorn, Supaporn; Vichitvejpaisal, Pornpattana; Nitirungjaras, Anupong; Kritsaneepaiboon, Supika; Kiddee, Weerawat; Singha, Penny

    2015-07-01

    This is a case of ocular malformations with presumable intraocular calcification based on computed tomography (CT) imaging, magnetic resonance imaging (MRI) and ocular ultrasound (US) findings. The authors presented the clinical, imaging and pathological findings of this case. Intraocular calcification is the most important finding in retinoblastoma, which requires aggressive management. It is important to distinguish it from other intraocular lesions, especially intraocular calcified hematoma. PMID:26267997

  12. Air bag associated posterior segment ocular trauma.

    PubMed

    Yang, Chang-Sue; Chou, Tzu-Fang; Liu, Jorn-Hon; Hsu, Wen-Ming

    2004-08-01

    Airbags indeed reduce the risk of injury and death in motor vehicle accidents, however, ocular injury induced by airbag deployment has been reported. From 1999 to 2001, medical records were retrospectively reviewed for patients with severe ocular injury related to airbag inflation at Taipei Veterans General Hospital. The ocular presentation, clinical course, management and visual outcome were recorded and studied in detail. Three cases of ocular posterior segment injury associated with airbag inflation were identified. Mean age was 37.3 years old (range 34-39 years). None of the patients was wearing a seat belt. All patients had periocular contusion, corneal edema, and hyphema. Vitreous hemorrhage was found in 3 cases, and there were 2 cases with severe macular injury, including traumatic maculopathy and hypotony maculopathy. Retinal detachment developed in 1 case. One patient presented with traumatic macular hole 6 weeks after injury. The initial visual acuity was hand motion only in all patients, the final visual outcomes recovered to 6/20, 1/60 and 2/60, respectively. The airbag-associated posterior segment ocular trauma was induced by impact with fully deployed airbag. Severe ocular posterior segment trauma with devastating visual sequelae might occur in drivers and passengers who have not fastened their seat belt. PMID:15553805

  13. [Ocular involvement in familial amyloid polyneuropathy].

    PubMed

    Rousseau, A; Kaswin, G; Adams, D; Cauquil, C; Thaudin, M; Mincheva, Z; M'garrech, M; Labetoulle, M; Barreau, E

    2013-11-01

    Familial amyloid polyneuropathy (FAP) or transthyretin (TTR) amyloid polyneuropathy is a progressive sensorimotor and autonomic neuropathy of adult onset, which is transmitted as an autosomal dominant trait. In addition to neurologic symptoms, FAP may be associated with weight loss, cardiac and renal failure and ocular complications. FAP is a devastating disease, causing death within 10years after the first symptoms. The TTR Val30Met mutation is the most common of more than 100 amyloidogenic mutations identified worldwide. Liver transplantation (LT) is currently the only treatment for preventing synthesis of the amyloidogenic variants of TTR. LT can halt progression of the neuropathy in up to 70% of cases and doubles the overall median survival of young Val30Met patients. Oral administration of tafamidis, which prevents deposition of mutated TTR, is now available to delay neurologic complications in early stages of the disease. Ocular manifestations of FAP are frequent and mainly include keratoconjunctivitis sicca, secondary glaucoma, vitreous deposits and pupillary abnormalities. Retinal and choroidal vascular abnormalities are more rare. Since ocular TTR is synthesized, at least in part, in the retinal pigment epithelium, LT does not influence the course of ocular involvement. The effects of tafamidis on the latter are still unknown. Because LT and symptomatic treatments greatly improve life expectancy of patients with FAP, ocular involvement is becoming a more frequent challenge to address. This review summarizes the pathophysiology, clinical findings and possible treatments of ocular manifestations of FAP. PMID:24144522

  14. Cockpit Ocular Recording System (CORS)

    NASA Technical Reports Server (NTRS)

    Rothenheber, Edward; Stokes, James; Lagrossa, Charles; Arnold, William; Dick, A. O.

    1990-01-01

    The overall goal was the development of a Cockpit Ocular Recording System (CORS). Four tasks were used: (1) the development of the system; (2) the experimentation and improvement of the system; (3) demonstrations of the working system; and (4) system documentation. Overall, the prototype represents a workable and flexibly designed CORS system. For the most part, the hardware use for the prototype system is off-the-shelf. All of the following software was developed specifically: (1) setup software that the user specifies the cockpit configuration and identifies possible areas in which the pilot will look; (2) sensing software which integrates the 60 Hz data from the oculometer and heat orientation sensing unit; (3) processing software which applies a spatiotemporal filter to the lookpoint data to determine fixation/dwell positions; (4) data recording output routines; and (5) playback software which allows the user to retrieve and analyze the data. Several experiments were performed to verify the system accuracy and quantify system deficiencies. These tests resulted in recommendations for any future system that might be constructed.

  15. Ocular microtremor laser speckle metrology

    NASA Astrophysics Data System (ADS)

    Al-Kalbani, M.; Mihaylova, E.; Collins, N.; Toal, V.; Coakley, D.; Boyle, G.

    2009-02-01

    Ocular Microtremor (OMT) is a continual, high frequency physiological tremor of the eye present in all subjects even when the eye is apparently at rest. OMT causes a peak to peak displacement of around 150nm-2500nm with a broadband frequency spectrum between 30Hz to 120Hz; with a peak at about 83Hz. OMT carries useful clinical information on depth of consciousness and on some neurological disorders. Nearly all quantitative clinical investigations have been based on OMT measurements using an eye contacting piezoelectric probe which has low clinical acceptability. Laser speckle metrology is a candidate for a high resolution, non-contacting, compact, portable OMT measurement technique. However, tear flow and biospeckle might be expected to interfere with the displacement information carried by the speckle. The paper investigates the properties of the scattered speckle of laser light (λ = 632.8nm) from the eye sclera to assess the feasibility of using speckle techniques to measure OMT such as the speckle correlation. The investigation is carried using a high speed CMOS video camera adequate to capture the high frequency of the tremor. The investigation is supported by studies using an eye movement simulator (a bovine sclera driven by piezoelectric bimorphs). The speckle contrast and the frame to frame spatiotemporal variations are analyzed to determine if the OMT characteristics are detectable within speckle changes induced by the biospeckle or other movements.

  16. Automated detection of ocular focus.

    PubMed

    Hunter, David G; Nusz, Kevin J; Gandhi, Nainesh K; Quraishi, Imran H; Gramatikov, Boris I; Guyton, David L

    2004-01-01

    We characterize objectively the state of focus of the human eye, utilizing a bull's eye photodetector to detect the double-pass blur produced from a point source of light. A point fixation source of light illuminates the eye. Fundus-reflected light is focused by the optical system of the eye onto a bull's eye photodetector [consisting of an annulus (A) and a center (C) of approximately equal active area]. To generate focus curves, C/A is measured with a range of trial lenses in the light path. Three human eyes and a model eye are studied. In the model eye, the focus curve showed a sharp peak with a full width at half maximum (FWHM) of +/-0.25 D. In human eyes, the ratio C/A was >4 at best focus in all cases, with a FWHM of +/-1 D. The optical apparatus detects ocular focus (as opposed to refractive error) in real time. A device that can assess focus rapidly and objectively will make it possible to perform low-cost, mass screening for focusing problems such as may exist in children at risk for amblyopia. PMID:15447031

  17. New observations on ocular onchocerciasis

    PubMed Central

    Rodger, F. C.

    1957-01-01

    The records of 2000 blind or partially blind persons in the onchocerciasis areas of West Africa provided the background information for this report. The author has grouped his material in three sections. The first of these deals with diagnostic methods, and contains the results of skin and conjunctival biopsies, as well as a description of onchocercomas and an estimate of the life-span of Onchocerca adults. Next, the pathogenesis of ocular lesions is discussed in the light of evidence obtained from a series of animal experiments designed to test two theoriesnamely, the existence of an allergic state and damage by toxins. In the last section, which is devoted to clinical observations, the author demonstrates the existence of a relationship between the posterior segmental lesion and vitamin A deficiency, and shows that punctate corneal opacities result more often from certain virus diseases and malaria than from onchocerciasis. A description follows of various degenerations due to a local nutritional disorder combined with vitamin A deficiency in onchocercal limbitis and anterior uveitis. PMID:13472406

  18. Categorical evaluation of the ocular irritancy of cosmetic and consumer products by human ocular instillation procedures.

    PubMed

    Gao, Yang; Kanengiser, Bruce E

    2004-01-01

    The assessment of ocular irritation potential is an important part of safety testing for cosmetic and consumer products. The purpose of this investigation was to examine ocular irritancy levels elicited in humans by various categories of a specific class of cosmetic and consumer products that have a potential to enter the eye inadvertently during use. Test materials assessed belonged to one of seven categories, which included liquid makeup, shampoo, baby wash, mascara, eye makeup remover, powder eye shadow, and facial cleanser. These test materials were evaluated by human ocular instillation, followed by examinations, for which subjective perceptions of irritation were recorded, and component areas of ocular tissues were individually examined for inflammation and for the area and density of fluorescein staining patterns at 30 seconds and at 5, 15, 60, and 120 minutes post-instillation. Subjective and objective ocular irritation scores of 410 eyes were analyzed by product classification. Average score levels were determined for subjective responses, inflammation, and fluorescein staining patterns. This investigation determined that irritation levels of the evaluated test materials varied markedly with respect to product category, type of ocular irritation, and ocular tissue, demonstrating that these factors are important considerations for the prediction of the ocular irritancy of a test material. PMID:15386023

  19. Treatment of ocular disorders by gene therapy.

    PubMed

    Solins, M ngeles; del Pozo-Rodrguez, Ana; Apaolaza, Paola S; Rodrguez-Gascn, Alicia

    2015-09-01

    Gene therapy to treat ocular disorders is still starting, and current therapies are primarily experimental, with most human clinical trials still in research state, although beginning to show encouraging results. Currently 33 clinical trials have been approved, are in progress, or have been completed. The most promising results have been obtained in clinical trials of ocular gene therapy for Leber Congenital Amaurosis, which have prompted the study of several ocular diseases that are good candidates to be treated with gene therapy: glaucoma, age-related macular degeneration, retinitis pigmentosa, or choroideremia. The success of gene therapy relies on the efficient delivery of the genetic material to target cells, achieving optimum long-term gene expression. Although viral vectors have been widely used, their potential risk associated mainly with immunogenicity and mutagenesis has promoted the design of non-viral vectors. In this review, the main administration routes and the most studied delivery systems, viral and non-viral, for ocular gene therapy are presented. The primary ocular disease candidates to be treated with gene therapy have been also reviewed, including the genetic basis and the most relevant preclinical and clinical studies. PMID:25536112

  20. Ocular Findings in Volcanic Fog Induced Conjunctivitis

    PubMed Central

    Lagunzad, John Kenneth D

    2011-01-01

    Objective To describe the ocular signs and symptoms of patients complaining of eye irritation due to volcanic fog (vog). Methods The study utilized a non-comparative, retrospective chart review of 30 patients who had a chief complaint of eye irritation, which the subjects attributed to vog. Ocular signs and symptoms are described and related to the ambient concentration of sulfur dioxide (SO2), particulate matter sized 2.5 microns (PM2.5), and vog visibility in Oahu during the period of the study. Results Ocular signs noted were conjunctival injection (100%), clear mucous discharge (100%), papillary reaction (100%), punctal edema (80%), eyelid swelling (73.3%) and chemosis (63.3%). Ocular symptoms were itchiness (100%), foreign body sensation (100%), tearing (96.6%) and burning sensation (90%). All patients had concurrent respiratory symptoms. During the period of study, the highest 24-hour average concentration of particulate matter sized 2.5 microns (PM2.5) was 49.04 g/m3 and vog was visually present. Conclusions Patients complaining of eye irritation due to vog have observable ocular signs and symptoms. PMID:22187513

  1. Ocular toxicity from systemically administered xenobiotics

    PubMed Central

    Gokulgandhi, Mitan R; Vadlapudi, Aswani Dutt; Mitra, Ashim K

    2015-01-01

    Introduction The eye is considered as the most privileged organ because of the bloodocular barrier that acts as a barrier to systemically administered xenobiotics. However, there has been a significant increase in the number of reports on systemic drug-induced ocular complications. If such complications are left untreated, then it may cause permanent damage to vision. Hence, knowledge of most recent updates on ever-increasing reports of such toxicities has become imperative to develop better therapy while minimizing toxicities. Areas covered The article is mainly divided into anterior and posterior segment manifestations caused by systemically administered drugs. The anterior segment is further elaborated on corneal complications where as the posterior segment is focused on optic nerve, retinal and vitreous complications. Furthermore, this article includes recent updates on acute and chronic ocular predicaments, in addition to discussing various associated symptoms caused by drugs. Expert opinion Direct correlation of ocular toxicities due to systemic drug therapy is evident from current literature. Therefore, it is necessary to have detailed documentation of these complications to improve understanding and predict toxicities. We made an attempt to ensure that the reader is aware of the characteristic ocular complications, the potential for irreversible drug toxicity and indications for cessation. PMID:22803583

  2. Ocular torsion on earth and in weightlessness

    NASA Technical Reports Server (NTRS)

    Young, L. R.; Lichtenberg, B. K.; Arrott, A. P.; Crites, T. A.; Oman, C. M.; Edelman, E. R.

    1981-01-01

    Otolith function is studied by means of measurements of ocular torsion under various acceleration environments on earth and in weightlessness. Photographic measurements of ocular torsion as indicated by the rotation of landmarks on the iris with respect to head-fixed fiducial marks were obtained in subjects undergoing horizontal linear acceleration in a ground-based version of the space sled, lateral acceleration from weightlessness during pullout from the free-fall portion of parabolic flight, and optokinetic stimulation about the roll axis in the supine position in the laboratory and during weightlessness. The responses of ocular torsion to horizontal acceleration are in agreement with a simple low-order linear system with a dominant time constant of 0.33 sec, with a transfer function fit by a model with a pure delay of 0 to 400 msec and a first-order lag. In the pullout experiment, torsion was not observed in response to the onset of acceleration in the right-ear-down position, although it was present in response to the lateral stimulus. Results of the roll vection experiments indicate the independence of ocular torsion and visually induced tilt. In addition, an automatic video system using a soft contact lens target is presented which has been developed for ocular torsion measurements.

  3. Impacts of Nanomedicines in Ocular Pharmacotherapy

    PubMed Central

    Nakhlband, Ailar; Barar, Jaleh

    2011-01-01

    Introduction The integrity of the cells/tissues in anterior and/or posterior segments of the eye plays a crucial role in biofunctions of the vision. To maintain ocular homeostasis, selective restrictiveness of the ophthalmic membranes and barriers control must act on shuttling of biomolecules. Thus, not all attempts to apply de novo nanotechnology approaches for ocular pharmacotherapy have met with the same successes as those cited here in this review, and sometimes these novel technologies tools provoke a great deal of challenges and hurdles mainly because of functional presence of these barriers. Methods Recent published articles related to applications of ocular nanomedicines were reviewed and highlighted in this review article. Results It seems the emergence of nanomedicines have arisen great hopes for ophthalmic pharmacotherapy, in which nanostructured medicines are expected to be able to cross the restrictive barriers of the eye. Although such fast inauguration of ocular nanomedicines will literally convey new challenges in the regulatory and translational processes, it will also grant a prolific platform from which many exciting, and yet unimagined, applications of biomedical nanotechnology will emerge for pharmacotherapy of the eye. Conclusion This review provides recent advancements on ocular nanomedicines. PMID:23678403

  4. Adenocarcinoma With Breast/Adnexal and Upper Gastrointestinal Differentiation Arising in an Ovarian Mature Cystic Teratoma: A Case Report and Review of the Literature.

    PubMed

    Wheeler, Lindsay; Westhoff, Gina L; O'Keefe, Mary C; Kong, Christina S; Karam, Amer

    2016-01-01

    Mature cystic teratomas are the most common type of ovarian germ cell tumors. In about 1% of cases, usually among postmenopausal women, a mature cystic teratoma can undergo malignant transformation. Among malignant transformations, squamous cell carcinoma is the most common histology, comprising approximately 80% of cases. In this report, we present the unique case of a 55-yr-old woman with a pelvic mass found to be a mature cystic teratoma with malignant transformation to adenocarcinoma with breast/adnexal, upper gastrointestinal, and neuroendocrine differentiation. The predominant malignant component was the adenocarcinoma exhibiting breast/skin adnexal differentiation, which was found to involve the omentum and a right para-aortic node. We provide an in-depth review of the pathologic findings, as well as a review of the current literature on malignant transformation to adenocarcinoma. This report aims to open a conversation regarding the management of these patients, with a specific focus on the role of molecular analysis and targeted therapies. PMID:26352552

  5. The Contribution of Qualitative CEUS to the Determination of Malignancy in Adnexal Masses, Indeterminate on Conventional US – A Multicenter Study

    PubMed Central

    Zhang, Xinling; Mao, Yongjiang; Zheng, Rongqin; Zheng, Zhijuan; Huang, Zeping; Huang, Dongmei; Zhang, Jing; Dai, Qing; Zhou, Xiaodong; Wen, Yanling

    2014-01-01

    The aim of this study is to evaluate the efficacy of qualitative analysis of contrast-enhanced ultrasound (CEUS) in discrimination of adnexal masses which were undetermined by conventional ultrasound (US). A total of 120 patients underwent transabdominal CEUS. The initial enhancement time and intensity compared with the uterine myometrium, contrast agent distribution patterns and dynamic changes of enhancement were assessed. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV), accuracy (ACC) and Youden’s index were calculated for contrast variables. The gold standard was the histological diagnosis. There were 48 malignant tumors and 72 benign tumors. The enhancement features of malignant masses were different from benign ones. Earlier or simultaneous enhancement with inhomogeneous enhancement yielded the highest capability in differential diagnosis, and Sen, Spe, PPV, NPV, ACC, Youden’s index was 89.6%, 97.2%, 93.2%, 95.6%, 93.3%, and 0.88, respectively. The qualitative evaluation of CEUS is useful in the differential diagnosis of adnexal masses where conventional US is indeterminate. PMID:24736589

  6. Ocular effects of cosmetic products and procedures.

    PubMed

    Coroneo, Minas T; Rosenberg, Marni L; Cheung, Leanne M

    2006-04-01

    Cosmetic products and procedures can produce adverse effects on the ocular surface, ranging from mild discomfort to vision-threatening conditions. Complications of skin and eye products can be related to allergy or toxicity, often attributable to perfumes. Complications of blepharoplasty may be associated with overcorrection, scarring, or uneven contour of the lid margins, conditions that can cause significant ocular surface disease until they are corrected. Ocular surface effects of botulinum toxin injection include dry eye syndromes and also epiphora. More serious complications occur (rarely) and are dose- and location-related. Adverse effects of micropigmentation procedures involve pathological processes or, simply, poor cosmetic results. In certain youth cultures, special-effect contact lenses and even decorative conjunctival implants have gained popularity, presenting a wide variety of dangers, often attributable to poor education about care and hygiene. PMID:16681080

  7. Vascular basophilia in ocular and orbital tumors.

    PubMed

    Stowe, G C; Zakov, Z N; Albert, D M; Smith, T R; Sang, D N; Craft, J L

    1979-10-01

    The occurrence of vascular basophilia in ocular tumors has been a selective histologic feature of retinoblastomas. We recently observed a metastatic oat-cell carcinoma to the choroid which also demonstrated such a vascular hematoxyphilia. Histologic review of a variety of ocular and orbital metastatic carcinomas failed to yield a similar basophilic pattern. Examination of 100 consecutive retinoblastomas for vascular basophilia revealed an incidence of 6.0%. Similar material was not seen in any of 125 melanomas, including 10 with areas of necrosis. Histochemical studies showed the basophilic material to be DNA, and electron microscopy revealed the nuclear debris of pyknotic tumor cells to be continuous with identical material surrounding the adjacent blood vessels. The pathogenesis of vascular deposition of DNA in these two ocular tumors remains unclear. This finding most likely represents a form of tumor activity requiring comparatively healthy blood vessels to adequately precipitate liberated nucleic acids being filtered from the necrotic and degenerating tumor tissue. PMID:225286

  8. Developments in Ocular Genetics: 2013 Annual Review

    PubMed Central

    Aboobakar, Inas F.; Allingham, R. Rand

    2014-01-01

    Purpose To highlight major advancements in ocular genetics from the year 2013. Design Literature review. Methods A literature search was conducted on PubMed to identify articles pertaining to genetic influences on human eye diseases. This review focuses on manuscripts published in print or online in the English language between January 1, 2013 and December 31, 2013. A total of 120 papers from 2013 were included in this review. Results Significant progress has been made in our understanding of the genetic basis of a broad group of ocular disorders, including glaucoma, age-related macular degeneration, cataract, diabetic retinopathy, keratoconus, Fuchs’ endothelial dystrophy, and refractive error. Conclusions The latest next-generation sequencing technologies have become extremely effective tools for identifying gene mutations associated with ocular disease. These technological advancements have also paved the way for utilization of genetic information in clinical practice, including disease diagnosis, prediction of treatment response and molecular interventions guided by gene-based knowledge. PMID:25097799

  9. Ocular Fundus Photography as an Educational Tool.

    PubMed

    Mackay, Devin D; Garza, Philip S

    2015-10-01

    The proficiency of nonophthalmologists with direct ophthalmoscopy is poor, which has prompted a search for alternative technologies to examine the ocular fundus. Although ocular fundus photography has existed for decades, its use has been traditionally restricted to ophthalmology clinical care settings and textbooks. Recent research has shown a role for nonmydriatic fundus photography in nonophthalmic settings, encouraging more widespread adoption of fundus photography technology. Recent studies have also affirmed the role of fundus photography as an adjunct or alternative to direct ophthalmoscopy in undergraduate medical education. In this review, the authors examine the use of ocular fundus photography as an educational tool and suggest future applications for this important technology. Novel applications of fundus photography as an educational tool have the potential to resurrect the dying art of funduscopy. PMID:26444395

  10. Ocular Tuberculosis with Progressive Unilateral Corneal Melting

    PubMed Central

    Bayraktutar, Betl N.; Uakhan-Gndz, mr

    2015-01-01

    Objectives In this case report, we present a patient with ocular tuberculosis presenting with progressive unilateral corneal melting. Patient A 47-year-old female was admitted with melting at the inferior half of the peripheral cornea and inferior subconjunctival nodules. Biopsy material of the nodules was negative for tuberculosis bacillus. However, polymerase chain reaction of the biopsy sample revealed the DNA of the bacillus, and the diagnosis was confirmed. Conclusion In endemic areas, ocular tuberculosis should be kept in mind in the differential diagnosis of patients with chronic and atypical corneal involvement. PMID:26483670

  11. Ocular motor abnormalities in neurodegenerative disorders

    PubMed Central

    Antoniades, C A; Kennard, C

    2015-01-01

    Eye movements are a source of valuable information to both clinicians and scientists as abnormalities of them frequently act as clues to the localization of a disease process. Classically, they are divided into two main types: those that hold the gaze, keeping images steady on the retina (vestibulo-ocular and optokinetic reflexes) and those that shift gaze and redirect the line of sight to a new object of interest (saccades, vergence, and smooth pursuit). Here we will review some of the major ocular motor abnormalities present in neurodegenerative disorders. PMID:25412716

  12. Cogan's syndrome and other ocular vasculitides.

    PubMed

    Espinoza, Gabriela M; Prost, Angela

    2015-04-01

    The clinical presentation of Cogan's syndrome has been classified as typical and atypical. Like other forms of ocular vasculitis, Cogan's syndrome has been found to have autoimmune origins with antibodies against the cornea, inner ear, and endothelial antigens. Antineutrophil cytoplasmic antibody (ANCA) and rheumatoid factor (RF) have been associated with Cogan's syndrome as well as ocular-involving vasculitides not as strongly associated with the audiovestibular manifestations such as granulomatosis with polyangiitis and rheumatoid arthritis. The mainstay of therapy has been corticosteroids although other methods have been described in recalcitrant disease and to prevent development of systemic sequelae. PMID:25854487

  13. Ocular laser bioeffects in Operation Iraqi Freedom

    NASA Astrophysics Data System (ADS)

    Hacker, Henry D.; Lund, Jack; Cheramie, Rachel; Stuck, Bruce E.

    2008-02-01

    Laser hazards on the modern battlefield include numerous applications with the potential for eye damage from both pulsed and high luminance continuous energy laser devices. The multitude of laser devices deployed both by friendly and threat forces represent a significant hazard to vision, and consequently duty performance. Increased application of high luminance devices for tactical use may result in accidental exposure and temporary or persistent symptoms. These symptoms may be confounded by ongoing ocular retinal disorders. The management of these patients requires additional laser training to prevent injury as well as more experience and training for first responders in order to triage individuals with vision disturbances thought secondary to ocular laser exposure.

  14. Ocular manifestations of genetic skin disorders.

    PubMed

    Jen, Melinda; Nallasamy, Sudha

    2016-01-01

    Genetic skin diseases, or genodermatoses, often have extracutaneous manifestations. Ocular manifestations in particular can have significant clinical implications, like blindness. Other manifestations, such as the corneal opacities that occur in X-linked ichthyosis, are asymptomatic but characteristic of a particular genodermatosis. Ophthalmologic examination can aid in diagnosis when characteristic findings are seen. The genodermatoses with ocular manifestations will be reviewed, but neurocutaneous, syndromes, genetic pigmentary disorders, and genetic metabolic diseases are not included because they are covered elsewhere in this issue. PMID:26903188

  15. 21 CFR 886.4360 - Ocular surgery irrigation device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ocular surgery irrigation device. 886.4360 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4360 Ocular surgery irrigation device. (a) Identification. An ocular surgery irrigation device is a device intended to be suspended over...

  16. 21 CFR 886.4360 - Ocular surgery irrigation device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ocular surgery irrigation device. 886.4360 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4360 Ocular surgery irrigation device. (a) Identification. An ocular surgery irrigation device is a device intended to be suspended over...

  17. 21 CFR 886.4360 - Ocular surgery irrigation device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ocular surgery irrigation device. 886.4360 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4360 Ocular surgery irrigation device. (a) Identification. An ocular surgery irrigation device is a device intended to be suspended over...

  18. 21 CFR 886.4360 - Ocular surgery irrigation device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ocular surgery irrigation device. 886.4360 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4360 Ocular surgery irrigation device. (a) Identification. An ocular surgery irrigation device is a device intended to be suspended over...

  19. 21 CFR 886.4610 - Ocular pressure applicator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ocular pressure applicator. 886.4610 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4610 Ocular pressure applicator. (a) Identification. An ocular pressure applicator is a manual device that consists of a sphygmomanometer-type...

  20. 21 CFR 886.4610 - Ocular pressure applicator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ocular pressure applicator. 886.4610 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4610 Ocular pressure applicator. (a) Identification. An ocular pressure applicator is a manual device that consists of a sphygmomanometer-type...

  1. 21 CFR 886.4610 - Ocular pressure applicator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ocular pressure applicator. 886.4610 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4610 Ocular pressure applicator. (a) Identification. An ocular pressure applicator is a manual device that consists of a sphygmomanometer-type...

  2. 21 CFR 886.4360 - Ocular surgery irrigation device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ocular surgery irrigation device. 886.4360 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices 886.4360 Ocular surgery irrigation device. (a) Identification. An ocular surgery irrigation device is a device intended to be suspended over...

  3. Evolution of the vestibulo-ocular system

    NASA Technical Reports Server (NTRS)

    Fritzsch, B.

    1998-01-01

    The evolutionary and developmental changes in the eye muscle innervation, the inner ear, and the vestibulo-ocular reflex are examined. Three eye muscle patterns, based on the innervation by distinct ocular motoneurons populations, can be identified: a lamprey, an elasmobranch, and a bony fish/tetrapod pattern. Four distinct patterns of variation in the vestibular system are described: a hagfish pattern, a lamprey pattern, an elasmobranch pattern, and a bony fish/tetrapod pattern. Developmental data suggest an influence of the hindbrain on ear pattern formation, thus potentially allowing a concomitant change of eye muscle innervation and ear variation. The connections between the ear and the vestibular nuclei and between the vestibular nuclei and ocular motoneurons are reviewed, and the role of neurotrophins for pattern specification is discussed. Three patterns are recognized in central projections: a hagfish pattern, a lamprey pattern, and a pattern for jawed vertebrates. Second-order connections show both similarities and differences between distantly related species such as lampreys and mammals. For example, elasmobranchs lack an internuclear system, which is at best poorly developed in lampreys. It is suggested that the vestibulo-ocular system shows only a limited degree of variation because of the pronounced functional constraints imposed on it.

  4. Controlled release polymeric ocular delivery of acyclovir.

    PubMed

    Deshpande, Praful Balavant; Dandagi, Panchaxari; Udupa, Nayanabhirama; Gopal, Shavi V; Jain, Samata S; Vasanth, Surenalli G

    2010-01-01

    The aim of the present study was to formulate and evaluate controlled release polymeric ocular delivery of acyclovir. Reservoir-type ocular inserts were fabricated by sandwiching hydroxypropyl methylcellulose (HPMC) matrix film containing acyclovir between two rate controlling membranes of cellulose acetate phthalate (CAP). The solubility and dissolution rate of poorly soluble acyclovir was enhanced by preparing binary systems with beta-cyclodextrin and then incorporated into HPMC matrix. Nine formulations (AB-1 to AB-9) with varying ratio of HPMC (drug matrix) and CAP (rate controlling membrane) were developed and sterilized by gamma radiation. The formulations were subjected to various physico-chemical evaluations. The in vitro release profile of all the formulations showed a steady, controlled drug release up to 20 h with non-Fickian diffusion behavior. A high correlation coefficient found between in vitro/in vivo release rate studies. Formation of acyclovir complex was confirmed by differential scanning calorimetry. In addition, dissolution rate studies revealed improved solubility of acyclovir when complexed with beta-cyclodextrin. Stability studies showed that the ocular inserts could be stored safely at study storage conditions. In conclusion, the present study demonstrated controlled release formulation of acyclovir inserts for ocular delivery using biodegradable polymers. PMID:19772377

  5. Ocular rosacea, psoriasis, and lichen planus.

    PubMed

    Webster, Guy F; Durrani, Khayyam; Suchecki, Jeanine

    2016-01-01

    Although the number of dermatologic conditions with ocular manifestations is relatively limited, these entities have a high prevalence and represent a large proportion of clinic visits to both dermatologic and ophthalmic practices. This contribution will review oculocutaneous diseases that are not part of the allergic or autoantibody-mediated spectrum. PMID:26903182

  6. Controlled Ocular Drug Delivery with Nanomicelles

    PubMed Central

    Vaishya, Ravi D.; Khurana, Varun; Patel, Sulabh; Mitra, Ashim K.

    2014-01-01

    Many vision threatening ocular diseases such as age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, and proliferative vitreoretinopathy may result in blindness. Ocular drug delivery specifically to the intraocular tissues remains a challenging task due to the presence of various physiological barriers. Nonetheless, recent advancements in the field of nanomicelle based novel drug delivery system could fulfil these unmet needs. Nanomicelles consists of amphiphilic molecules that self-assemble in aqueous media to form organized supramolecular structures. Micelles can be prepared in various sizes (10 to 1000nm) and shapes depending on the molecular weights of the core and corona forming blocks. Nanomicelles have been an attractive carriers for their potential to solubilize hydrophobic molecules in aqueous solution. In addition, small size in nanometer range and highly modifiable surface properties have been reported to be advantageous in ocular drug delivery. In the present review various factors influencing rationale design of nanomicelles formulation and disposition are discussed along with case studies. Despite the progress in the field, influence of various properties of nanomicelles such as size, shape, surface charge, rigidity of structure on ocular disposition need to be studied in further details to develop an efficient nanocarrier system. PMID:24888969

  7. Recent Perspectives in Ocular Drug Delivery

    PubMed Central

    Gaudana, Ripal; Jwala, J.; Boddu, Sai H. S.; Mitra, Ashim K.

    2015-01-01

    Anatomy and physiology of the eye makes it a highly protected organ. Designing an effective therapy for ocular diseases, especially for the posterior segment, has been considered as a formidable task. Limitations of topical and intravitreal route of administration have challenged scientists to find alternative mode of administration like periocular routes. Transporter targeted drug delivery has generated a great deal of interest in the field because of its potential to overcome many barriers associated with current therapy. Application of nanotechnology has been very promising in the treatment of a gamut of diseases. In this review, we have briefly discussed several ocular drug delivery systems such as microemulsions, nanosuspensions, nanoparticles, liposomes, niosomes, dendrimers, implants, and hydrogels. Potential for ocular gene therapy has also been described in this article. In near future, a great deal of attention will be paid to develop non-invasive sustained drug release for both anterior and posterior segment eye disorders. A better understanding of nature of ocular diseases, barriers and factors affecting in vivo performance, would greatly drive the development of new delivery systems. Current momentum in the invention of new drug delivery systems hold a promise towards much improved therapies for the treatment of vision threatening disorders. PMID:18758924

  8. Diffuse corneal abrasion after ocular exposure to laundry detergent pod.

    PubMed

    Whitney, Rachel E; Baum, Carl R; Aronson, Paul L

    2015-02-01

    Although ocular injury from alkaline household cleaning products is well described, there is less known about the significance and extent of injury with ocular exposure to detergent pods. We report a 12-month-old with diffuse corneal abrasion caused by ocular contact with a laundry detergent pod. In addition to the known risks with aspiration with detergent pods, the potential for severe ocular injury is important for parents and clinicians to recognize. Children with ocular exposure to detergent pods should seek immediate medical care. PMID:25422858

  9. Ocular neovascularization: a valuable model system.

    PubMed

    Campochiaro, Peter Anthony; Hackett, Sean Francis

    2003-09-29

    There is no unique formula for angiogenesis. Instead there is a large group of potential participating proteins that interact in complex ways. Depending upon the surrounding cell types and the relative expression levels of angiogenesis-related proteins, the 'angiogenesis cascade' can vary. Therefore, it is valuable to study and compare the role of proteins in several well-characterized vascular beds. The eye provides a useful model system, because it contains several vascular beds sandwiched between avascular tissue. This allows for unequivocal identification and quantitation of new vessels. Retina-specific promoters combined with inducible promoter systems provide a means to regulate the expression of proteins of interest. As a relatively isolated compartment, the eye also provides advantages for gene transfer. By gaining insight regarding the molecular signals involved in various types of ocular angiogenesis, general concepts can emerge that may apply to other settings, including tumor angiogenesis. One concept that has emerged is that despite participation of multiple stimulatory factors for ocular neovascularization, VEGF plays an essential role and interruption of VEGF signaling is an important therapeutic strategy. Another concept is that while most studies have focused on prevention of ocular neovascularization, regression of new vessels is desirable and is achievable with at least three agents, combretastatin A-4 phosphate, pigment epithelium-derived factor, and angiopoietin-2. Finally, endostatin and angiostatin, which have been sources of controversy because of inconsistent results in tumor models, have been shown to have good efficacy when delivered by gene transfer in models of ocular neovascularization. These results provide leads for new ocular treatments and perspective for evaluation of studies of neovascularization in extraocular tissues. PMID:14528278

  10. RECURRENCE RATES OF OCULAR TOXOPLASMOSIS DURING PREGNANCY

    PubMed Central

    Braakenburg, Arthur M.D.; Crespi, Catherine M.; Holland, Gary N.; Wu, Sheng; Yu, Fei; Rothova, Aniki

    2014-01-01

    Purpose To investigate whether recurrence rates of ocular toxoplasmosis are higher during pregnancy among women of childbearing age. Design Retrospective longitudinal cohort study. Methods We reviewed medical records of all women seen at a university eye clinic (Utrecht, Netherlands) during episodes of active toxoplasmic retinochoroiditis that occurred while the women were of childbearing age (1642 years). Each woman was sent a questionnaire requesting information regarding all pregnancies and episodes of ocular toxoplasmosis, whether or not episodes were observed at the eye clinic. Conditional fixed-effects Poisson regression was used to model incident rate ratios of recurrence during pregnant versus non-pregnant intervals, adjusted for potential confounders, including age at time of active toxoplasmic retinochoroiditis and interval since last episode of active disease, which are known to influence risk of recurrence. Results Questionnaires were returned by 50 (58%) of 86 women, 34 of whom had 69 pregnancies during 584 person-years of study. There were 128 episodes of ocular toxoplasmosis during the study period (6 during pregnancy). First episodes of ocular toxoplasmosis occurred between ages 9.6 and 38.5 years. Youngest age at pregnancy was 16.1 years; oldest age at childbirth was 40.9 years. Incident rate ratios for pregnant versus non-pregnant intervals were in the direction of lower recurrence rates during pregnancy, with point estimates of 0.54 and 0.75 under two different approaches, but ratios were not significantly different from the null value (p-values of 0.16 and 0.55). Conclusions Recurrence rates of ocular toxoplasmosis are likely not higher during pregnancy, in contrast to traditional beliefs. PMID:24412127

  11. Ocular drug development--future directions.

    PubMed

    Sherris, David

    2007-01-01

    Technology has caught up with retinal diseases of neovasculature. Work with anti-cancer, anti-angiogenic agents has fueled the way for ocular therapeutics. The market size for age-related macular degeneration and diabetic retinopathy is huge. Fifteen million people in the United States alone have age-related macular degeneration with 2 million new cases each year (1). About 20.8 million people in the United States have diabetes. Of those, 14.6 million are diagnosed and 6.2 million are undiagnosed (2). Of patients who have had type 1 diabetics for more than 20 years, 50% will have proliferative diabetic retinopathy (3). Between 60% and 80% of type 2 diabetics will manifest retinopathy after 15 years, and 20% will progress to proliferative retinopathy after 25 years of duration (4). Big pharma and biotech were complacent in developing drugs capable of having effect on ocular neovascular diseases even though technologies were available, at least on the research level, long before there was serious activity to bring such technologies to the clinic. Finally, over the last three years, triple digit million dollar business development deals have been consummated, mostly for VEGF-A targeted modalities. Such biodollar partnerships were the eye openers which have now led to a concerted action to develop ocular drugs to combat ocular neovascularization. Anti-VEGF-A technologies do not constitute the whole story. Agents with broader activity, activity that occurs later down the angiogenic pathway and those drugs which are capable to synergize with anti-VEGF-A technologies will dominate the next wave in ocular diseases of neovascularization and will lead the next round of significant business development deals. PMID:17372850

  12. Ocular toxicity of authentic lunar dust

    PubMed Central

    2012-01-01

    Background Dust exposure is a well-known occupational hazard for terrestrial workers and astronauts alike and will continue to be a concern as humankind pursues exploration and habitation of objects beyond Earth. Humankind’s limited exploration experience with the Apollo Program indicates that exposure to dust will be unavoidable. Therefore, NASA must assess potential toxicity and recommend appropriate mitigation measures to ensure that explorers are adequately protected. Visual acuity is critical during exploration activities and operations aboard spacecraft. Therefore, the present research was performed to ascertain the ocular toxicity of authentic lunar dust. Methods Small (mean particle diameter = 2.9 ± 1.0 μm), reactive lunar dust particles were produced by grinding bulk dust under ultrapure nitrogen conditions. Chemical reactivity and cytotoxicity testing were performed using the commercially available EpiOcularTM assay. Subsequent in vivo Draize testing utilized a larger size fraction of unground lunar dust that is more relevant to ocular exposures (particles <120 μm; median particle diameter = 50.9 ± 19.8 μm). Results In vitro testing indicated minimal irritancy potential based on the time required to reduce cell viability by 50% (ET50). Follow-up testing using the Draize standard protocol confirmed that the lunar dust was minimally irritating. Minor irritation of the upper eyelids was noted at the 1-hour observation point, but these effects resolved within 24 hours. In addition, no corneal scratching was observed using fluorescein stain. Conclusions Low-titanium mare lunar dust is minimally irritating to the eyes and is considered a nuisance dust for ocular exposure. No special precautions are recommended to protect against ocular exposures, but fully shielded goggles may be used if dust becomes a nuisance. PMID:22817808

  13. Natural product inhibitors of ocular angiogenesis

    PubMed Central

    Sulaiman, Rania S.; Basavarajappa, Halesha D.; Corson, Timothy W.

    2014-01-01

    Natural products are characterized by high chemical diversity and biochemical specificity; therefore, they are appealing as lead compounds for drug discovery. Given the importance of angiogenesis to many pathologies, numerous natural products have been explored as potential anti-angiogenic drugs. Ocular angiogenesis underlies blinding eye diseases such as retinopathy of prematurity (ROP) in children, proliferative diabetic retinopathy (DR) in adults of working age, and age-related macular degeneration (AMD) in the elderly. Despite the presence of effective therapy in many cases, these diseases are still a significant health burden. Anti-VEGF biologics are the standard of care, but may cause ocular or systemic side effects after intraocular administration and patients may be refractory. Many anti-angiogenic compounds inhibit tumor growth and metastasis alone or in combination therapy, but a more select subset of them has been tested in the context of ocular neovascular diseases. Here, we review the promise of natural products as anti-angiogenic agents, with a specific focus on retinal and choroidal neovascularization. The multifunctional curcumin and the chalcone isoliquiritigenin have demonstrated promising anti-angiogenic effects in mouse models of DR and choroidal neovascularization (CNV) respectively. The homoisoflavanone cremastranone and the flavonoid deguelin have been shown to inhibit ocular neovascularization in more than one disease model. The isoflavone genistein and the flavone apigenin on the other hand are showing potential in the prevention of retinal and choroidal angiogenesis with long-term administration. Many other products with antiangiogenic potential in vitro such as the lactone withaferin A, the flavonol quercetin, and the stilbenoid combretastatin A4 are awaiting investigation in different ocular disease relevant animal models. These natural products may serve as lead compounds for the design of more specific, efficacious, and affordable drugs with minimal side effects. PMID:25304218

  14. Epidemiological aspects of ocular superglue injuries

    PubMed Central

    Tabatabaei, Seyed Ali; Modanloo, Shokoufeh; Ghiyasvand, Arezoo Mohammadkhani; Pouryani, Abolghasem; Soleimani, Mohammad; Tabatabaei, Seyed Mehdi; Pakrah, Ahmad Reza; Masarat, Hamideh

    2016-01-01

    AIM To report the frequency, associated risk factors and characteristics of cases referred to Farabi Eye Hospital with ocular superglue injuries. METHODS In a descriptive cross-sectional study conducted between December 2012 and February 2013, patients with ocular superglue injuries were evaluated. Age, sex, educational level, location, time, mechanism, type, site and time of eye injury were gathered through interview using a customized questionnaire. All participants had given consent to undergo thorough eye examination. RESULTS Over the course of three months, 105 patients with ocular superglue injuries enrolled in the study, including 56(53.3%) men and 49(46.7%) women with the mean age of 24.7±11.6 (range, 2 to 53)y. The right eye, left eye and both eyes were involved in 52%, 42% and 6% of the patients, respectively. Most of injuries had occurred at home (72.4%) and at night (55%). More than half of patients (52.4%) did not take any primary aids following the ocular injury. Patient carelessness (78.1%), childhood curiosity and lack of parental supervision (11.4%), storing superglue in inappropriate places and inadvertently using superglue as eye drops due to poor vision (2.9%), inadequate awareness of superglue applications [used to stick on artificial nails (3.8%), artificial eyelashes (1.9%) and broken tooth (1%)] and being assaulted with glue (1%) were common risk factors. CONCLUSION The frequency of ocular superglue injuries in patients referred to Farabi Eye Hospital is relatively high. This finding underlines the importance of public education and awareness about superglue injuries to the eye and taking protective measures and safety strategies in order to prevent these injures. PMID:26949651

  15. Ocular Drug Delivery; Impact of in vitro Cell Culture Models

    PubMed Central

    Barar, Jaleh; Asadi, Masoud; Mortazavi-Tabatabaei, Seyed Abdolreza; Omidi, Yadollah

    2009-01-01

    Normal vision depends on the optimal function of ocular barriers and intact membranes that selectively regulate the environment of ocular tissues. Novel pharmacotherapeutic modalities have aimed to overcome such biological barriers which impede efficient ocular drug delivery. To determine the impact of ocular barriers on research related to ophthalmic drug delivery and targeting, herein we provide a review of the literature on isolated primary or immortalized cell culture models which can be used for evaluation of ocular barriers. In vitro cell cultures are valuable tools which serve investigations on ocular barriers such as corneal and conjunctival epithelium, retinal pigment epithelium and retinal capillary endothelium, and can provide platforms for further investigations. Ocular barrier-based cell culture systems can be simply set up and used for drug delivery and targeting purposes as well as for pathological and toxicological research. PMID:23198080

  16. Prognostic value of an ocular trauma score in ocular firecracker trauma.

    PubMed

    Qi, Ying; Zhu, Yu

    2013-01-01

    The aim of this study was to report the incidence and management of ocular firecracker trauma and to assess the predictive value of an Ocular Trauma Score (OTS) in ocular firecracker trauma. The study includes consecutive case study and retrospective analysis of ocular firecracker trauma. Numerical values rendered to the OTS variables (visual acuity, rupture, endophthalmitis, perforating or penetrating injury, retinal detachment, and afferent pupillary defect) at presentation were summated and converted to OTS categories. The likelihood of the final visual acuities in each category were calculated. The sensitivity and specificity of OTS were also determined. Forty-eight patients (54 eyes) were enrolled in the study. Male patients accounted for 85.4%. Of the total patients, 62.5% were younger than 15 years. Bystanders accounted for 47.9%. The average follow up was 18.5±3.6 months. The most common clinical manifestation was ocular penetrating or perforating injury. Of the total number of patients, 53.7% had best-corrected vision, at the time of their last follow up, ranging from 20/50-20/200. The OTS has 100% sensitivity and specificity to predict nonlight perception, light perception/hand motion, and 1/200-19/200. The OTS has 45% sensitivity and 100% specificity to predict vision of 20/200-20/50. The OTS has 100% sensitivity and 65% specificity to predict vision of ≥20/40. The clinical manifestations of ocular firecracker trauma in Zhengzhou are more severe than in other countries, but similar to reports of other cities of comparable size to that in China. The OTS has good predictive value for ocular firecracker trauma with 100% sensitivity and specificity to predict a final vision of nonlight perception, light perception/hand motion, and 1/200-19/200. PMID:23237820

  17. Ocular and systemic pharmacokinetics of lidocaine hydrochloride ophthalmic gel in rabbits after topical ocular administration.

    PubMed

    Liu, Bing; Ding, Li; Xu, Xiaowen; Lin, Hongda; Sun, Chenglong; You, Linjun

    2015-12-01

    Lidocaine hydrochloride ophthalmic gel is a novel ophthalmic preparation for topical ocular anesthesia. The study is aimed at evaluating the ocular and systemic pharmacokinetics of lidocaine hydrochloride 3.5% ophthalmic gel in rabbits after ocular topical administration. Thirty-six rabbits were randomly placed in 12 groups (3 rabbits per group). The rabbits were quickly killed according to their groups at 0 (predose), 0.0833, 0.167, 0.333, 0.667, 1, 1.5, 2, 3, 4, 6, and 8h postdose and then the ocular tissue and plasma samples were collected. All the samples were analyzed by a validated LC-MS/MS method. The test result showed that the maximum concentration (C max) of lidocaine in different ocular tissues and plasma were all achieved within 20min after drug administration, and the data of C max were (2,9871814) ?g/g, (44.6712.91) ?g/g, (26.267.19) ?g/g, (11,0462,734) ng/mL, and (160.361.0) ng/mL for tear fluid, cornea, conjunctiva, aqueous humor, and plasma, respectively. The data of the elimination half-life in these tissues were 1.5, 3.2, 3.5, 1.9, and 1.7h for tear fluid, cornea, conjunctiva, aqueous humor, and plasma, respectively. The intraocular lidocaine levels were significantly higher than that in plasma, and the elimination half-life of lidocaine in cornea, conjunctiva, and aqueous humor was relatively longer than that in tear fluid and plasma. The high intraocular penetration, low systemic exposure, and long duration in the ocular tissues suggested lidocaine hydrochloride 3.5% ophthalmic gel as an effective local anesthetic for ocular anesthesia during ophthalmic procedures. PMID:25031074

  18. Outcome of unexpected adnexal neoplasia discovered during risk reduction salpingo-oophorectomy in women with germ-line BRCA1 or BRCA2 mutations

    PubMed Central

    Conner, James R.; Meserve, Emily; Pizer, Ellen; Garber, Judy; Roh, Michael; Urban, Nicole; Drescher, Charles; Quade, Bradley J.; Muto, Michael; Howitt, Brooke E.; Pearlman, Mark D.; Berkowitz, Ross S.; Horowitz, Neil; Crum, Christopher P.; Feltmate, Colleen

    2014-01-01

    Purpose This study computed the risk of clinically silent adnexal neoplasia in women with germ-line BRCA1 or BRCA2 mutations (BRCAm+) and determined recurrence risk. Methods We analyzed risk reduction salpingo-oophorectomies (RRSOs) from 349 BRCAm+ women processed by the SEE-FIM protocol and addressed recurrence rates for 29 neoplasms from three institutions. Results Nineteen neoplasms (5.4%) were identified at one institution, 9.2% of BRCA1 and 3.4% of BRCA2 mutation-positive women. Fourteen had a high-grade tubal intraepithelial neoplasm (HGTIN, 74%). Mean age (54.4) was higher than the BRCAm+ cohort without neoplasia (47.8) and frequency increased with age (p<0.001). Twenty-nine BRCA m+ patients with neoplasia from three institutions were followed for a median of 5 years (18 yrs.). One of 11 with HGTIN alone (9%) recurred at 4 years, in contrast to 3 of 18 with invasion or involvement of other sites (16.7%). All but two, are currently alive. Among the 29 patients in the three institution cohort, mean ages for HGTIN and advanced disease were 49.2 and 57.7 (p = 0.027). Conclusions Adnexal neoplasia is present in 56% of RRSOs, is more common in women with BRCA1 mutations, and recurs in 9% of women with HGTIN alone. The lag in time from diagnosis of the HGTIN to pelvic recurrence (4 years) and differences in mean age between HGTIN and advanced disease (8.5 years) suggest an interval of several years from the onset of HGTIN until pelvic cancer develops. However, some neoplasms occur in the absence of HGTIN. PMID:24333842

  19. Cultured corneal epithelia for ocular surface disease.

    PubMed Central

    Schwab, I R

    1999-01-01

    PURPOSE: To evaluate the potential efficacy for autologous and allogeneic expanded corneal epithelial cell transplants derived from harvested limbal corneal epithelial stem cells cultured in vitro for the management of ocular surface disease. METHODS: Human Subjects. Of the 19 human subjects included, 18 (20 procedures) underwent in vitro cultured corneal epithelial cell transplants using various carriers for the epithelial cells to determine the most efficacious approach. Sixteen patients (18 procedures on 17 eyes) received autologous transplants, and 2 patients (1 procedure each) received allogeneic sibling grafts. The presumed corneal epithelial stem cells from 1 patient did not grow in vitro. The carriers for the expanded corneal epithelial cells included corneal stroma, type 1 collagen (Vitrogen), soft contact lenses, collagen shields, and amniotic membrane for the autologous grafts and only amniotic membrane for the allogeneic sibling grafts. Histologic confirmation was reviewed on selected donor grafts. Amniotic membrane as carrier. Further studies were made to determine whether amniotic membrane might be the best carrier for the expanding corneal epithelial cells. Seventeen different combinations of tryspinization, sonication, scraping, and washing were studied to find the simplest, most effective method for removing the amniotic epithelium while still preserving the histologic appearance of the basement membrane of the amnion. Presumed corneal epithelial stem cells were harvested and expanded in vitro and applied to the amniotic membrane to create a composite graft. Thus, the composite graft consisted of the amniotic membrane from which the original epithelium had been removed without significant histologic damage to the basement membrane, and the expanded corneal epithelial stem cells, which had been applied to and had successfully adhered to the denuded amniotic membrane. Animal model. Twelve rabbits had the ocular surface of 1 eye damaged in a standard manner with direct removal of the presumed limbal stem cells, corneal epithelium, and related epithelium, followed by the application of n-heptanol for 60 seconds. After 6 weeks, all damaged eyes were epithelialized and vascularized. Two such treated eyes were harvested without further treatment, to be used for histologic study as damaged controls. The remaining 10 rabbits received composite grafts (consisting of amniotic membrane with expanded allogeneic rabbit corneal epithelial cell transplants) applied to the ocular surface in a standard manner followed by the application of a contact lens. At 16 days following transplantation, 5 of the rabbits were sacrificed and the corneal rims were removed for histologic study. At 28 days, the remaining rabbits were sacrificed and the previously damaged eyes were harvested for histologic and immunohistochemical study. RESULTS: Human subjects. Of the 19 total patients admitted to the study, the presumed corneal epithelial stem cells of 1 patient did not grow in vitro. Of the remaining 18 patients (20 procedures, 19 eyes), 3 patients had unsuccessful results (3 autologous procedures), 1 patient had a partially successful procedure (allogeneic procedure), and 1 patient had a procedure with an undetermined result at present (allogeneic procedure). One unsuccessful patient had entropion/trichiasis and mechanically removed the graft and eventually went into phthisis. The other 2 unsuccessful patients suffered presumed loss of autologous donor epithelium and recurrence of the ocular surface disease (pterygium). The partially successful patient receiving an allogeneic transplant had infectious keratitis delay of his re-epithelialization; he has only minimal visual improvement but has re-epithelialized. The patient receiving the second allogeneic graft lost his donor epithelium at day 4. Additional donor epithelium was reapplied, but the result is undetermined at present. Amniotic membrane as carrier. The in vitro preparation of the amniotic membrane with corneal epithelial stem cell graft overlay was successful.Histology documented removal of the amniotic epithelium and reapplication of corneal epithelial cells. Animal model. The 2 rabbits that had no reparative surgery following standard ocular surface injury had histology and immunopathology consistent with incomplete corneal epithelial stem cell failure with vascularization and scarring of the ocular surface. Light microscopy and immunohistologic staining with AE5 confirmed the conjunctival phenotype of the ocular surface repair but also documented the incomplete model. The allogeneic stern cell transplants had varying results. One rabbit had a suppurative infection and lost the graft. Reparative surgery failed in 2 of the rabbits, failed partially in 3 of the rabbits, was partially successful in 3 others, and was successful in 1 rabbit at 28 days. Histologic and immunopathologic study documented successful growth of corneal epithelium onto the recipient surface. CONCLUSIONS: 1. Presumed corneal epithelial stem cells can be harvested safely from the limbus and expanded successfully in vitro. 2. Expanded corneal epithelial cell cultures can be grown onto various carriers, but currently denuded amniotic membrane seems to be the best carrier for ocular surface repair. 3. Expanded corneal epithelial cell transplants appear to resurface damaged ocular surfaces successfully, but cellular tracking and further confirmation are required. 4. Expanded allogeneic corneal epithelial cell transplants are technically possible and may represent alternative treatment modalities for selected ocular surface problems. 5. These techniques potentially offer a new method of restoring a normal ocular surface while minimizing the threat of damage or depletion to the contralateral or sibling limbal corneal epithelial stem cells. 6. The rabbit model was probably incomplete and should be interpreted with caution. The complete eradication of all corneal epithelial stem cells from any eye is difficult, making confirmation of such work challenging. 7. The results of the rabbit model suggest that allogeneic grafts may restore a nearly normal ocular epithelial surface to certain ocular surface injuries. Images FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7 FIGURE 8 FIGURE 9 FIGURE 10 FIGURE 11 FIGURE 12 FIGURE 13 FIGURE 14 FIGURE 15 FIGURE 16 FIGURE 17 FIGURE 18 FIGURE 19 FIGURE 20 FIGURE 21 FIGURE 22 FIGURE 23 FIGURE 24 FIGURE 25 FIGURE 26 FIGURE 27 FIGURE 28 FIGURE 29 FIGURE 30 FIGURE 31 FIGURE 32 FIGURE 33 FIGURE 34 FIGURE 35 FIGURE 36 FIGURE 37 FIGURE 38 FIGURE 39 FIGURE 40 FIGURE 41 FIGURE 42 FIGURE 43 FIGURE 44 FIGURE 45 FIGURE 46 FIGURE 47 FIGURE 48 FIGURE 49 FIGURE 50 FIGURE 51 FIGURE 52 FIGURE 53 FIGURE 54 FIGURE 55 FIGURE 56 FIGURE 57 FIGURE 58 PMID:10703147

  20. Ocular pseudoexfoliation syndrome and life span

    PubMed Central

    Slettedal, Jon Klokk; Sandvik, Leiv; Ringvold, Amund

    2015-01-01

    Background To compare life span of persons with and without ocular pseudoexfoliation syndrome (PES). Methods The study is based on an epidemiological survey conducted in Sr-Trndelag county, Norway, in 198586. All inhabitants over 64years of age (2109 individuals) were invited. Mortality information was obtained from The Norwegian Institute of Public Health in 2014, by which time 99% of the participants were deceased. Results When adjusting for age and gender, life span was not statistically different in persons with and without PES. Following the diagnosis of PES, patients' survival was up to, and beyond, 30years. Conclusions Our observations suggest that, despite all the systemic aberrations reported in persons with ocular PES, none or only marginal functional changes are caused in extraocular organs and tissues. The present study supports the notion that systemic PES is not a life-threatening condition. PMID:26288849

  1. Ocular screening tests of elementary school children

    NASA Technical Reports Server (NTRS)

    Richardson, J.

    1983-01-01

    This report presents an analysis of 507 abnormal retinal reflex images taken of Huntsville kindergarten and first grade students. The retinal reflex images were obtained by using an MSFC-developed Generated Retinal Reflex Image System (GRRIS) photorefractor. The system uses a 35 mm camera with a telephoto lens with an electronic flash attachment. Slide images of the eyes were examined for abnormalities. Of a total of 1835 students screened for ocular abnormalities, 507 were found to have abnormal retinal reflexes. The types of ocular abnormalities detected were hyperopia, myopia, astigmatism, esotropia, exotropia, strabismus, and lens obstuctions. The report shows that the use of the photorefractor screening system is an effective low-cost means of screening school children for abnormalities.

  2. Ocular injuries due to projectile impacts.

    PubMed

    Scott, W R; Lloyd, W C; Benedict, J V; Meredith, R

    2000-01-01

    An animal model has been developed using enucleated porcine eyes to evaluate ocular trauma. The eyes were pressurized to approximately 18 mmHg and mounted in a container with a 10% gelatin mixture. The corneas of sixteen pressurized eyes were impacted by a blunt metal projectile (mass of 2.6 gm, 3.5 gm or 45.5 gm) at velocities of 4.0 to 38.1 m/s. The impacted eyes were evaluated by an ophthalmologist. A numerical classification scheme was used to categorize the severity of the ocular injury. A chi-squared test indicates that the injury level is associated with the kinetic energy (KE) and not the momentum of the projectile. The enucleated eyes began to experience lens dislocations when the KE of the projectile was approximately 0.75 Nm, and retinal injuries when the KE was approximately 1.20 Nm. PMID:11558084

  3. Ocular manifestations of genetic and development diseases.

    PubMed

    Diamond, G R

    1995-12-01

    Significant advances were reported this year in the identification of the chromosomal location of mutated genes on the 13 and 6 chromosomes which cause forms of autosomal dominant Stargardt's macular dystrophy. Observations in monozygotic twins with age-related macular dystrophy were described. Mitochondrial DNA mutations in Cubans with optic and peripheral neuropathy were reported. A new autosomal dominant proximal myotonic myopathy was described. Persistence of the tunica vasculosa lentis was suggested as a helpful sign of congenital myotonic dystrophy. The panoply of ocular findings in acromesomelic dysplasia were presented. Genetic characterization of the ocular findings in Duchenne type and Becker's muscular dystrophy was reported. Finally, a new syndrome of autosomal dominant cerebellar ataxia with retinal degeneration was described. PMID:10160422

  4. Ocular Toxicity Testing of Lunar Dust

    NASA Technical Reports Server (NTRS)

    Meyers, Valerie E.

    2010-01-01

    This slide presentation reviews the use of ocular testing to determine the toxicity of lunar dust. The OECD recommendations are reviewed. With these recommendations in mind the test methodology was to use EpiOcular, tissues derived from normal human epidermal keratinocytes, the cells of which have been differentiated on cell culture inserts to form a multi-layered structure, which closely parallels the corneal epithelium and to dose the tissue with 100 mg dust from various sources. The in-vitro study provides evidence that lunar dust is not severely corrosive or irritating, however, in vitro tests have limitations, and in vivo tests provides a more complete scenario, and information, it is recommended that in vivo tests be performed.

  5. Orchestrating epigenetic roles targeting ocular tumors

    PubMed Central

    Wen, Xuyang; Lu, Linna; He, Zhang; Fan, Xianqun

    2016-01-01

    Epigenetics is currently one of the most promising areas of study in the field of biomedical research. Scientists have dedicated their efforts to studying epigenetic mechanisms in cancer for centuries. Additionally, the field has expanded from simply studying DNA methylation to other areas, such as histone modification, non-coding RNA, histone variation, nucleosome location, and chromosome remodeling. In ocular tumors, a large amount of epigenetic exploration has expanded from single genes to the genome-wide level. Most importantly, because epigenetic changes are reversible, several epigenetic drugs have been developed for the treatment of cancer. Herein, we review the current understanding of epigenetic mechanisms in ocular tumors, including but not limited to retinoblastoma and uveal melanoma. Furthermore, the development of new pharmacological strategies is summarized. PMID:27013893

  6. Ocular fundus in neurofibromatosis type 2.

    PubMed Central

    Landau, K; Ya?argil, G M

    1993-01-01

    Several ocular findings have been associated with neurofibromatosis type 2 (NF 2) since the identification of this disease as a distinct clinical entity. Juvenile cataracts were reported first, followed by combined pigment epithelial and retinal hamartomas. In a recent report, epiretinal membranes were described in seven of nine patients. Moreover, an association between NF 2 and optic disc gliomas has been suggested based on earlier published reports. Six patients with a confirmed diagnosis of NF 2 were examined. Four patients (six of 12 eyes) had epiretinal membranes and one had an optic disc glioma. In addition, one case of an optic disc glioma in a patient with NF 2 was tracked. It is concluded that epiretinal membranes are frequent in NF 2, and that optic disc glioma is a rare but specific sign of NF 2. Patients at risk for development of this disease should undergo careful examination of the ocular fundus. Images PMID:8218034

  7. Role of molecular diagnostics in ocular microbiology

    PubMed Central

    Taravati, Parisa; Lam, Deborah; Van Gelder, Russell N.

    2013-01-01

    Although microbial culture remains the gold standard for diagnosis of many ocular infections, the technique is limited by low yield, inability to detect certain organisms, and potentially long delays to results. DNA-based molecular diagnostic techniques use detection of specific nucleic acid sequences as evidence for presence of suspected pathogens. The polymerase chain reaction (PCR) is a powerful molecular biology technique that allows for detection of fewer than 10 copies of pathogen genome. Recent technical advances in PCR have permitted quantitation of pathogen load using quantitative PCR (qPCR), and have permitted multiplexing of primer sets. Use of pan-bacterial and pan-fungal primers for ribosomal DNA sequences has allowed diagnosis of bacterial and fungal infections using molecular techniques. In this review, we highlight recent advances in the application of PCR to the diagnosis of anterior segment and posterior segment ocular infectious diseases. PMID:24416712

  8. [Rare ocular manifestation with suspect alport syndrome].

    PubMed

    Krejčířová, I; Varadyová, B; Doležel, Z; Autrata, R; Matúšová, J; Gregorová, E

    2014-06-01

    The authors mention a case report of a 13 year old girl with renal disease, who visited the outpatient Department of Pediatric Ophthalmology, University Hospital Brno with subjective complaints on decreased vision of both eyes. Ophthalmologic examination showed physiological foveolar reflex on fundus and very discrete changes of the retinal pigment epithelium in macula, the fundus periphery was without pathology. OCT images showed bilateral atrophy of central macula and changes at the level of the photoreceptors. The authors describe a rare ocular manifestation of macular atrophy with suspect Alport syndrome, which strengthened the suspicion of this disease. The authors also mention other possible ocular manifestations of Alport syndrome and compare the findings with the up to date international references. Key words: Alport syndrome, X heterozygot Alport syndrome, macular atrophy, lentikonus. PMID:25032798

  9. Ocular Surface as Barrier of Innate Immunity

    PubMed Central

    Bolaos-Jimnez, Rodrigo; Navas, Alejandro; Lpez-Lizrraga, Erika Paulina; de Ribot, Francesc March; Pea, Alexandra; Graue-Hernndez, Enrique O; Garfias, Yonathan

    2015-01-01

    Sight is one of the most important senses that human beings possess. The ocular system is a complex structure equipped with mechanisms that prevent or limit damage caused by physical, chemical, infectious and environmental factors. These mechanisms include a series of anatomical, cellular and humoral factors that have been a matter of study. The cornea is not only the most powerful and important lens of the optical system, but also, it has been involved in many other physiological and pathological processes apart from its refractive nature; the morphological and histological properties of the cornea have been thoroughly studied for the last fifty years; drawing attention in its molecular characteristics of immune response. This paper will review the anatomical and physiological aspects of the cornea, conjunctiva and lacrimal apparatus, as well as the innate immunity at the ocular surface. PMID:26161163

  10. Ocular and orbital metastasis from systemic malignancies.

    PubMed

    Jain, I S; Dinesh, K; Mohan, K

    1987-01-01

    One hundred and seventy adult patients and one hundred and forty-eight children with systemic malignancies were examined for ocular and/or orbital metastases. Thirty-six patients (11.3%) had intraocular and/or orbital metastasis. Twenty-nine of the 36 patients (80.5%) had orbital metastasis, five patients (13.9%) had intraocular and two patients (5.5%) had intraocular and orbital metastasis. The commonest malignancy producing ocular metastasis was carcinoma breast in females and carcinoma bronchus in males. Eight of the 17 children had orbital deposits from leukaemia (47%) and six from neuroblastoma (35%). One child had uveal infiltration from acute lymphatic leukaemia. Ophthalmic metastasis were treated by external irradiation and/or combination chemotherapy whenever possible. The mean survival was five months for intraocular metastasis and 15.6 months for the orbital metastasis in adults. Prognosis was very poor in children. PMID:3508830

  11. Ocular aberrations in the peripheral visual field.

    PubMed

    Mathur, Ankit; Atchison, David A; Scott, Dion H

    2008-04-15

    We modified a commercial Hartmann-Shack aberrometer and used it to measure ocular aberrations twice at each of 38 points across the central 42 degrees horizontal x 32 degrees vertical visual fields of five young emmetropic subjects. Some Zernike aberration coefficients show coefficient field distributions that were similar to the field dependence predicted by Seidel theory (astigmatism, oblique astigmatism, horizontal coma, vertical coma), but defocus did not demonstrate such similarity. PMID:18414558

  12. Ocular Myasthenia Gravis Associated With Thymic Amyloidosis.

    PubMed

    Chapman, Kristin O; Beneck, Debra M; Dinkin, Marc J

    2016-03-01

    A 45-year-old woman with ptosis and diplopia was found to have myasthenia gravis (MG) associated with amyloidosis of the thymus gland. Systemic MG is frequently associated with thymomas or thymic hyperplasia but has only once previously been reported in association with amyloidosis of the thymus. This case demonstrates that isolated ocular MG rarely may also be associated with amyloidosis of the thymus. PMID:25822660

  13. Ocular quinine toxicity in a sleepwalker.

    PubMed

    Sinha, Amit; Al Husainy, Sahar

    2013-01-01

    A 55-year-old woman presented to the emergency department following an episode of severe visual impairment, headache, dizziness and confusion. The patient had been taking quinine sulfate as long-term medication for leg cramps. During an episode of sleepwalking, the patient had taken an overdose of quinine sulfate. Following a thorough investigation and assessment, a diagnosis of ocular quinine toxicity was made. We present this case and highlight the risks of quinine prescription. PMID:24287479

  14. Ocular quinine toxicity in a sleepwalker

    PubMed Central

    Sinha, Amit; Al Husainy, Sahar

    2013-01-01

    A 55-year-old woman presented to the emergency department following an episode of severe visual impairment, headache, dizziness and confusion. The patient had been taking quinine sulfate as long-term medication for leg cramps. During an episode of sleepwalking, the patient had taken an overdose of quinine sulfate. Following a thorough investigation and assessment, a diagnosis of ocular quinine toxicity was made. We present this case and highlight the risks of quinine prescription. PMID:24287479

  15. Nanoparticles in the ocular drug delivery

    PubMed Central

    Zhou, Hong-Yan; Hao, Ji-Long; Wang, Shuang; Zheng, Yu; Zhang, Wen-Song

    2013-01-01

    Ocular drug transport barriers pose a challenge for drug delivery comprising the ocular surface epithelium, the tear film and internal barriers of the blood-aqueous and blood-retina barriers. Ocular drug delivery efficiency depends on the barriers and the clearance from the choroidal, conjunctival vessels and lymphatic. Traditional drug administration reduces the clinical efficacy especially for poor water soluble molecules and for the posterior segment of the eye. Nanoparticles (NPs) have been designed to overcome the barriers, increase the drug penetration at the target site and prolong the drug levels by few internals of drug administrations in lower doses without any toxicity compared to the conventional eye drops. With the aid of high specificity and multifunctionality, DNA NPs can be resulted in higher transfection efficiency for gene therapy. NPs could target at cornea, retina and choroid by surficial applications and intravitreal injection. This review is concerned with recent findings and applications of NPs drug delivery systems for the treatment of different eye diseases. PMID:23826539

  16. Tear analysis in ocular surface diseases.

    PubMed

    Zhou, Lei; Beuerman, Roger W

    2012-11-01

    The thin layer of tears covering the ocular surface are a complex body fluid containing thousands of molecules of varied form and function of several origins. In this review, we have discussed some key issues in the analysis of tears in the context of understanding and diagnosing eye disease using current technologies of proteomics and metabolomics, and for their potential for clinical application. In the last several years, advances in proteomics/metabolomics/lipidomics technologies have greatly expanded our knowledge of the chemical composition of tear fluid. The quickened pace of studies has shown that tears as a complex extra-cellular fluid of the ocular surface contains a great deal of molecular information useful for the diagnosis, prognosis, and treatment of ocular surface diseases that has the ability to addresses the emphasis on personalized medicine and biomarkers of disease. Future research directions will likely include (1) standardize tear collection, storage, extraction, and sample preparation; (2) quantitative proteomic analysis of tear proteins using multiple reaction monitoring (MRM)-based mass spectrometry; (3) population based studies of human tear proteomics/metabolomics; (4) tear proteomics/metabolomics for systemic diseases; and (5) functional studies of tear proteins. PMID:22732126

  17. [Ocular surface investigations in dry eye].

    PubMed

    Labb, A; Brignole-Baudouin, F; Baudouin, C

    2007-01-01

    Dry eye is a complex clinicopathological entity involving tear film, lacrimal glands, eyelids, and a wide spectrum of ocular surface cells, including epithelial, inflammatory, immune, and goblet cells. From the tightly regulated lacrimal film functions and structure, a large variety of investigations have been developed, including tear meniscus measurements, fluorophotometry, meibometry, interference pattern analysis, evaporation rate, tear osmolarity, and thermography. Dry eye conditions also interfere with the ocular surface, causing corneal irregularities that may be explored using the techniques of videokeratography and in vivo confocal microscopy, or optical impairment, as confirmed by aberrometry. At the level of ocular surface cells, impression cytology remains a standard for assessing cell alterations. It has greatly benefited from new confocal microscopy, molecular biology, and flow cytometry techniques. Biological assessment of tear proteins or other mediators is also useful. Major limits should be acknowledged, however, such as technical issues in tear film collection, especially in dry eyes, and the lack of standardization of most measurements. Tear osmolarity, electrophoresis, and dosage of normal tear proteins, such as lysozyme or lactoferrin, remain the most useful tests. Finally, some extraocular explorations such as accessory gland biopsy or serum antinuclear antibody dosage may be useful for assessing the diagnosis of Sjgren's syndrome. PMID:17287676

  18. Ocular syphilis: an alarming infectious eye disease

    PubMed Central

    Shen, Jie; Feng, Liguo; Li, Yumin

    2015-01-01

    Background: To describe the clinical manifestations and ancillary examination outcomes of ocular syphilis in Southeast China. Materials and methods: This is a retrospective, nonrandom case study. Demographic information, serum and cerebrospinal fluid (CSF) test results, and findings of fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. Results: The study examined 21 eyes of 13 patients (average age 50.3 ± 5.9 (range 37-61) years). HIV co-infection was found in one patient. The most common manifestation was chorioretinitis (52.4%). Disc hyperfluorescence (66.7%) and persistent dark spots (91.7%) were the most common findings on FFA and ICGA, respectively. The inner segment/outer segment junction (IS/OS) loss was the most frequent manifestation (86.7%). Among the six patients with confirmed neurosyphilis, the average CSF protein level was 528.8 ± 327.1 mg/L. Visual acuity (VA) was improved in 8 of 13 eyes (61.5%) after treatment. Conclusions: The manifestations of ocular syphilis can mimic any eye disease. Chorioretinitis was the most common finding in this case series. “Leopard spots” was the characteristic manifestation on FFA. IS/OS loss was the most common finding in patients with posterior uveitis on SD-OCT. Lumbar puncture can contribute to the diagnosis of neurosyphilis. Treatment for ocular syphilis was effective in these patients. PMID:26221328

  19. Ocular Complications of Leprosy in Yemen

    PubMed Central

    Salem, Raga A. A.

    2012-01-01

    Objectives: This study was conducted to identify the main ocular- and vision-threatening complications of leprosy in Yemen. Methods: This is a cross-sectional observational study which took place from February to July 2010. Leprosy patients attending the Skin and Venereal Diseases Hospital in the City of Light in Taiz, Yemen, who consented to participate in the study, were enrolled. Detailed demographic and medical histories were taken and clinical examination findings were recorded. A detailed eye examination, including visual acuity (VA), slit-lamp, and fundus examinations, was conducted on each patient by a qualified ophthalmologist. Results: A total of 192 patients (180 male, 12 female, with a male to female ratio of 15:1) were included in the study. The majority of the patients (157; 81.8%) were over 40 years. Over two-thirds of the patients (129; 67.2%) had had leprosy for more than 20 years. Ocular complications were found in 97% of cases; 150 (39.1%) of the patients eyes had at least one pathology. Eyelid involvement was the most common problem observed in 102 (26.5%) patients. Half of the eyes (192; 50%) had a VA of <6/60. The main cause of blindness among these patients was corneal opacity detected in 69 out of 192 patients (35.9%). Conclusion: Ocular complications are frequent among leprosy patients in Yemen. They are true vision-threatening lesions. It is important to prevent these lesions through early diagnosis and adequate treatment. PMID:23275842

  20. Ocular Blood Flow and Normal Tension Glaucoma

    PubMed Central

    Fan, Ning; Wang, Pei; Tang, Li; Liu, Xuyang

    2015-01-01

    Normal tension glaucoma (NTG) is known as a multifactorial optic neuropathy characterized by progressive retinal ganglion cell death and glaucomatous visual field loss, even though the intraocular pressure (IOP) does not exceed the normal range. The pathophysiology of NTG remains largely undetermined. It is hypothesized that the abnormal ocular blood flow is involved in the pathogenesis of this disease. A number of evidences suggested that the vascular factors played a significant role in the development of NTG. In recent years, the new imaging techniques, fluorescein angiography, color Doppler imaging (CDI), magnetic resonance imaging (MRI), and laser speckle flowgraphy (LSFG), have been used to evaluate the ocular blood flow and blood vessels, and the impaired vascular autoregulation was found in patients with NTG. Previous studies showed that NTG was associated with a variety of systemic diseases, including migraine, Alzheimer's disease, primary vascular dysregulation, and Flammer syndrome. The vascular factors were involved in these diseases. The mechanisms underlying the abnormal ocular blood flow in NTG are still not clear, but the risk factors for glaucomatous optic neuropathy likely included oxidative stress, vasospasm, and endothelial dysfunction. PMID:26558263

  1. Ocular rhinosporidiosis presenting as recurrent chalazion.

    PubMed

    Mukhopadhyay, Somnath; Shome, Subrata; Bar, Prasenjit Kumar; Chakrabarti, Amit; Mazumdar, Swati; De, Avisek; Sadhukhan, Kaushik; Bala, Bivas

    2015-10-01

    Rhinosporidiosis, a granulomatous disease caused by Rhinosporidium seeberi, is widely prevalent in Sri Lanka and southern parts of India. Besides the eye, the lacrimal passage and nasal cavity are affected. The most common ocular involvement is a subconjunctival bleeding mass. Our case, a 9-year-old girl from a rural background with a history of pond water bathing, presented with a marginal chalazion involving the left lower lid. She had a history of chalazion involving the same site three months earlier which was managed by incision and curettage. A decision of surgical exploration was made and the evacuated mass was examined histologically showing evidence of rhinosporidiosis. This type of clinical presentation for ocular rhinosporidiosis (as recurrent chalazion) has not been reported earlier in the literature. This case emphasises that the clinicians from this part of the world must consider ocular rhinosporidiosis as differential diagnosis in cases with recurrent chalazion especially in a rural background with a habit of pond water bathing. PMID:22986579

  2. Ocular shell structures in some Cretaceous trachyleberid Ostracoda

    USGS Publications Warehouse

    Kontrovitz, M.; Puckett, T.M.

    1998-01-01

    This is the first study of internal ocular shell structures of Cretaceous ostracodes. Internal molds from eight species of four genera from Santonian, Campanian, and Maastrichtian strata revealed a stalked ocular sinus constricted along its length and distally inflated. The latter part has anterior and posterior lobes and a subcentral concavity. These Cretaceous trachyleberids have ocular shell structures similar to Cenozoic taxa and it is presumed they functioned similarly. However, each taxon has a diagnostic ocular sinus and an inner surface of the eye tubercle that distinguishes each from all other forms examined.

  3. Albinism: Particular Attention to the Ocular Motor System

    PubMed Central

    Hertle, Richard W.

    2013-01-01

    The purpose of this report is to summarize an understanding of the ocular motor system in patients with albinism. Other than the association of vertical eccentric gaze null positions and asymmetric, (a) periodic alternating nystagmus in a large percentage of patients, the ocular motor system in human albinism does not contain unique pathology, rather has typical types of infantile ocular oscillations and binocular disorders. Both the ocular motor and afferent visual system are affected to varying degrees in patients with albinism, thus, combined treatment of both systems will maximize visual function. PMID:24014991

  4. Ocular effects following the volcanic eruptions of Mount St Helens.

    PubMed

    Fraunfelder, F T; Kalina, R E; Buist, A S; Bernstein, R S; Johnson, D S

    1983-03-01

    Three hundred thirty-two ophthalmologists examined 1,523 patients with immediate ocular complaints following the 1980 eruptions of Mount St Helens. Loggers working up to 18 months in environments with high concentrations of volcanic ash were compared with a control group of loggers without volcanic ash contact. Although the ash particles acted as ocular foreign bodies, the small particles were apparently well tolerated for the most part, except for acute irritation. Patients with contact lenses or sicca syndrome had the most frequent ocular complaints. To date, no long-term ocular effects have been noted secondary to volcanic ash exposure. PMID:6830486

  5. Plasticity of the human otolith-ocular reflex

    NASA Technical Reports Server (NTRS)

    Wall, C. 3rd; Smith, T. R.; Furman, J. M.

    1992-01-01

    The eye movement response to earth vertical axis rotation in the dark, a semicircular canal stimulus, can be altered by prior exposure to combined visual-vestibular stimuli. Such plasticity of the vestibulo-ocular reflex has not been described for earth horizontal axis rotation, a dynamic otolith stimulus. Twenty normal human subjects underwent one of two types of adaptation paradigms designed either to attenuate or enhance the gain of the semicircular canal-ocular reflex prior to undergoing otolith-ocular reflex testing with horizontal axis rotation. The adaptation paradigm paired a 0.2 Hz sinusoidal rotation about a vertical axis with a 0.2 Hz optokinetic stripe pattern that was deliberately mismatched in peak velocity. Pre- and post-adaptation horizontal axis rotations were at 60 degrees/s in the dark and produced a modulation in the slow component velocity of nystagmus having a frequency of 0.17 Hz due to putative stimulation of the otolith organs. Results showed that the magnitude of this modulation component response was altered in a manner similar to the alteration in semicircular canal-ocular responses. These results suggest that physiologic alteration of the vestibulo-ocular reflex using deliberately mismatched visual and semicircular canal stimuli induces changes in both canal-ocular and otolith-ocular responses. We postulate, therefore, that central nervous system pathways responsible for controlling the gains of canal-ocular and otolith-ocular reflexes are shared.

  6. Sitting at the window to the world--ocular parasites.

    PubMed

    Barisani-Asenbauer, Talin

    2014-10-01

    Parasitic infections cause significant ophthalmic disease, both in developing countries and in the Western world. The parasitic infections Acanthamoeba keratitis, ocular toxoplasmosis, and ocular toxocariasis are responsible for a significant proportion of ocular pathology. Especially in light of the recent increase of immunocompromised (i.e. using immunosuppressants or HIV) and aged populations, parasitic infections of the eye are rising in number. This reviews aims to describe the pathogenesis, symptoms, diagnosis and management of infection, as well as preventative measures for these three parasitic ocular diseases. PMID:25358598

  7. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study

    PubMed Central

    Van Hoorde, Kirsten; Valentin, Lil; Testa, Antonia C; Fischerova, Daniela; Van Holsbeke, Caroline; Savelli, Luca; Franchi, Dorella; Epstein, Elisabeth; Kaijser, Jeroen; Van Belle, Vanya; Czekierdowski, Artur; Guerriero, Stefano; Fruscio, Robert; Lanzani, Chiara; Scala, Felice; Bourne, Tom; Timmerman, Dirk

    2014-01-01

    Objectives To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic ovarian tumours. Design Observational diagnostic study using prospectively collected clinical and ultrasound data. Setting 24 ultrasound centres in 10 countries. Participants Women with an ovarian (including para-ovarian and tubal) mass and who underwent a standardised ultrasound examination before surgery. The model was developed on 3506 patients recruited between 1999 and 2007, temporally validated on 2403 patients recruited between 2009 and 2012, and then updated on all 5909 patients. Main outcome measures Histological classification and surgical staging of the mass. Results The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and malignant tumours was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I cancer, 0.99 for benign versus stage II-IV cancer, and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I cancer and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. Conclusions The ADNEX model discriminates well between benign and malignant tumours and offers fair to excellent discrimination between four types of ovarian malignancy. The use of ADNEX has the potential to improve triage and management decisions and so reduce morbidity and mortality associated with adnexal pathology. PMID:25320247

  8. Intravitreous injection for establishing ocular diseases model.

    PubMed

    Chiu, Kin; Chang, Raymond Chuen-Chung; So, Kwok-Fai

    2007-01-01

    Intravitreous injection is a widely used technique in visual sciences research. It can be used to establish animal models with ocular diseases or as direct application of local treatment. This video introduces how to use simple and inexpensive tools to finish the intravitreous injection procedure. Use of a 1 ml syringe, instead of a Hamilton syringe, is used. Practical tips for how to make appropriate injection needles using glass pipettes with perfect tips, and how to easily connect the syringe needle with the glass pipette tightly together, are given. To conduct a good intravitreous injection, there are three aspects to be observed: 1) injection site should not disrupt retina structure; 2) bleeding should be avoided to reduce the risk of infection; 3) lens should be untouched to avoid traumatic cataract. In brief, the most important point is to reduce the interruption of normal ocular structure. To avoid interruption of retina, the superior nasal region of rat eye was chosen. Also, the puncture point of the needle was at the par planar, which was about 1.5 mm from the limbal region of the rat eye. A small amount of vitreous is gently pushed out through the puncture hole to reduce the intraocular pressure before injection. With the 45 degrees injection angle, it is less likely to cause traumatic cataract in the rat eye, thus avoiding related complications and influence from lenticular factors. In this operation, there was no cutting of the conjunctiva and ocular muscle, no bleeding. With quick and minor injury, a successful intravitreous injection can be done in minutes. The injection set outlined in this particular protocol is specific for intravitreous injection. However, the methods and materials presented here can also be used for other injection procedures in drug delivery to the brain, spinal cord or other organs in small mammals. PMID:18989417

  9. Chitosan based nanocarriers for indomethacin ocular delivery.

    PubMed

    Badawi, Alia A; El-Laithy, Hanan M; El Qidra, Riad K; El Mofty, Hala; El dally, Mohamed

    2008-08-01

    Two different chitosan (CS) nanocarriers namely nanoparticles and nanoemulsion were developed to prolong Indomethacin (IM) precorneal residence time and to improve its ocular bioavailability the main limitations in its management of post-operative inflammation and intraocular irritation after cataract extraction. CS-nanoparticles were developed by modified ionic gelation of CS with tripolyphosphate while nanoemulsion was prepared by spontaneous emulsification technique. Transmission electron microscopy revealed regular well-identified spherical shape. The nanoparticles had a mean size of 280 nm, a zeta potential of + 17 mV and high loading efficiency of 84.8 % while the mean size of nanoemulsion was affected by the nature of the surfactant used and varies between 220-690 nm. In vitro release studies, performed under sink conditions, revealed small initial burst release during the first hour followed by slow gradual drug release of 76 and 86% from nanoparticles and nanoemulsion respectively during a 24 h period. In vivo studies and histopathological examination revealed that eyes of rabbits treated with nanoemulsion showed clearer healing of corneal chemical ulcer with moderate effective inhibition of polymorph nuclear leukocytic infiltration (PMNLs) compared with nanoparticles preparation. Moreover, following topical instillation of CS-nanoemulsion to rabbits, it was possible to achieve therapeutic concentration of IM in the cornea through out the duration of the study and fairly high IM level in inner ocular structure, aqueous humor. These levels were significantly higher than those obtained following instillation of IM solution. Therefore, CS nanocarriers developed in this study were able to contact intimately with the cornea providing slow gradual IM release with long-term drug level thereby increasing delivery to both external and internal ocular tissues. PMID:18787795

  10. Endothelial TWIST1 Promotes Pathological Ocular Angiogenesis

    PubMed Central

    Li, Jie; Liu, Chi-Hsiu; Sun, Ye; Gong, Yan; Fu, Zhongjie; Evans, Lucy P.; Tian, Katherine T.; Juan, Aimee M.; Hurst, Christian G.; Mammoto, Akiko; Chen, Jing

    2014-01-01

    Purpose. Pathological neovessel formation impacts many blinding vascular eye diseases. Identification of molecular signatures distinguishing pathological neovascularization from normal quiescent vessels is critical for developing new interventions. Twist-related protein 1 (TWIST1) is a transcription factor important in tumor and pulmonary angiogenesis. This study investigated the potential role of TWIST1 in modulating pathological ocular angiogenesis in mice. Methods. Twist1 expression and localization were analyzed in a mouse model of oxygen-induced retinopathy (OIR). Pathological ocular angiogenesis in Tie2-driven conditional Twist1 knockout mice were evaluated in both OIR and laser-induced choroidal neovascularization models. In addition, the effects of TWIST1 on angiogenesis and endothelial cell function were analyzed in sprouting assays of aortic rings and choroidal explants isolated from Twist1 knockout mice, and in human retinal microvascular endothelial cells treated with TWIST1 small interfering RNA (siRNA). Results. TWIST1 is highly enriched in pathological neovessels in OIR retinas. Conditional Tie2-driven depletion of Twist1 significantly suppressed pathological neovessels in OIR without impacting developmental retinal angiogenesis. In a laser-induced choroidal neovascularization model, Twist1 deficiency also resulted in significantly smaller lesions with decreased vascular leakage. In addition, loss of Twist1 significantly decreased vascular sprouting in both aortic ring and choroid explants. Knockdown of TWIST1 in endothelial cells led to dampened expression of vascular endothelial growth factor receptor 2 (VEGFR2) and decreased endothelial cell proliferation. Conclusions. Our study suggests that TWIST1 is a novel regulator of pathologic ocular angiogenesis and may represent a new molecular target for developing potential therapeutic treatments to suppress pathological neovascularization in vascular eye diseases. PMID:25414194

  11. Silk film biomaterials for ocular surface repair

    NASA Astrophysics Data System (ADS)

    Lawrence, Brian David

    Current biomaterial approaches for repairing the cornea's ocular surface upon injury are partially effective due to inherent material limitations. As a result there is a need to expand the biomaterial options available for use in the eye, which in turn will help to expand new clinical innovations and technology development. The studies illustrated here are a collection of work to further characterize silk film biomaterials for use on the ocular surface. Silk films were produced from regenerated fibroin protein solution derived from the Bombyx mori silkworm cocoon. Methods of silk film processing and production were developed to produce consistent biomaterials for in vitro and in vivo evaluation. A wide range of experiments was undertaken that spanned from in vitro silk film material characterization to in vivo evaluation. It was found that a variety of silk film properties could be controlled through a water-annealing process. Silk films were then generated that could be use in vitro to produce stratified corneal epithelial cell sheets comparable to tissue grown on the clinical standard substrate of amniotic membrane. This understanding was translated to produce a silk film design that enhanced corneal healing in vivo on a rabbit injury model. Further work produced silk films with varying surface topographies that were used as a simplified analog to the corneal basement membrane surface in vitro. These studies demonstrated that silk film surface topography is capable of directing corneal epithelial cell attachment, growth, and migration response. Most notably epithelial tissue development was controllably directed by the presence of the silk surface topography through increasing cell sheet migration efficiency at the individual cellular level. Taken together, the presented findings represent a comprehensive characterization of silk film biomaterials for use in ocular surface reconstruction, and indicate their utility as a potential material choice in the development of innovative procedures and technologies for corneal repair.

  12. [Characteristics of ocular detachment after refractive surgery].

    PubMed

    Crstocea, B; Cerebulescu, Beatrice; Buliga, Simona; Po?taliu, Diana; Crstocea, Ana; Calin, Leti?ia; Dragomir, Adriana

    2008-01-01

    The myopic eye subject to refractive surgery maintains a high risk of retinal detachment (RD). We present the difficulties of endo-ocular surgery on patients with previous radial keratotomy as well as the particular aspects of RD in patient with LASIK. RD in lens refractive surgery eyes is not essentially different from RD on pseudophakic eyes. ReStore pseudophakic lenses rise particular problems following vitreo-retinal surgery (retinal laser photocoagulation, lens des-centering duet of vitreal architecture changes). PMID:19354176

  13. [Ocular relapse of acute lymphoblastic leukemia].

    PubMed

    Charif, Chefchaouni M; Loughzail, K; Benkirane, N; Berraho, A

    2002-01-01

    A bilateral leukemic hypopyon can be inaugural in the child's leukemia or reveal a relapse. A five years old child with acute lymphoblastic leukemia presented after 30 months of treatment a bilateral hypopyon. Anterior chamber paracentesis with cytological survey revealed leukemic cells and confirmed the ocular relapse. The treatment included the association of topical corticosteroids, chemotherapy and radiotherapy. This child died unfortunately 16 months later following a medullar relapse. We remind the different clinical aspects of leukemic invasion of the anterior segment and the therapeutic methods for this relapse. PMID:12564314

  14. Retinal sequelae of primary ocular blast injuries.

    PubMed

    Chalioulias, K; Sim, K T; Scott, R

    2007-06-01

    Primary ocular blast injury is an uncommon and disputed phenomenon. As personal ballistic protection of the head and torso improves for soldiers, increasing numbers of injuries to the unprotected areas such as the face and eyes may be expected; similarly the increase in the use of improvised explosive devices by insurgent terrorists in Iraq is increasing the number of primary blast injuries being seen by the Defence Medical Services. We report a rare case of primary blast injury to the eye and briefly discuss the literature on the subject. PMID:17896543

  15. Ocular cells and light: harmony or conflict?

    PubMed

    Jurja, Sanda; Hncu, Mihaela; Dobrescu, Mihaela Amelia; Golu, Andreea Elena; B?l??oiu, Andrei Theodor; Coman, M?lina

    2014-01-01

    Vision is based on the sensitivity of the eye to visible rays of the solar spectrum, which allows the recording and transfer of visual information by photoelectric reaction. Any electromagnetic radiation, if sufficiently intense, may cause damages in living tissues. In a changing environment, the aim of this paper is to point out the impact of light radiation on ocular cells, with its phototoxicity potential on eye tissues. In fact, faced with light and oxygen, the eye behaves like an ephemeral aggregate of unstable molecules, like a temporary crystallization threatened with entropia. PMID:24969972

  16. Fabrication of a Custom Ocular Prosthesis

    PubMed Central

    Sethi, Tania; Kheur, Mohit; Haylock, Colin; Harianawala, Husain

    2014-01-01

    Defects of the eye may follow removal of a part of or the entire orbit. This results in the patient becoming visually, esthetically and psychologically handicapped. Restoring the defect with a silicone- or acrylic-based prosthesis not only restores esthetics but also gives back the lost confidence to the patient. This is a case report of a patient with a pthisical eye and details the steps in fabrication of an ocular prosthesis. Particular attention has been given to the laboratory process in this technique to minimize the residual monomer content in the artificial eye. PMID:25100916

  17. Penetrating ocular trauma associated with blank cartridge

    PubMed Central

    2014-01-01

    Background Blank cartridge guns are generally regarded as being harmless and relative safe. However recent published articles demonstrated that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall, abdominal muscle, small intestine and the skull. And there has been a limited number of case reports of ocular trauma associated with blank cartridge injury. In addition, no report on case with split extraocular muscle injury with traumatic cataract and penetrating corneoscleral wound associated with blank cartridge has been previously documented. This report describes the case of patient who sustained penetrating ocular injury with extraocular muscle injury by a close-distance blank cartridge that required surgical intervention. Case presentation A 20-year-old man sustained a penetrating globe injury in the right eye while cleaning a blank cartridge pistol. His uncorrected visual acuity at presentation was hand motion and he had a flame burn of his right upper and lower lid with multiple missile wounds. On slit-lamp examination, there was a 12-mm laceration of conjunctiva along the 9 o'clock position with two pinhole-like penetrating injuries of cornea and sclera. There was also a 3-mm corneal laceration between 9 o'clock and 12 o'clock and the exposed lateral rectus muscle was split. Severe Descemet's membrane folding with stromal edema was observed, and numerous yellow, powder-like foreign bodies were impacted in the cornea. Layered anterior chamber bleeding with traumatic cataract was also noted. Transverse view of ultrasonography showed hyperechoic foreign bodies with mild reduplication echoes and shadowing. However, a computed tomographic scan using thin section did not reveal a radiopaque foreign body within the right globe. Conclusion To our best knowledge, this is the first case report of split extraocular muscle injury with traumatic cataract and penetrating ocular injury caused by blank cartridge injury. Intraocular foreign bodies undetectable by CT were identified by B-scan ultrasonography in our patient. This case highlights the importance of additional ultrasonography when evaluating severe ocular trauma. And ophthalmologists should consider the possibility of penetrating injury caused by blank ammunition. PMID:24589340

  18. Review: Epigenetic mechanisms in ocular disease

    PubMed Central

    He, Shikun; Li, Xiaohua; Chan, Nymph

    2013-01-01

    Epigenetics has become an increasingly important area of biomedical research. Increasing evidence shows that epigenetic alterations influence common pathologic responses including inflammation, ischemia, neoplasia, aging, and neurodegeneration. Importantly, epigenetic mechanisms may have a pathogenic role in many complex eye diseases such as corneal dystrophy, cataract, glaucoma, diabetic retinopathy, ocular neoplasia, uveitis, and age-related macular degeneration. The emerging emphasis on epigenetic mechanisms in studies of eye disease may provide new insights into the pathogenesis of complex eye diseases and aid in the development of novel treatments for these diseases.? PMID:23559860

  19. Experimental Models of Ocular Infection with Toxoplasma Gondii

    PubMed Central

    Dukaczewska, Agata; Tedesco, Roberto; Liesenfeld, Oliver

    2015-01-01

    Ocular toxoplasmosis is a vision-threatening disease and the major cause of posterior uveitis worldwide. In spite of the continuing global burden of ocular toxoplasmosis, many critical aspects of disease including the therapeutic approach to ocular toxoplasmosis are still under debate. To assist in addressing many aspects of the disease, numerous experimental models of ocular toxoplasmosis have been established. In this article, we present an overview on in vitro, ex vivo, and in vivo models of ocular toxoplasmosis available to date. Experimental studies on ocular toxoplasmosis have recently focused on mice. However, the majority of murine models established so far are based on intraperitoneal and intraocular infection with Toxoplasma gondii. We therefore also present results obtained in an in vivo model using peroral infection of C57BL/6 and NMRI mice that reflects the natural route of infection and mimics the disease course in humans. While advances have been made in ex vivo model systems or larger animals to investigate specific aspects of ocular toxoplasmosis, laboratory mice continue to be the experimental model of choice for the investigation of ocular toxoplasmosis. PMID:26716018

  20. Foveomacular retinitis as a result of ocular contusion.

    PubMed

    Abebe, M T; De Laey, J J

    1992-01-01

    Foveomacular retinitis is typically associated with eclipse burns. However a macular hole similar to that seen in cases of solar retinopathy, may be observed after ocular contusion or after whiplash injury. The case histories of 3 men, who sustained an ocular contusion and subsequently developed as aspect typical for foveomacular retinopathy, are described. PMID:1302149

  1. Ocular Toxicity of Benzalkonium Chloride Homologs Compared with Their Mixtures

    PubMed Central

    Okahara, Akihiko; Tanioka, Hidetoshi; Takada, Koichi; Kawazu, Kouichi

    2013-01-01

    This study was performed to assess the in vivo ocular toxicity of benzalkonium chloride (BAK) homologs compared with commercially available BAK (BAK mixture) and to assess the ocular toxicity of BAK homolog after repeated ocular application. Rabbit eyes were examined by ophthalmology and scanning electron microscopy (SEM) after 10 applications of BAK homologs with C12 (C12-BAK) and C14 (C14-BAK) alkyl chain lengths and a BAK mixture at concentrations of 0.001% (w/v), 0.003% (w/v), 0.005% (w/v), 0.01% (w/v) and 0.03% (w/v). The ocular toxicity of C12-BAK to rabbit eyes was examined by ophthalmology and histopathology after repeated ocular application for 39 weeks. In addition, the antimicrobial activities of C12-BAK and C14-BAK against A. niger, S. aureus and P. aeruginosa were assessed. Ocular toxicity of C12-BAK was less than those of the BAK mixture and C14-BAK. No ocular toxicity was noted after ocular application of 0.01% C12-BAK to rabbits for 39 weeks. C12-BAK showed antimicrobial activities at a concentration of 0.003%. These results suggest that the use of C12-BAK to replace BAK mixture as a preservative in ophthalmic solutions should be considered in order to reduce the incidence of the corneal epithelial cell injury induced clinically by BAK. PMID:24526806

  2. Microemulsion: New Insights into the Ocular Drug Delivery

    PubMed Central

    Hegde, Rahul Rama; Verma, Anurag; Ghosh, Amitava

    2013-01-01

    Delivery of drugs into eyes using conventional drug delivery systems, such as solutions, is a considerable challenge to the treatment of ocular diseases. Drug loss from the ocular surface by lachrymal fluid secretion, lachrymal fluid-eye barriers, and blood-ocular barriers are main obstacles. A number of ophthalmic drug delivery carriers have been made to improve the bioavailability and to prolong the residence time of drugs applied topically onto the eye. The potential use of microemulsions as an ocular drug delivery carrier offers several favorable pharmaceutical and biopharmaceutical properties such as their excellent thermodynamic stability, phase transition to liquid-crystal state, very low surface tension, and small droplet size, which may result in improved ocular drug retention, extended duration of action, high ocular absorption, and permeation of loaded drugs. Further, both lipophilic and hydrophilic characteristics are present in microemulsions, so that the loaded drugs can diffuse passively as well get significantly partitioned in the variable lipophilic-hydrophilic corneal barrier. This review will provide an insight into previous studies on microemulsions for ocular delivery of drugs using various nonionic surfactants, cosurfactants, and associated irritation potential on the ocular surface. The reported in vivo experiments have shown a delayed effect of drug incorporated in microemulsion and an increase in the corneal permeation of the drug. PMID:23936681

  3. Experimental Models of Ocular Infection with Toxoplasma Gondii.

    PubMed

    Dukaczewska, Agata; Tedesco, Roberto; Liesenfeld, Oliver

    2015-12-01

    Ocular toxoplasmosis is a vision-threatening disease and the major cause of posterior uveitis worldwide. In spite of the continuing global burden of ocular toxoplasmosis, many critical aspects of disease including the therapeutic approach to ocular toxoplasmosis are still under debate. To assist in addressing many aspects of the disease, numerous experimental models of ocular toxoplasmosis have been established. In this article, we present an overview on in vitro, ex vivo, and in vivo models of ocular toxoplasmosis available to date. Experimental studies on ocular toxoplasmosis have recently focused on mice. However, the majority of murine models established so far are based on intraperitoneal and intraocular infection with Toxoplasma gondii. We therefore also present results obtained in an in vivo model using peroral infection of C57BL/6 and NMRI mice that reflects the natural route of infection and mimics the disease course in humans. While advances have been made in ex vivo model systems or larger animals to investigate specific aspects of ocular toxoplasmosis, laboratory mice continue to be the experimental model of choice for the investigation of ocular toxoplasmosis. PMID:26716018

  4. Ocular toxoplasmosis in the United States: recent and remote infections.

    PubMed

    Jones, Jeffrey L; Bonetti, Valerie; Holland, Gary N; Press, Cindy; Sanislo, Steven R; Khurana, Rahul N; Montoya, Jose G

    2015-01-15

    We tested all samples from patients with ocular toxoplasmosis sent to the Palo Alto Medical Foundation Toxoplasma Reference Laboratory from June 2004 through August 2010 for serologic evidence of recent Toxoplasma gondii infection. Of 205 patients aged 10-96 years, 11.7% had recent infection. Many people develop ocular disease soon after T. gondii infection. PMID:25301214

  5. Lipid-Based Therapy for Ocular Surface Inflammation and Disease.

    PubMed

    Lim, Agnes; Wenk, Markus R; Tong, Louis

    2015-12-01

    Ocular surface diseases such as dry eye, allergic keratoconjunctivitis, and infection are very prevalent conditions and involve ocular surface stress and inflammation. Recently, various lipid-based therapies have been advocated for the modulation of ocular surface inflammation. Here we review the latest developments and challenges of these strategies. These include administration of essential fatty acids, cyclooxygenase (COX) inhibitors and resolvin analogs. Lipids form part of the tear film and are crucial for tear film stability; loss of tear film stability can aggravate ocular surface inflammation. Strategies to replenish tear film lipids - namely, eyelid warming and eye drops containing natural or synthetic lipids - are evaluated. Recent advances in the use of lipids as ocular drug delivery vehicles, antioxidants, and diagnostic markers are discussed. PMID:26596867

  6. Zeaxanthin and ocular health, from bench to bedside.

    PubMed

    Manikandan, Ramar; Thiagarajan, Raman; Goutham, Ganesh; Arumugam, Munusamy; Beulaja, Manikandan; Rastrelli, Luca; Skalicka-Wo?niak, Krystyna; Habtemariam, Solomon; Orhan, Ilkay Erdogan; Nabavi, Seyed Fazel; Nabavi, Seyed Mohammad

    2016-03-01

    Cataracts, glaucoma, and age-related macular degeneration are known as major ocular problems which cause blindness among the elderly population worldwide. Oxidative stress plays an important role in both the initiation and progression of ocular problems and with respect to this; dietary antioxidants can serve as a therapeutic strategy for the improvement of ocular health. Zeaxanthin is known as one of the most important and common xanthophyll carotenoids, possessing multiple therapeutic effects such as strong antioxidant and pro-oxidant behaviour as well as anti-inflammatory effects. A growing body of literature shows that zeaxanthin mitigates ocular problems and suppresses oxidative stress in the retinal tissues. This paper aims to critically review the available literature regarding the beneficial effects of zeaxanthin on ocular problems with emphasis on its chemistry, bioavailability, and sources. PMID:26705841

  7. Erratum: Psychoneuroimmunology: application to ocular diseases.

    PubMed

    Ventura, Lori M

    2009-09-01

    Psychoneuroimmunology (PNI) is a relatively new discipline within the field of neuroscience which researches the relationship between emotional states, the central and peripheral nervous systems, and the endocrine and immune systems. Negative psychological states, such as stress, anxiety, and depression, may alter immune system regulation and modulation of peripheral cytokines. A plethora of PNI studies have shown that increased psychological stress and depression are associated with an alteration of immune functioning and worsened health outcomes for many conditions. To date, application of PNI methodology has not been reported for ocular diseases. This article provides an historical perspective on the origins of the rift between the emotional and spiritual from physical aspects of disease. A review of how stress is mediated through sympathetic adrenomedullary and hypothalamic pituitary axis activation with shifts in immunity is provided. The literature which supports spirituality in healing is presented. Finally, ocular diseases which would be most amenable to a PNI approach are discussed.[This corrects the article on p. in vol. .]. PMID:20046843

  8. Ocular toxoplasmosis in immunosuppressed nonhuman primates

    SciTech Connect

    Holland, G.N.; O'Connor, G.R.; Diaz, R.F.; Minasi, P.; Wara, W.M.

    1988-06-01

    To investigate the role of cellular immunodeficiency in recurrent toxoplasmic retinochoroiditis, six Cynomolgus monkeys (Macaca fascicularis) with healed toxoplasmic lesions of the retina were immunosuppressed by total lymphoid irradiation. Three months prior to irradiation 30,000 Toxoplasma gondii organisms of the Beverley strain had been inoculated onto the macula of eye in each monkey via a pars plana approach. Toxoplasmic retinochoroiditis developed in each animal, and lesions were allowed to heal without treatment. During total lymphoid irradiation animals received 2000 centigrays (cGy) over a 7-week period. Irradiation resulted in an immediate drop in total lymphocyte counts and decreased ability to stimulate lymphocytes by phytohemagglutinin. Weekly ophthalmoscopic examinations following irradiation failed to show evidence of recurrent ocular disease despite persistent immunodeficiency. Four months after irradiation live organisms were reinoculated onto the nasal retina of the same eye in each animal. Retinochoroidal lesions identical to those seen in primary disease developed in five of six animals. Toxoplasma organisms therefore were able to proliferate in ocular tissue following the administration of immunosuppressive therapy. This study fails to support the hypothesis that cellular immunodeficiency alone will initiate recurrent toxoplasmic retinochoroiditis. Results suggest that reactivation of disease from encysted organisms involves factors other than suppression of Toxoplasma proliferation. If reactivation occurs by other mechanisms, however, cellular immunodeficiency then may allow development of extensive disease.

  9. Fluid Transport Phenomena in Ocular Epithelia

    PubMed Central

    Candia, Oscar A.; Alvarez, Lawrence J.

    2008-01-01

    This article discusses three largely unrecognized aspects related to fluid movement in ocular tissues; namely, a) the dynamic changes in water permeability observed in corneal and conjunctival epithelia under anisotonic conditions; b) the indications that the fluid transport rate exhibited by the ciliary epithelium is insufficient to explain aqueous humor production; and c) the evidence for fluid movement into and out of the lens during accommodation. We have studied each of these subjects in recent years and present an evaluation of our data within the context of the results of others who have also worked on electrolyte and fluid transport in ocular tissues. We propose that 1) the corneal and conjunctival epithelia, with apical aspects naturally exposed to variable tonicities, are capable of regulating their water permeabilities as part of the cell-volume regulatory process, 2) fluid may directly enter the anterior chamber of the eye across the anterior surface of the iris, thereby representing an additional entry pathway for aqueous humor production, and 3) changes in lens volume occur during accommodation, and such changes are best explained by a net influx and efflux of fluid. PMID:18289913

  10. Ocular Metastatic Renal Carcinoma Presenting With Proptosis.

    PubMed

    Rai, Ruju; Jakobiec, Frederick A; Fay, Aaron

    2015-01-01

    Metastatic renal carcinoma is the third most common source of ocular and second most common source of orbital metastases. This is the first published case of von Hippel-Lindau (vHL) disease that developed renal cell carcinoma metastatic to an eye with a retinal hemangioblastoma. A 73-year-old woman had a history of vHL disease that included prior retinal hemangioblastomas, 2 cerebellar hemangioblastomas, and bilateral renal cell carcinomas with sacral metastasis. After presenting with progressive, painful proptosis secondary to a large mass observable by ocular CT, an enucleation-orbitotomy was performed, and the surgical specimen was sent for histopathological analysis. The ophthalmic renal metastatic tumor, like the primary tumor, was a clear cell variant that involved both the eyeball and orbit in continuity. The intraocular component was larger than the extraocular portion, which was interpreted as an outward extension of an initial retinal metastasis that probably first settled within a hemangioblastoma. Clusters of ectatic ghost vessels with thickened walls produced by periodic acid Schiff-positive, redundant basement membrane material were partially infiltrated by tumor cells at their periphery, thereby lending some support for this hypothesis. Immunohistochemical positivity for the biomarkers cytokeratin 18, vimentin, carbonic anhydrase IX, PAX2, and PAX 8 confirmed the diagnosis. The patient has refused further treatment. Her anophthalmic socket has comfortably retained a porous polyethylene implant without clinical evidence of local recurrence during 5 months of follow up. PMID:24828963

  11. Lipid Nanoparticles for Ocular Gene Delivery

    PubMed Central

    Wang, Yuhong; Rajala, Ammaji; Rajala, Raju V. S.

    2015-01-01

    Lipids contain hydrocarbons and are the building blocks of cells. Lipids can naturally form themselves into nano-films and nano-structures, micelles, reverse micelles, and liposomes. Micelles or reverse micelles are monolayer structures, whereas liposomes are bilayer structures. Liposomes have been recognized as carriers for drug delivery. Solid lipid nanoparticles and lipoplex (liposome-polycation-DNA complex), also called lipid nanoparticles, are currently used to deliver drugs and genes to ocular tissues. A solid lipid nanoparticle (SLN) is typically spherical, and possesses a solid lipid core matrix that can solubilize lipophilic molecules. The lipid nanoparticle, called the liposome protamine/DNA lipoplex (LPD), is electrostatically assembled from cationic liposomes and an anionic protamine-DNA complex. The LPD nanoparticles contain a highly condensed DNA core surrounded by lipid bilayers. SLNs are extensively used to deliver drugs to the cornea. LPD nanoparticles are used to target the retina. Age-related macular degeneration, retinitis pigmentosa, and diabetic retinopathy are the most common retinal diseases in humans. There have also been promising results achieved recently with LPD nanoparticles to deliver functional genes and micro RNA to treat retinal diseases. Here, we review recent advances in ocular drug and gene delivery employing lipid nanoparticles. PMID:26062170

  12. Consumer product-related ocular trauma.

    PubMed Central

    Sastry, S. M.; Copeland, R. A.; Mezghebe, H. M.; Siram, S. M.; Spencer, M.; Cowan, C. L.

    1995-01-01

    Leading causes of consumer product-related ocular trauma have not been well described. To delineate these causes in a nationally representative sample, data collected by the US Consumer Product Safety Commission (USCPSC) were reviewed. Data were obtained from the National Electronic Injury Surveillance System (NEISS), a national probability sample survey conducted by USCPSC that continuously monitors consumer product-related injuries treated in hospital emergency rooms across the United States. These data formulated the product summary report for the calendar year 1991. The sampling frame for the NEISS consisted of hospitals listed on the Center for Health Statistics Master Inventory File stratified geographically by size of hospital and number of emergency-room visits. During the calendar year 1991, there were a nationally estimated 298,852 consumer product-related eye injuries treated in hospital emergency rooms. Appoximately 500 different products were implicated in these injuries, with the leading cause being contact lenses (hard and soft), accounting for an estimated 26,490 emergency-room visits. This is followed by welding equipment (12,771 visits), hair curlers/curling irons (5946 visits), and workshop power grinders (5476 visits). Consumer products account for a sizable number of ocular injuries requiring treatment in hospital emergency rooms. Research on outcomes and prevention strategies of the injuries is warranted. PMID:7783242

  13. Interleukin-6 blockade in ocular inflammatory diseases

    PubMed Central

    Mesquida, M; Leszczynska, A; Lloren, V; Adn, A

    2014-01-01

    Interleukin-6 (IL-6) is a key cytokine featuring redundancy and pleiotropic activity. It plays a central role in host defence against environmental stress such as infection and injury. Dysregulated, persistent interleukin (IL)-6 production has been implicated in the development of various autoimmune, chronic inflammatory diseases and even cancers. Significant elevation of IL-6 has been found in ocular fluids derived from refractory/chronic uveitis patients. In experimental autoimmune uveitis models with IL-6 knock-out mice, IL-6 has shown to be essential for inducing inflammation. IL-6 blockade can suppress acute T helper type 17 (Th17) responses via its differentiation and, importantly, can ameliorate chronic inflammation. Tocilizumab, a recombinant humanized anti-IL-6 receptor antibody, has been shown to be effective in several autoimmune diseases, including uveitis. Herein, we discuss the basic biology of IL-6 and its role in development of autoimmune conditions, focusing particularly on non-infectious uveitis. It also provides an overview of efficacy and safety of tocilizumab therapy for ocular inflammatory diseases. PMID:24528300

  14. Ocular side effects of accutane therapy.

    TOXLINE Toxicology Bibliographic Information

    Lerman S

    1992-01-01

    The recent interest in treating acne with one of the retinoid drugs has been accompanied by a wide variety of ocular side effects involving the eyelids, cornea, lens, optic nerve and retina. In one group of patients being evaluated for possible efficacy of a retinoic acid analogue in treating psoriasis, several patients complained of difficulty driving at night due to decreased dark adaptation which we were able to document. Fortunately, most of the above side effects tend to disappear within months after the drug is discontinued. However, we have recently seen two cases of dry eye syndrome associated with Accutane therapy that have persisted for more than two years. In addition, scattered reports have appeared regarding cataracts in young patients (teens to early 40's) which developed during, and/or after Accutane treatment. We have examined lens matter derived from two such patients who had extracapsular cataract extractions. Their lens proteins showed an elevation in UV absorptivity (between 330-390 nm) compared with matched control material (derived from Eye Bank specimens) and HPLC analyses demonstrated an abnormal peak in their profiles which was similar to one present in control samples incubated with retinoic acid and was not present in lens protein samples derived from cataracts not associated with Accutance therapy. These observations demonstrate that some of the Accutane induced ocular side affects are not reversible when the drug is stopped, and patients on such therapy should be carefully monitored.

  15. Ocular Involvement in Systemic Autoimmune Diseases.

    PubMed

    Generali, Elena; Cantarini, Luca; Selmi, Carlo

    2015-12-01

    Eye involvement represents a common finding in patients with systemic autoimmune diseases, particularly rheumatoid arthritis, Sjogren syndrome, seronegative spondyloarthropathy, and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The eye is a privileged immune site but commensal bacteria are found on the ocular surface. The eye injury may be inflammatory, vascular or infectious, as well as iatrogenic, as in the case of hydroxychloroquine, chloroquine, corticosteroids, and bisphosphonates. Manifestations may affect different components of the eye, with episcleritis involving the episclera, a thin layer of tissue covering the sclera; scleritis being an inflammation of the sclera potentially leading to blindness; keratitis, referring to corneal inflammation frequently associated with scleritis; and uveitis as the inflammation of the uvea, including the iris, ciliary body, and choroid, subdivided into anterior, posterior, or panuveitis. As blindness may result from the eye involvement, clinicians should be aware of the possible manifestations and their management also independent of the ophthalmologist opinion as the therapeutic approach generally points to the underlying diseases. In some cases, the eye involvement may have a diagnostic implication, as for episcleritis in rheumatoid arthritis, or acute anterior uveitis in seronegative spondyloarthritis. Nonetheless, some conditions lack specificity, as in the case of dry eye which affects nearly 30 % of the general population. The aim of this review is to elucidate to non-ophthalmologists the major ocular complications of rheumatic diseases and their specific management and treatment options. PMID:26494481

  16. Numerical Modeling of Ocular Dysfunction in Space

    NASA Technical Reports Server (NTRS)

    Nelson, Emily S.; Mulugeta, Lealem; Vera, J.; Myers, J. G.; Raykin, J.; Feola, A. J.; Gleason, R.; Samuels, B.; Ethier, C. R.

    2014-01-01

    Upon introduction to microgravity, the near-loss of hydrostatic pressure causes a marked cephalic (headward) shift of fluid in an astronaut's body. The fluid shift, along with other factors of spaceflight, induces a cascade of interdependent physiological responses which occur at varying time scales. Long-duration missions carry an increased risk for the development of the Visual Impairment and Intracranial Pressure (VIIP) syndrome, a spectrum of ophthalmic changes including posterior globe flattening, choroidal folds, distension of the optic nerve sheath, kinking of the optic nerve and potentially permanent degradation of visual function. In the cases of VIIP found to date, the initial onset of symptoms occurred after several weeks to several months of spaceflight, by which time the gross bodily fluid distribution is well established. We are developing a suite of numerical models to simulate the effects of fluid shift on the cardiovascular, central nervous and ocular systems. These models calculate the modified mean volumes, flow rates and pressures that are characteristic of the altered quasi-homeostatic state in microgravity, including intracranial and intraocular pressures. The results of the lumped models provide initial and boundary data to a 3D finite element biomechanics simulation of the globe, optic nerve head and retrobulbar subarachnoid space. The integrated set of models will be used to investigate the evolution of the biomechanical stress state in the ocular tissues due to long-term exposure to microgravity.

  17. Ocular changes induced by drugs commonly used in dermatology.

    PubMed

    Turno-Kręcicka, Anna; Grzybowski, Andrzej; Misiuk-Hojło, Marta; Patryn, Eliza; Czajor, Karolina; Nita, Małgorzata

    2016-01-01

    The use of many drugs in dermatologic diseases may cause ocular side effects. Some may regress after discontinuation of the therapy, but others persist or progress even after the cessation of treatment. This review presents four groups of commonly prescribed drugs-antimalarial medicines, glucocorticoids, retinoids, and psoralens + ultraviolet A (UVA) therapy-and discusses their possible ocular side effects. The most significant complication of antimalarial drugs is retinopathy with the risk of permanent visual impairment. There are different recommendations for screening for this drug-related retinopathy. The most important ocular manifestations of steroid management are irreversible optic nerve damage in "steroid responders" (steroid glaucoma) and cataract. Some other side effects may disappear after discontinuation of the therapy. Retinoid-induced ocular side effects include ocular surface disease as well as retinal dysfunction. It is recommended to modify the therapy when night blindness occurs or after the decrease of color vision. Protective eyewear is sufficient to avoid ocular surface problems during psoralen + UVA therapy. The knowledge of screening schemes and closer cooperation between physicians may decrease the risk of serious or irreversible ocular side effects. PMID:26903180

  18. Normal Ocular Development in Young Rhesus Monkeys (Macaca mulatta)

    PubMed Central

    Qiao-Grider, Ying; Hung, Li-Fang; Kee, Chea-su; Ramamirtham, Ramkumar; Smith, Earl L.

    2007-01-01

    Purpose The purpose of this study was to characterize normal ocular development in infant monkeys and to establish both qualitative and quantitative relationships between human and monkey refractive development. Methods The subjects were 214 normal rhesus monkeys. Cross-sectional data were obtained from 204 monkeys at about 3 weeks of age and longitudinal data were obtained from 10 representative animals beginning at about 3 weeks of age for a period of up to 5 years. Ocular development was characterized via refractive status, corneal power, crystalline lens parameters, and the eye’s axial dimensions, which were determined by retinoscopy, keratometry, phakometry and A-scan ultrasonography, respectively. Results From birth to about 5 years of age, the growth curves for refractive error and most ocular components (excluding lens thickness and equivalent lens index) followed exponential trajectories and were highly coordinated between the two eyes. However, overall ocular growth was not a simple process of increasing the scale of each ocular component in a proportional manner. Instead the rates and relative amounts of change varied within and between ocular structures. Conclusion The configuration and contribution of the major ocular components in infant and adolescent monkey eyes are qualitatively and quantitatively very comparable to those in human eyes and their development proceeds in a similar manner in both species. As a consequence, in both species the adolescent eye is not simply a scaled version of the infant eye. PMID:17416396

  19. Downbeat nystagmus: evidence for enhancement of utriculo-ocular pathways by ocular vestibular evoked myogenic potentials?

    PubMed

    Bremova, Tatiana; Glasauer, Stefan; Strupp, Michael

    2015-11-01

    Downbeat nystagmus (DBN) is caused by an impairment of Purkinje cells in the flocculus. The decreased cerebellar inhibitory input affects otolith pathways. Since ocular and cervical vestibular evoked myogenic potentials (o-/cVEMP) test the otoliths, the VEMP were measured in DBN patients and in controls. Sixteen patients with DBN, 14 cerebellar oculomotor disorder patients without DBN (COMD), and 16 healthy controls were examined with o-/cVEMP. Computational modeling was used to predict VEMP differences between groups. DBN patients had significantly higher oVEMP peak-to-peak (PP) amplitudes than COMD patients without DBN and controls. Cervical VEMP did not differ. The computational model of DBN predicted a twofold oVEMP increase for DBN patients. These findings suggest an enhancement of the utriculo-ocular response. The unchanged cVEMP indicate no effect on the otolith-cervical reflex in DBN. Computational modeling suggests that the utriculo-ocular enhancement is caused by an impaired vertical neural integrator resulting in the increased influence of utricular signals. This also explains the gravitational dependence of DBN. PMID:26024694

  20. Nanotechnology Approaches for Ocular Drug Delivery

    PubMed Central

    Xu, Qingguo; Kambhampati, Siva P.; Kannan, Rangaramanujam M.

    2013-01-01

    Blindness is a major health concern worldwide that has a powerful impact on afflicted individuals and their families, and is associated with enormous socio-economical consequences. The Middle East is heavily impacted by blindness, and the problem there is augmented by an increasing incidence of diabetes in the population. An appropriate drug/gene delivery system that can sustain and deliver therapeutics to the target tissues and cells is a key need for ocular therapies. The application of nanotechnology in medicine is undergoing rapid progress, and the recent developments in nanomedicine-based therapeutic approaches may bring significant benefits to address the leading causes of blindness associated with cataract, glaucoma, diabetic retinopathy and retinal degeneration. In this brief review, we highlight some promising nanomedicine-based therapeutic approaches for drug and gene delivery to the anterior and posterior segments. PMID:23580849

  1. Complimentary imaging technologies in blunt ocular trauma

    PubMed Central

    Kolomeyer, Anton M.; Szirth, Bernard C.; Nayak, Natasha V.; Khouri, Albert S.

    2013-01-01

    We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF) images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT) helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations. PMID:24082670

  2. Complimentary imaging technologies in blunt ocular trauma.

    PubMed

    Kolomeyer, Anton M; Szirth, Bernard C; Nayak, Natasha V; Khouri, Albert S

    2013-05-01

    We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF) images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT) helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations. PMID:24082670

  3. The Chinchilla's vestibulo-ocular reflex

    NASA Technical Reports Server (NTRS)

    Merwin, W. H., Jr.; Wall, Conrad, III; Tomko, D. L.

    1989-01-01

    The horizontal vestibulo-ocular reflex (VOR) was measured and characterized in seven adult chinchillas using 0.01 to 1.0 Hz angular velocity sinusoids. Gains were less than compensatory, and were variable from day to day, but phases were highly repeatable both within and between animals. The best fitting transfer function to the average data of all animals had a dominant time constant of 7.5 sec, and an adaptation operator with a time constant of 24.0 sec. There were certain nonlinearities in the horizontal VOR of this animal, and it was difficult to elicit a robust optokinetic response. Results are discussed in relation to similar measurements in other species.

  4. Ocular Manifestations of Oblique Facial Clefts

    PubMed Central

    Ortube, Maria Carolina; Dipple, Katrina; Setoguchi, Yoshio; Kawamoto, Henry K.; Demer, Joseph L.

    2014-01-01

    Introduction In the Tessier classification, craniofacial clefts are numbered from 0 to 14 and extend along constant axes through the eyebrows, eyelids, maxilla, nostrils, and the lips. We studied a patient with bilateral cleft 10 associated with ocular abnormalities. Method Clinical report with orbital and cranial computed tomography. Results After pregnancy complicated by oligohydramnios, digoxin, and lisinopril exposure, a boy was born with facial and ocular dysmorphism. Examination at age 26 months showed bilateral epibulbar dermoids, covering half the corneal surface, and unilateral morning glory anomaly of the optic nerve. Ductions of the right eye were normal, but the left eye had severely impaired ductions in all directions, left hypotropia, and esotropia. Under anesthesia, the left eye could not be rotated freely in any direction. Bilateral Tessier cleft number 10 was implicated by the presence of colobomata of the middle third of the upper eyelids and eyebrows. As the cleft continued into the hairline, there was marked anterior scalp alopecia. Computed x-ray tomography showed a left middle cranial fossa arachnoid cyst and calcification of the reflected tendon of the superior oblique muscle, trochlea, and underlying sclera, with downward and lateral globe displacement. Discussion Tessier 10 clefts are very rare and usually associated with encephalocele. Bilateral 10 clefts have not been reported previously. In this case, there was coexisting unilateral morning glory anomaly and arachnoid cyst of the left middle cranial fossa but no encephalocele. Conclusions Bilateral Tessier facial cleft 10 may be associated with alopecia, morning glory anomaly, epibulbar dermoids, arachnoid cyst, and restrictive strabismus. PMID:20856062

  5. Novel ocular antihypertensive compounds in clinical trials

    PubMed Central

    Chen, June; Runyan, Stephen A; Robinson, Michael R

    2011-01-01

    Introduction: Glaucoma is a multifactorial disease characterized by progressive optic nerve injury and visual field defects. Elevated intraocular pressure (IOP) is the most widely recognized risk factor for the onset and progression of open-angle glaucoma, and IOP-lowering medications comprise the primary treatment strategy. IOP elevation in glaucoma is associated with diminished or obstructed aqueous humor outflow. Pharmacotherapy reduces IOP by suppressing aqueous inflow and/or increasing aqueous outflow. Purpose: This review focuses on novel non-FDA approved ocular antihypertensive compounds being investigated for IOP reduction in ocular hypertensive and glaucoma patients in active clinical trials within approximately the past 2 years. Methods: The mode of IOP reduction, pharmacology, efficacy, and safety of these new agents were assessed. Relevant drug efficacy and safety trials were identified from searches of various scientific literature databases and clinical trial registries. Compounds with no specified drug class, insufficient background information, reformulations, and fixed-combinations of marketed drugs were not considered. Results: The investigational agents identified comprise those that act on the same targets of established drug classes approved by the FDA (ie, prostaglandin analogs and β-adrenergic blockers) as well as agents belonging to novel drug classes with unique mechanisms of action. Novel targets and compounds evaluated in clinical trials include an actin polymerization inhibitor (ie, latrunculin), Rho-associated protein kinase inhibitors, adenosine receptor analogs, an angiotensin II type 1 receptor antagonist, cannabinoid receptor agonists, and a serotonin receptor antagonist. Conclusion: The clinical value of novel compounds for the treatment of glaucoma will depend ultimately on demonstrating favorable efficacy and benefit-to-risk ratios relative to currently approved prostaglandin analogs and β-blockers and/or having complementary modes of action. PMID:21629573

  6. Risk factors for ocular toxoplasmosis in Brazil.

    PubMed

    Ferreira, A I C; De Mattos, C C Brando; Frederico, F B; Meira, C S; Almeida, G C; Nakashima, F; Bernardo, C R; Pereira-Chioccola, V L; De Mattos, L C

    2014-01-01

    The aim of this study was to investigate risk factors for ocular toxoplasmosis (OT) in patients who received medical attention at a public health service. Three hundred and forty-nine consecutive patients, treated in the Outpatient Eye Clinic of Hospital de Base, So Jos do Rio Preto, So Paulo state, Brazil, were enrolled in this study. After an eye examination, enzyme-linked immunosorbent assay (ELISA) was used to determine anti-Toxoplasma gondii antibodies. The results showed that 25.5% of the patients were seronegative and 74.5% were seropositive for IgG anti-T. gondii antibodies; of these 27.3% had OT and 72.7% had other ocular diseases (OOD). The presence of cats or dogs [odds ratio (OR) 2.22, 95% confidence interval (CI) 1.24-3.98, P = 0.009] and consumption of raw or undercooked meat (OR 1.77, 95% CI 1.05-2.98, P = 0.03) were associated with infection but not with the development of OT. Age (OT 48.2 21.2 years vs. OOD: 69.5 14.7 years, P < 0.0001) and the low level of schooling/literacy (OT vs. OOD: OR 0.414, 95% CI 0.2231-0.7692, P = 0.007) were associated with OT. The presence of dogs and cats as well as eating raw/undercooked meat increases the risk of infection, but is not associated with the development of OT. PMID:23507508

  7. Ocular comparative anatomy of the family Rodentia.

    PubMed

    Rodriguez-Ramos Fernandez, Julia; Dubielzig, Richard R

    2013-07-01

    There is little information regarding ocular anatomy and histology in many of the rodent species. Histological analyses for morphologic features were performed in 31 globes from 18 rodent species submitted to and archived at the Comparative Ocular Pathology Laboratory of Wisconsin. The following measurements were taken: thickness of the cornea, corneal epithelium, corneal stroma, Descemet's membrane, and retina. H&E sections were evaluated for the following anatomical features: presence of pigmented epithelial cells in the peripheral cornea, presence and location of Schlemm's canal, presence of iridal sphincter and dilator and ciliary body muscles, presence of pars plicata and plana, presence of retinal vessels, presence of lamina cribrosa, and presence of tapetum lucidum. The springhaas was the only rodent in our collection that presented a well-developed tapetum lucidum fibrosum. The presence of retinal vessels was variable: vessels were observed in all of the members of the mouse-related clade, except the springhaas and the beaver, in all of the squirrel-related clade members, and in none of the Ctenohystrica. In the flying squirrels, blood vessels extended to the outer limiting membrane in the photoreceptor layer. Beavers, chinchillas, capybara, and guinea pigs lacked vessels within the retina; however, they had vessels within the optic nerve head. Ground squirrels have an optic nerve head, which is linear in the horizontal plane and an asymmetric retina. The tree-dwelling squirrels have a rounded but still elongated optic nerve, and the flying squirrel has a round optic nerve head like all the other rodents. PMID:23734597

  8. Using neural nets to measure ocular refractive errors: a proposal

    NASA Astrophysics Data System (ADS)

    Netto, Antonio V.; Ferreira de Oliveira, Maria C.

    2002-12-01

    We propose the development of a functional system for diagnosing and measuring ocular refractive errors in the human eye (astigmatism, hypermetropia and myopia) by automatically analyzing images of the human ocular globe acquired with the Hartmann-Schack (HS) technique. HS images are to be input into a system capable of recognizing the presence of a refractive error and outputting a measure of such an error. The system should pre-process and image supplied by the acquisition technique and then use artificial neural networks combined with fuzzy logic to extract the necessary information and output an automated diagnosis of the refractive errors that may be present in the ocular globe under exam.

  9. Ocular manifestations in a child with systemic brucellosis

    PubMed Central

    Mohammadi, Zahra; Dehghani, Alireza; Ghanbari, Heshmat Ollah; Akhlaghi, Mohammad Reza; Nasrollahi, Kobra; Salam, Hasan

    2014-01-01

    Brucellosis is a zoonotic disease with widespread prevalence. It presents with in various range and often with the presence of non-specific clinical signs and symptoms. Brucellosis also may cause different manifestations in eyes such as uveitis, keratitis, conjunctivitis and neuro-ophthalmic defects. Ocular brucellosis is rare among children. Herein, we present a 7-year-old girl with systemic and ocular brucellosis. After treatment with systemic steroid and antibiotics, her signs and symptoms disappeared. Since early treatment is important in preventing permanent visual loss and the other complications of ocular brucellosis, examination of the eyes in brucellosis patients must always be noticed by clinicians working in this field. PMID:25364370

  10. Laser applications and system considerations in ocular imaging

    PubMed Central

    Elsner, Ann E.; Muller, Matthew S.

    2009-01-01

    We review laser applications for primarily in vivo ocular imaging techniques, describing their constraints based on biological tissue properties, safety, and the performance of the imaging system. We discuss the need for cost effective sources with practical wavelength tuning capabilities for spectral studies. Techniques to probe the pathological changes of layers beneath the highly scattering retina and diagnose the onset of various eye diseases are described. The recent development of several optical coherence tomography based systems for functional ocular imaging is reviewed, as well as linear and nonlinear ocular imaging techniques performed with ultrafast lasers, emphasizing recent source developments and methods to enhance imaging contrast. PMID:21052482

  11. Panretinal photocoagulation for radiation-induced ocular ischemia

    SciTech Connect

    Augsburger, J.J.; Roth, S.E.; Magargal, L.E.; Shields, J.A.

    1987-08-01

    We present preliminary findings on the effectiveness of panretinal photocoagulation in preventing neovascular glaucoma in eyes with radiation-induced ocular ischemia. Our study group consisted of 20 patients who developed radiation-induced ocular ischemia following cobalt-60 plaque radiotherapy for a choroidal or ciliary body melanoma. Eleven of the 20 patients were treated by panretinal photocoagulation shortly after the diagnosis of ocular ischemia, but nine patients were left untreated. In this non-randomized study, the rate of development of neovascular glaucoma was significantly lower (p = 0.024) for the 11 photocoagulated patients than for the nine who were left untreated.

  12. High temporal resolution ocular aberrometry with pupil tracking

    NASA Astrophysics Data System (ADS)

    Jarosz, Jessica; Meimon, Serge; Conan, Jean-Marc; Paques, Michel

    2014-02-01

    More cost effective and robust designs of ocular adaptive optics systems could probably be derived from a thorough knowledge of ocular time-varying aberrations. This would in particular benefit to therapeutic systems where the problem of robustness is critical. Unfortunately, high frequency temporal statistical behavior of ocular aberrations remains poorly characterized. We set up an original high resolution custom-built Shack-Hartmann aberrometer running at a frequency of 236Hz additionally featuring pupil tracking and performedmeasurements on a 50-eye population. First analyses are carried out over 20 eyes. Qualitative correlation between dynamic aberrations and saccadic pupil movements is highlighted.

  13. Ocular manifestation of lymphoma in newly diagnosed cats.

    PubMed

    Nerschbach, V; Eule, J C; Eberle, N; Höinghaus, R; Betz, D

    2016-03-01

    Ocular manifestations of lymphoma are described in humans and dogs but rarely in cats. In this prospective study, cats with newly diagnosed and treatment-naïve lymphoma were evaluated concerning clinical stage and ophthalmologic findings. Twenty-six cats were included. In 12 cats (48%), ocular changes were documented. Uveitis anterior and posterior were predominant findings, being present in 58% of affected individuals. Other findings included exophthalmos, corneal surface lesions and chemosis. Eight cats received chemotherapy, two of which had ocular involvement. In these two cats, a complete remission of an anterior and a partial remission of a posterior uveitis were documented. Due to the detection of ocular involvement, a stage migration from stage IV to V occurred in four patients. In the light of these findings, an opthalmological examination may be considered as an important part of staging in feline lymphoma as well as of follow-up examination in affected cats. PMID:24102737

  14. Glaucoma drainage implant surgery and ocular surface transplant graft preservation.

    PubMed

    Aref, Ahmad A; Sivaraman, Kavitha R; Djalilian, Ali R

    2015-05-01

    Glaucoma may develop or worsen after ocular surface transplantation and often requires surgical management for adequate intraocular pressure control. Traditional glaucoma filtering procedures in patients with prior ocular surface transplant may be problematic for several reasons, which include mechanical disruption of the pre-existing graft, epithelial and stem cell toxicity induced by antifibrotic agents, and increased risk of future corneal transplantation failure. We describe the implantation of a glaucoma drainage implant via a limbal-based conjunctival incision with tube placement in the ciliary sulcus in three eyes of two patients with prior ocular surface transplantation. At a follow-up interval of 3-7 months, all three eyes have excellent postoperative control of intraocular pressure, stable vision, and healthy ocular surface grafts. PMID:24116393

  15. The importance of vitamin D in systemic and ocular wellness

    PubMed Central

    Richer, Stuart P.; Pizzimenti, Joseph J.

    2013-01-01

    Vitamin D is good for bones and teeth. It may also have a role in preventing and treating diabetes, certain cancers, atherosclerosis, multiple sclerosis, hip fractures and ocular conditions such as age-related macular degeneration.

  16. Autoimmunity at the ocular surface: pathogenesis and regulation

    PubMed Central

    Stern, ME; Schaumburg, CS; Dana, R; Calonge, M; Niederkorn, JY; Pflufelder, SC

    2013-01-01

    A healthy ocular surface environment is essential to preserve visual function, and as such the eye has evolved a complex network of mechanisms to maintain homeostasis. Fundamental to the health of the ocular surface is the immune system, designed to respond rapidly to environmental and microbial insults, whereas maintaining tolerance to self-antigens and commensal microbes. To this end, activation of the innate and adaptive immune response is tightly regulated to limit bystander tissue damage. However, aberrant activation of the immune system can result in autoimmunity to self-antigens localized to the ocular surface and associated tissues. Environmental, microbial and endogenous stress, antigen localization, and genetic factors provide the triggers underlying the immunological events that shape the outcome of the diverse spectrum of autoimmune-based ocular surface disorders. PMID:20485329

  17. Value of PAX-8 and SF-1 Immunohistochemistry in the Distinction Between Female Adnexal Tumor of Probable Wolffian Origin and its Mimics.

    PubMed

    Goyal, Abha; Masand, Ramya P; Roma, Andres A

    2016-03-01

    Female adnexal tumors of probable wolffian origin (FATWOs) are rare. They can closely mimic endometrioid adenocarcinomas with a prominent spindle cell component and Sertoli cell tumors (SCTs). To further define their immunohistochemical profile and origin, we investigated the expression of PAX-8, PAX-2, and GATA binding protein 3 (GATA-3) (wolffian markers) and of steroidogenic factor-1 (SF-1) (sex-cord stromal marker) in FATWOs. We also studied the expression of PAX-8 and PAX-2 in endometrioid adenocarcinomas; of SF-1 in Sertoli-Leydig cell and SCTs; and of PAX-8, PAX-2, GATA-3, and SF-1 in rete ovarii-a proposed site of origin for FATWOs. A database search yielded 8 FATWOs, 18 ovarian/tubal/paraovarian endometrioid adenocarcinomas, and 8 ovarian Sertoli-Leydig cell and SCTs. Eleven cases with rete ovarii sections were included. Of the FATWOs studied, all were negative for PAX-8, PAX-2, GATA-3, and SF-1. Of the endometrioid adenocarcinomas studied, PAX-8 was positive in all and PAX-2 was positive in 57%. Of the Sertoli-Leydig cell and SCTs, all were positive for SF-1 except one. The rete ovarii were positive for PAX-8, weakly positive for SF-1, and negative for PAX-2 and GATA-3. Our study suggests that PAX-8 and SF-1 can be helpful in the distinction between FATWOs and endometrioid adenocarcinomas and SCTs, respectively. Our results do not support a Mullerian or sex-cord stromal or rete ovarii origin for FATWOs. It is curious, however, that FATWOs do not express wolffian markers-it is possibly related to their origin from a distinctive portion of the wolffian duct. PMID:26352548

  18. A rare ocular complication after a heart transplant: toxoplasma retinitis.

    PubMed

    Kervan, Umit; Ozdamar, Yasemin; Yurdakok, Okan; Kucuker, Seref Alp; Pac, Mustafa

    2014-02-01

    Ocular infections after a heart transplant are rare; but when present, they generally appear during the first year after surgery. Ocular infections may cause significant loss of vision and morbidity if not diagnosed early. For that reason, heart transplant patients should undergo a routine visual examination during follow-up. We report our experience regarding the followup and treatment of a case of toxoplasma retinitis diagnosed in one of our heart transplant recipients. PMID:24471726

  19. Temporal dynamics of ocular indicators of sleepiness across sleep restriction

    PubMed Central

    Ftouni, Suzanne; Rahman, Shadab A.; Crowley, Kate E.; Anderson, Clare; Rajaratnam, Shantha M.W.; Lockley, Steven W.

    2015-01-01

    The current study characterized the temporal dynamics of ocular indicators of sleepiness during extended sleep restriction. Ten male participants (mean age ± SD = 23.3 ± 1.6 years) underwent 40-hours of continuous wakefulness under constant routine (CR) conditions, and completed the Karolinska Sleepiness Scale (KSS) and a 10-minute auditory psychomotor vigilance task (aPVT) hourly. Waking electroencephalography (EEG) and ocular measures were recorded continuously throughout the CR. Infrared-reflectance oculography was used to collect the ocular measures positive and negative amplitude/velocity ratio, mean blink duration, the percentage of eye closure, and a composite score of sleepiness levels (Johns Drowsiness Scale). All ocular measures except blink duration, displayed homeostatic and circadian properties. Only circadian effects were detected in blink duration. Significant, phase-locked cross-correlations (p < 0.05) were detected between ocular measures and aPVT reaction time (RT), aPVT lapses, KSS, and EEG delta-theta (0.5-5.5 Hz), theta-alpha (5.0-9.0 Hz) and beta (13.0-20.0 Hz) activity. Receiver Operating Characteristic (ROC) curve analysis demonstrated reasonable sensitivity and specificity of ocular measures in correctly classifying aPVT lapses above individual baseline thresholds (initial 16 h of wakefulness). Under conditions of sleep restriction, ocular indicators of sleepiness paralleled performance impairment and self-rated sleepiness levels, and demonstrated their potential to detect sleepiness-related attentional lapses. These findings, if reproduced in a larger sample, will have implications on the use of ocular based sleepiness-warning systems in operational settings. PMID:24336419

  20. Late effects of radiation on the eye and ocular adnexa

    SciTech Connect

    Gordon, K.B.; Char, D.H.; Sagerman, R.H.

    1995-03-30

    A clinically useful classification system is suggested that can be used in prospective trials to evaluate the effects of radiation on the visual system. We review radiation-induced pathophysiological and clinical changes of the various ocular structures as well as dose-response data and management of ocular complications. The rationale for the classification scheme chosen is also discussed. 90 refs., 5 figs., 3 tabs.

  1. An unusual case of penetrating ocular trauma with metallic spoon

    PubMed Central

    Bhaduri, Gautam; Chattopadhyay, Soumya Swarup; Ghosh, Rudra Prasad; Saurabh, Kumar; Goyal, Mukesh

    2010-01-01

    Ocular trauma is an important cause of vision loss. The agents incriminated in such injuries are diverse. We present a case of ocular trauma with a metallic spoon causing deep laceration of lid and temple region with sclerocorneal laceration. After assessment of the general condition and stabilization of the systemic parameters the operative procedure was undertaken on elective basis. Though the final visual outcome was not rewarding due to the severity of the injury, any potential hemostatic catastrophe was averted. PMID:20534927

  2. Fundus Autofluorescence Imaging in an Ocular Screening Program

    PubMed Central

    Kolomeyer, A. M.; Nayak, N. V.; Szirth, B. C.; Khouri, A. S.

    2012-01-01

    Purpose. To describe integration of fundus autofluorescence (FAF) imaging into an ocular screening program. Methods. Fifty consecutive screening participants were included in this prospective pilot imaging study. Color and FAF (530/640 nm exciter/barrier filters) images were obtained with a 15.1MP Canon nonmydriatic hybrid camera. A clinician evaluated the images on site to determine need for referral. Visual acuity (VA), intraocular pressure (IOP), and ocular pathology detected by color fundus and FAF imaging modalities were recorded. Results. Mean ± SD age was 47.4 ± 17.3 years. Fifty-two percent were female and 58% African American. Twenty-seven percent had a comprehensive ocular examination within the past year. Mean VA was 20/39 in the right eye and 20/40 in the left eye. Mean IOP was 15 mmHg bilaterally. Positive color and/or FAF findings were identified in nine (18%) individuals with diabetic retinopathy or macular edema (n = 4), focal RPE defects (n = 2), age-related macular degeneration (n = 1), central serous retinopathy (n = 1), and ocular trauma (n = 1). Conclusions. FAF was successfully integrated in our ocular screening program and aided in the identification of ocular pathology. Larger studies examining the utility of this technology in screening programs may be warranted. PMID:23316224

  3. Validating and Troubleshooting Ocular In Vitro Toxicology Tests

    PubMed Central

    Barile, Frank A.

    2010-01-01

    In vitro organotypic models for testing ocular irritants have warranted sufficient interest as methods to replace in vivo ocular testing. The in vitro organotypic models claim to maintain short-term normal physiological and biochemical function of the mammalian cornea in an isolated system. In these test methods, damage by the test substance is assessed by quantitative measurements of changes in corneal opacity and permeability using opacitometry and spectrophotometry, respectively. Both measurements are used quantitatively for irritancy classification for prediction of the in vivo ocular irritation potential of a test substance. Examples of organotypic models that incorporate these criteria include: the bovine corneal opacity and permeability (BCOP) assay, the isolated chicken eye (ICE) test method and the isolated rabbit eye (IRE) assay. A fourth method, the hen's egg test-chorioallantoic membrane (HET-CAM) assay, differs in the evaluation criteria but is also normally included among this class of in vitro protocols. Each of these protocols is discussed in detail as representative candidate in vitro methods for assessing ocular irritation and corrosion. The methodologies, protocol details, applications, and their validation status are discussed. A brief historical perspective of the development of original in vitro ocular testing models is also mentioned. More importantly, improvement and troubleshooting the current techniques, in order to present the models as stand-alone in vitro tools for ocular toxicity assessment, is emphasized. PMID:20096797

  4. Characterization of ocular gland morphology and tear composition of pinnipeds

    PubMed Central

    Davis, Robin Kelleher; Doane, Marshall G.; Knop, Erich; Knop, Nadja; Dubielzig, Richard R.; Colitz, Carmen M. H.; Argeso, Pablo; Sullivan, David A.

    2012-01-01

    Objective The importance of tear film integrity to ocular health in terrestrial mammals is well established, however, in marine mammals, the role of the tear film in protection of the ocular surface is not known. In an effort to better understand the function of tears in maintaining health of the marine mammal eye surface, we examined ocular glands of the California sea lion, and began to characterize the biochemical nature of the tear film of pinnipeds. Procedures Glands dissected from California sea lion eyelids and adnexa were examined for gross morphology, sectioned for microscopic analysis, and stained with haematoxylin and eosin. The tear film was examined using interferometry. Tears were collected from humans and pinnipeds for analysis of protein and carbohydrate content. Results The sea lion has sebaceous glands in the lid, but these glands are different in size and orientation compared to typical meibomian glands of terrestrial mammals. Two other accessory ocular glands located dorsotemporally and medially appeared to be identical in morphology, with tubulo-acinar morphology. An outer lipid layer on the ocular surface of the sea lion was not detected using interferometry, consistent with the absence of typical meibomian glands. Similar to human tears, the tears of pinnipeds contain several proteins but the ratio of carbohydrate to protein was greater than that in human tears. Conclusions Our findings indicate that the ocular gland architecture and biochemical nature of the tear film of pinnipeds have evolved to adapt to the challenges of an aquatic environment. PMID:23067374

  5. Novel Strategies for Anterior Segment Ocular Drug Delivery

    PubMed Central

    Cholkar, Kishore; Patel, Sulabh P.; Vadlapudi, Aswani Dutt

    2013-01-01

    Abstract Research advancements in pharmaceutical sciences have led to the development of new strategies in drug delivery to anterior segment. Designing a new delivery system that can efficiently target the diseased anterior ocular tissue, generate high drug levels, and maintain prolonged and effective concentrations with no or minimal side effects is the major focus of current research. Drug delivery by traditional method of administration via topical dosing is impeded by ocular static and dynamic barriers. Various products have been introduced into the market that prolong drug retention in the precorneal pocket and to improve bioavailability. However, there is a need of a delivery system that can provide controlled release to treat chronic ocular diseases with a reduced dosing frequency without causing any visual disturbances. This review provides an overview of anterior ocular barriers along with strategies to overcome these ocular barriers and deliver therapeutic agents to the affected anterior ocular tissue with a special emphasis on nanotechnology-based drug delivery approaches. PMID:23215539

  6. Reduction of ocular counter-rolling by adaptation to space

    NASA Technical Reports Server (NTRS)

    Dai, Mingjia; Mcgarvie, Leigh; Kozlovskaya, Inessa; Sirota, Mischa; Raphan, Theodore; Cohen, Bernard

    1993-01-01

    We studied the three-dimensional vestibulo-ocular reflex (VOR) of rhesus monkeys before and after the COSMOS Biosatellite 2229 Mission of 1992-1993. This included tests of ocular counter-rolling (OCR), the gain of the vestibulo-ocular reflex (VOR), and spatial orientation of velocity storage. A four-axis vestibular and oculomotor stimulator was transported to the Institute of Biomedical Problems in Moscow for the pre- and postflight ground-based testing. Twelve normal juvenile male rhesus monkey were implanted surgically with eye coils and tested 60-90 days before spaceflight. Two monkey (7906 and 6151), selected from the twelve as flight animals, flew from 12/29/92 to 1/10/93. Upon recovery, they were tested for 11 days postflight along with three control animals. Compensatory ocular torsion was produced in two ways: (1) Lateral head tilts evoked OCR through otolith-ocular reflexes. OCR was also measured dynamically during off-vertical axis rotation (OVAR). (2) Rotation about a naso-occipital axis that was either vertical of horizontal elicited torsional nystagmus through semicircular canal-ocular reflexes (roll VOR). OCR from the otoliths was substantially reduced (70 percent) for 11 days after reentry on both modes of testing. The gain of the roll VOR was also decreased, but less than OCR. These data demonstrate that there was a long-lasting depression of torsional or roll eye movements after adaptation to microgravity in these monkeys, especially those movements produced by the otolith organs.

  7. Clusterin Seals the Ocular Surface Barrier in Mouse Dry Eye

    PubMed Central

    Bauskar, Aditi; Mack, Wendy J.; Mauris, Jerome; Argüeso, Pablo; Heur, Martin; Nagel, Barbara A.; Kolar, Grant R.; Gleave, Martin E.; Nakamura, Takahiro; Kinoshita, Shigeru; Moradian-Oldak, Janet; Panjwani, Noorjahan; Pflugfelder, Stephen C.; Wilson, Mark R.; Fini, M. Elizabeth; Jeong, Shinwu

    2015-01-01

    Dry eye is a common disorder caused by inadequate hydration of the ocular surface that results in disruption of barrier function. The homeostatic protein clusterin (CLU) is prominent at fluid-tissue interfaces throughout the body. CLU levels are reduced at the ocular surface in human inflammatory disorders that manifest as severe dry eye, as well as in a preclinical mouse model for desiccating stress that mimics dry eye. Using this mouse model, we show here that CLU prevents and ameliorates ocular surface barrier disruption by a remarkable sealing mechanism dependent on attainment of a critical all-or-none concentration. When the CLU level drops below the critical all-or-none threshold, the barrier becomes vulnerable to desiccating stress. CLU binds selectively to the ocular surface subjected to desiccating stress in vivo, and in vitro to the galectin LGALS3, a key barrier component. Positioned in this way, CLU not only physically seals the ocular surface barrier, but it also protects the barrier cells and prevents further damage to barrier structure. These findings define a fundamentally new mechanism for ocular surface protection and suggest CLU as a biotherapeutic for dry eye. PMID:26402857

  8. Paintball-related ocular trauma: Paintball or Painball?

    PubMed Central

    Keles, Sadullah; Ondas, Osman; Ekinci, Metin; Sener, Mustafa Talip; Erhan, Erim; Sirinkan, Ahmet; Salman, Ilknur Akyol; Kocer, Ibrahim; Baykal, Orhan

    2014-01-01

    Background The aim of this study is to describe the type and severity of paintball-related ocular trauma and to determine the necessary precautions to minimize the risk of ocular injury regardless of whether adequate eye protection was used. Material/Methods A retrospective chart review identified patients treated for paintball-related ocular trauma at the Ataturk University Medical Hospital from June 2010 through March 2013. A descriptive analysis of data was performed. Results Ten patients with paintball-related ocular trauma were identified. At the time of their first examination, 7 of these patients had visual acuity (VA) of 20/200 or worse. One patient had a final VA of no light perception and 4 patients had a final VA of 20/200 or worse. Hyphema was noted in 7 patients, traumatic cataract in 2, iridodialysis in 2, retinal detachment in 3, and secondary glaucoma in 1. Six patients required surgery. Although all victims have used eye protection during the game, all patients were injured after they thought the game was over and had taken off their helmets or eye-protective devices. Conclusions Paintball-related accidents result in serious ocular trauma and most of the patients require surgery. These injuries result in severe loss of VA in some patients. Uninterrupted use of proper eye protection whenever a player is in the game field, even after they believe the game has ended, may reduce the incidence of severe ocular trauma in paintball players. PMID:24704783

  9. Review of external ocular compression: clinical applications of the ocular pressure estimator

    PubMed Central

    Korenfeld, Michael S; Dueker, David K

    2016-01-01

    Purpose The authors have previously validated an Ocular Pressure Estimator (OPE) that can estimate the intraocular pressure (IOP) during external ocular compression (EOC). The authors now apply the OPE in clinical states where EOC is clinically important. The original work is described for two periods of risk: during sleep and during the digital ocular massage (DOM) maneuver used by surgeons after trabeculectomy to keep the operation functional. Other periods of risk for external ocular compression are then reviewed. Methods The first protocol estimated the IOP in the dependent eye during simulated sleep. Subjects had their IOPs initially measured in an upright-seated position, immediately upon assuming a right eye dependent side sleeping position (with nothing contacting the eye), and then 5 minutes later while still in this position. While maintaining this position, the fluid filled bladder of the OPE was then placed between the subject’s closed eye and a pillow during simulated sleep. The IOP was continuously estimated in this position for 5 minutes. The subjects then had the IOP measured in both eyes in an upright-seated position. The second protocol determined if a larger vertical cup-to-disc ratio was more common on the side that patients reported they preferred to sleep on. The hypothesis was that chronic asymmetric, compression induced, elevations of IOP during sleep would be associated with otherwise unexplained asymmetry of the vertical cup-to-disc ratio. The third protocol assessed the IOP during DOM. The OPE was used to characterize the IOP produced during the DOM maneuver of five glaucoma surgeons. After this, 90 mmHg was chosen as a target pressure for DOM. The surgeons were then verbally coached during three additional compressions. After a 5-minute period, the surgeons were asked to reproduce this targeted IOP during subsequent compressions. Results The mean IOP during the “sleep session” was 22±5 mmHg (SEM). The mean peak pressure was 40±11 mmHg (SEM) and the mean trough pressure was 15±2 mmHg (SEM). There was a 78% agreement between the eye that was reported to be dependent during sleep and the eye with the larger vertical cup-to-disc ratio, for eyes with at least a 0.10 cup-to-disc ratio difference, P=0.001, n=137. The OPE estimated an average induced IOP during typical DOM of 104±8 mmHg (SEM), with each compression having an average range of 17±3 mmHg (SEM). After coaching, and a 5-minute waiting period, the average induced IOP reduced to 95±3 mmHg (SEM) with a reduced average range of IOP to 11±1 mmHg. Conclusion The OPE was successfully used to estimate the IOP while subjects experienced EOC during normal sleep postures. These EOC-induced elevations of IOP were considerable, and likely contribute to significant ocular pathology, not only for glaucoma, but for retinal vascular occlusive diseases, retinal vascular leakage, and the induction of the ocular-cardiac reflex in infants, as well. The correlation of a larger vertical cup-to-disc ratio in patients with a sleep posture preference suggests a causal relationship, since patients with other conditions known to be associated with cup-to disc ratio asymmetry were excluded from this study. The OPE is a useful device to teach DOM to surgeons and patients for home use. PMID:26966349

  10. Functional Roles of Bestrophins in Ocular Epithelia

    PubMed Central

    Marmorstein, Alan D.; Cross, Harold E.; Peachey, Neal S.

    2009-01-01

    There are four members of the bestrophin family of proteins in the human genome, of which two are known to be expressed in the eye. The gene BEST1 (formerly VMD2) which encodes the protein bestrophin-1 (Best1) was first identified in 1998. Mutations in this gene have now been associated with four clinically distinguishable human eye diseases, collectively referred to as bestrophinopathies. Over the last decade, laboratories have sought to understand how Best1 mutations could result in eye diseases that range in presentation from macular degeneration to nanophthalmos. The majority of our knowledge comes from studies that have sought to understand how Best1 mutations or dysfunction could induce the classical symptoms of the most common of these diseases: Best vitelliform macular dystrophy (BVMD). BVMD is a dominant trait that is characterized electrophysiologically by a diminished electrooculogram light peak with a normal clinical electroretinogram. This together with the localization of Best1 to the retinal pigment epithelium (RPE) basolateral plasma membrane and data from heterologous expression studies, have led to the proposal that Best1 generates the light peak, and that bestrophins are a family of Ca2+ activated Cl- channels (CaCCs). However, data from Best1 knock-out and knock-in mice, coupled with the recent discovery of a recessive bestrophinopathy suggest that Best1 does not generate the light peak. Recently Best2 was found to be expressed in non-pigmented epithelia in the ciliary body. However, aqueous dynamics in Best2 knock-out mice do not support a role for Best2 as a Cl- channel. Thus, the purported CaCC function of the bestrophins and how loss of this function relates to clinical disease needs to be reassessed. In this article, we examine data obtained from tissue-type and animal models and discuss the current state of bestrophin research, what roles Best1 and Best2 may play in ocular epithelia and ocular electrophysiology, and how perturbation of these functions may result in disease. PMID:19398034

  11. Variability of Ocular Deviation in Strabismus

    PubMed Central

    Economides, John R.; Adams, Daniel L.; Horton, Jonathan C.

    2015-01-01

    IMPORTANCE In strabismus, the fixating eye conveys the direction of gaze while the fellow eye points at a peripheral location in space. The stability of the eyes may be reduced by the absence of a common target. OBJECTIVE To quantify the stability of eye position in strabismus and to measure variability in the ocular deviation. DESIGN, SETTING, AND PARTICIPANTS From 2010 to 2014, a prospective comparative case study of 25 patients with alternating exotropia with normal visual acuity in each eye and 25 control individuals was conducted in a laboratory at a tertiary eye center. A video eye tracker was used to measure the position of each eye while participants alternated fixation on the center of a cross under dichoptic conditions or scanned pictures of natural scenes. MAIN OUTCOMES AND MEASURES Spatial and temporal variability in the position of the fixating eye and the nonfixating eye in patients with strabismus and control individuals, quantified by the log area of ellipses containing 95% of eye positions or mean SDs of eye position. RESULTS In the 25 patients with strabismus, the mean (SD) age was 28 (14) years (range, 8–55 years) and the mean (SD) ocular deviation was 14.2° (5.9°) (range, 4.4°–22.4°). In the patients with strabismus, the mean position variability (1.80 log units; 95% CI, 1.66–1.93) for the deviating eye was greater than for the fixating eye (1.26 log units; 95% CI, 1.17–1.35) (P < .001). The fixating eye of patients with strabismus was more variable in position than the fixating eye of individuals without strabismus (0.98 log units; 95% CI, 0.88–1.08) (P < .005). CONCLUSIONS AND RELEVANCE In patients with strabismus, even without amblyopia, the deviated eye is more variable in position than the fixating eye. Both eyes are less stable in position than the eyes of control individuals, which indicates that strabismus impairs the ability to fixate targets steadily. Saccades contribute to variability of the deviation angle because they are less conjugate in patients with strabismus. PMID:26562632

  12. Multiple congenital ocular anomalies in Icelandic horses

    PubMed Central

    2011-01-01

    Background Multiple congenital ocular anomalies (MCOA) syndrome is a hereditary congenital eye defect that was first described in Silver colored Rocky Mountain horses. The mutation causing this disease is located within a defined chromosomal interval, which also contains the gene and mutation that is associated with the Silver coat color (PMEL17, exon 11). Horses that are homozygous for the disease-causing allele have multiple defects (MCOA-phenotype), whilst the heterozygous horses predominantly have cysts of the iris, ciliary body or retina (Cyst-phenotype). It has been argued that these ocular defects are caused by a recent mutation that is restricted to horses that are related to the Rocky Mountain Horse breed. For that reason we have examined another horse breed, the Icelandic horse, which is historically quite divergent from Rocky Mountain horses. Results We examined 24 Icelandic horses and established that the MCOA syndrome is present in this breed. Four of these horses were categorised as having the MCOA-phenotype and were genotyped as being homozygous for the PMEL17 mutation. The most common clinical signs included megaloglobus, iris stromal hypoplasia, abnormal pectinate ligaments, iridociliary cysts occasionally extending into the peripheral retina and cataracts. The cysts and pectinate ligament abnormalities were observed in the temporal quadrant of the eyes. Fourteen horses were heterozygous for the PMEL17 mutation and were characterized as having the Cyst-phenotype with cysts and occasionally curvilinear streaks in the peripheral retina. Three additional horses were genotyped as PMEL17 heterozygotes, but in these horses we were unable to detect cysts or other forms of anomalies. One eye of a severely vision-impaired 18 month-old stallion, homozygous for the PMEL17 mutation was examined by light microscopy. Redundant duplication of non-pigmented ciliary body epithelium, sometimes forming cysts bulging into the posterior chamber and localized areas of atrophy in the peripheral retina were seen. Conclusions The MCOA syndrome is segregating with the PMEL17 mutation in the Icelandic Horse population. This needs to be taken into consideration in breeding decisions and highlights the fact that MCOA syndrome is present in a breed that are more ancient and not closely related to the Rocky Mountain Horse breed. PMID:21615885

  13. Dendrimer based nanotherapeutics for ocular drug delivery

    NASA Astrophysics Data System (ADS)

    Kambhampati, Siva Pramodh

    PAMAM dendrimers are a class of well-defined, hyperbranched polymeric nanocarriers that are being investigated for ocular drug and gene delivery. Their favorable properties such as small size, multivalency and water solubility can provide significant opportunities for many biologically unstable drugs and allows potentially favorable ocular biodistribution. This work exploits hydroxyl terminated dendrimers (G4-OH) as drug/gene delivery vehicles that can target retinal microglia and pigment epithelium via systemic delivery with improved efficacy at much lower concentrations without any side effects. Two different drugs Triamcinolone acetonide (TA) and N-Acetyl Cysteine (NAC) conjugated to G4-OH dendrimers showed tailorable sustained release in physiological relevant solutions and were evaluated in-vitro and in-vivo. Dendrimer-TA conjugates enhanced the solubility of TA and were 100 fold more effective at lower concentrations than free TA in its anti-inflammatory activity in activated microglia and in suppressing VEGF production in hypoxic RPE cells. Dendrimers targeted activated microglia/macrophages and RPE and retained for a period of 21 days in I/R mice model. The relative retention of intravitreal and intravenous dendrimers was comparable, if a 30-fold intravenous dose is used; suggesting intravenous route targeting retinal diseases are possible with dendrimers. D-NAC when injected intravenously attenuated retinal and choroidal inflammation, significantly reduced (˜73%) CNV growth at early stage of AMD in rat model of CNV. A combination therapy of D-NAC + D-TA significantly suppressed microglial activation and promoted CNV regression in late stages of AMD without causing side-effects. G4-OH was modified with linker having minimal amine groups and incorporation of TA as a nuclear localization enhancer resulted in compact gene vectors with favorable safety profile and achieved high levels of transgene expression in hard to transfect human retinal pigment epithelial cells (hRPE). Prepared dendrimer-gene complexes were non-toxic and achieved significant cell uptake and safe delivery of gene in to the nucleus. Further, polyethylene glycol (PEG) surface coating enhanced colloidal stability in physiological relevant solutions without affecting its transfection efficacy.

  14. Human ocular carotenoid-binding proteins†

    PubMed Central

    Li, Binxing; Vachali, Preejith

    2014-01-01

    Two dietary carotenoids, lutein and zeaxanthin, are specifically delivered to the human macula at the highest concentration anywhere in the body. Whenever a tissue exhibits highly selective uptake of a compound, it is likely that one or more specific binding proteins are involved in the process. Over the past decade, our laboratory has identified and characterized several carotenoid-binding proteins from human retina including a pi isoform of glutathione S-transferase (GSTP1) as a zeaxanthin-binding protein, a member of the steroidogenic acute regulatory domain (StARD) family as a lutein-binding protein, and tubulin as a less specific, but higher capacity site for carotenoid deposition. In this article, we review the purification and characterization of these carotenoid-binding proteins, and we relate these ocular carotenoid-binding proteins to the transport and uptake role of serum lipoproteins and scavenger receptor proteins in a proposed pathway for macular pigment carotenoid delivery to the human retina. PMID:20820671

  15. Robust approach to ocular fundus image analysis

    NASA Astrophysics Data System (ADS)

    Tascini, Guido; Passerini, Giorgio; Puliti, Paolo; Zingaretti, Primo

    1993-07-01

    The analysis of morphological and structural modifications of retinal blood vessels plays an important role both to establish the presence of some systemic diseases as hypertension and diabetes and to study their course. The paper describes a robust set of techniques developed to quantitatively evaluate morphometric aspects of the ocular fundus vascular and micro vascular network. They are defined: (1) the concept of 'Local Direction of a vessel' (LD); (2) a special form of edge detection, named Signed Edge Detection (SED), which uses LD to choose the convolution kernel in the edge detection process and is able to distinguish between the left or the right vessel edge; (3) an iterative tracking (IT) method. The developed techniques use intensively both LD and SED in: (a) the automatic detection of number, position and size of blood vessels departing from the optical papilla; (b) the tracking of body and edges of the vessels; (c) the recognition of vessel branches and crossings; (d) the extraction of a set of features as blood vessel length and average diameter, arteries and arterioles tortuosity, crossing position and angle between two vessels. The algorithms, implemented in C language, have an execution time depending on the complexity of the currently processed vascular network.

  16. Peptide Therapeutics for Treating Ocular Surface Infections

    PubMed Central

    2014-01-01

    Abstract Microbial pathogens—bacteria, viruses, fungi, and parasites—are significant causes of blindness, particularly in developing countries. For bacterial and some viral infections a number of antimicrobial drugs are available for therapy but there are fewer available for use in treating fungal and parasitic keratitis. There are also problems with current antimicrobials, such as limited efficacy and the presence of drug-resistant microbes. Thus, there is a need to develop additional drugs. Nature has given us an example of 1 potential source of new antimicrobials: antimicrobial peptides and proteins that are either present in bodily fluids and tissues constitutively or are induced upon infection. Given the nature of peptides, topical applications are the most likely use to be successful and this is ideal for treating keratitis. Such peptides would also be active against drug-resistant pathogens and might act synergistically if used in combination therapy. Hundreds of peptides with antimicrobial properties have been isolated or synthesized but only a handful have been tested against ocular pathogens and even fewer have been tested in animal models. This review summarizes the currently available information on the use of peptides to treat keratitis, outlines some of the problems that have been identified, and discusses future studies that will be needed. Most of the peptides that have been tested have shown activity at concentrations that do not warrant further development, but 1 or 2 have promising activity raising the possibility that peptides can be developed to treat keratitis. PMID:25250986

  17. Speckle interferometric system to measure ocular microtremor

    NASA Astrophysics Data System (ADS)

    Ryle, James P.; Al-Kalbani, Mohammed; Collins, Niamh; Gopinathan, Unnikrishnan; Boyle, Gerard; Coakley, Davis; Sheridan, John T.

    2008-04-01

    Ocular microtremor (OMT) is a biological high frequency (up to 150Hz) low amplitude (25-2500nm peak to peak) involuntary motion of the human eye. Clinical OMT investigations to date have used eye-contacting mechanical piezoelectric probes or piezoelectric strain gauges. Before contact can be made, the eye must first be anaesthetized. In some cases, this eyelid spasms occur making it impossible to measure OMT. Using the contact probe method, the eye motion is mechanically loaded. Results from clinical studies with this method to date have given electrical signal amplitudes from the probe proportional to the displacement, but not the exact displacement information. Recent studies suggest a number of clinical applications for OMT, these include monitoring the depth of anesthesia of a patient in surgery, prediction of outcome in coma, diagnosis of brain stem death. In addition to this, in patients with neurological disorders such as Multiple Sclerosis and Parkinson's disease, abnormal OMT frequency content is present. In this paper, we design a compact non-contact phase modulating optical fiber speckle interferometer to measure eye motions. We simulate OMT motion using a calibrated piezoelectric vibration simulator and compare results produced using a contact method with those using our optical non-contact method.

  18. Contact lens sensors in ocular diagnostics.

    PubMed

    Farandos, Nicholas M; Yetisen, Ali K; Monteiro, Michael J; Lowe, Christopher R; Yun, Seok Hyun

    2015-04-22

    Contact lenses as a minimally invasive platform for diagnostics and drug delivery have emerged in recent years. Contact lens sensors have been developed for analyzing the glucose composition of tears as a surrogate for blood glucose monitoring and for the diagnosis of glaucoma by measuring intraocular pressure. However, the eye offers a wider diagnostic potential as a sensing site and therefore contact lens sensors have the potential to improve the diagnosis and treatment of many diseases and conditions. With advances in polymer synthesis, electronics and micro/nanofabrication, contact lens sensors can be produced to quantify the concentrations of many biomolecules in ocular fluids. Non- or minimally invasive contact lens sensors can be used directly in a clinical or point-of-care setting to monitor a disease state continuously. This article reviews the state-of-the-art in contact lens sensor fabrication, their detection, wireless powering, and readout mechanisms, and integration with mobile devices and smartphones. High-volume manufacturing considerations of contact lenses are also covered and a case study of an intraocular pressure contact lens sensor is provided as an example of a successful product. This Review further analyzes the contact lens market and the FDA regulatory requirements for commercialization of contact lens sensors. PMID:25400274

  19. Enucleation for Treating Rodent Ocular Disease

    PubMed Central

    Wilding, Laura A; Uchihashi, Mayu; Bergin, Ingrid L; Nowland, Megan H

    2015-01-01

    Our standard of care for rodent corneal lesions previously included treatment of the primary lesion, application of topical NSAIDs, and systemic NSAIDs in severe cases. When intensive medical management was unsuccessful, animals were euthanized, leading to premature loss of valuable genetically modified animals and those on long-term studies. We investigated enucleation surgery as a treatment for 15 cases of rodent corneal disease that did not respond to medical management. Enucleation was performed under isoflurane anesthesia and involved removal of the globe, extensive hemostasis, and packing the orbital space with absorbable gelatin sponge. The lid margins were closed by tarsorrhaphy and tissue glue. Analgesia was provided by using buprenorphine preoperatively and carprofen chew tabs postoperatively. To date, we have a 100% success rate with this procedure (n = 20; 15 clinically affected rodents [2 rats, 13 mice], 5 healthy controls), which included a 60-d follow-up period. The single complication involved dehiscence of the tarsorrhaphy site and was repaired by trimming the lid margins to provide fresh tissue for closure. Histologic examination at both 1 and 3 mo after surgery revealed no evidence of infection of the enucleation site. Enucleation in rodents is a straightforward procedure that represents a refinement to our current standard of care for rodents, does not cause significant inflammation of remaining periocular structures, and has reduced the number of animals euthanized prior to study endpoint because of severe ocular lesions. PMID:26045460

  20. Delusion and bi-ocular vision.

    PubMed

    De Masi, Franco

    2015-10-01

    The delusional experience is the result of a grave disjunction in the psyche whose outcome is not readily predictable. Examination of the specific mode of disjunction may help us understand the nature and radical character of delusion. I will present the therapy of a psychotic patient who after many years of analysis and progresses in his life continues to show delusional episodes although limited and contained. In his case, the two visions, one delusional and the other real, remain distinct and differentiated from each other because they both possess the same perceptual character, that of reality. He has a bi-ocular vision of reality and not a binocular one because his vision lacks integration, as would necessarily be the case if the two visions could be compared with each other. The principle of non-contradiction ceases to apply in delusion. A corollary of the failure of the principle of non-contradiction is that, if a statement and its negation are both true, then any statement is true. Logicians call this consequence the principle of explosion. For this reason, the distinction between truth, reality, improbability, probability, possibility and impossibility is lost in the delusional system, thus triggering an omnipotent, explosive mechanism with a potentially infinite progression. The paper presents some thoughts for a possible analytic transformation of the delusional experience. PMID:26298703

  1. Effect of gravitoinertial force on ocular counterrolling.

    NASA Technical Reports Server (NTRS)

    Miller, E. F., II; Graybiel, A.

    1971-01-01

    The effect of G loading on the magnitude of ocular counterrolling at various angles of tilt up to 63 deg. was measured on normal subjects and compared with the effect on persons with severe or complete loss of vestibular function. The group of six normal subjects manifested a compensatory eye roll which increased as a direct and essentially linear function of the component of the gravitoinertial force acting laterally on the subject. This increase in response was not observed in the five deaf subjects with severe or complete bilateral loss of their vestibular organs. These findings confirmed similar results found by other authors using other measuring techniques which show that the reflex eye movement is dependent on and limited to the magnitude of the gravitoinertial stimulus (within the range used) when the otolithocular system is functioning normally. However when this function is severely impaired or lost, the magnitude of the compensatory eye roll is limited to that manifested at 1 G and possibly to nonotolithic contributions. These findings offer means for differentiation between otolithic-defective and ?normal' persons who exhibit little counterrolling.

  2. Ocular following in humans: Spatial properties

    PubMed Central

    Quaia, Christian; Sheliga, Boris M.; FitzGibbon, Edmond J.; Optican, Lance M.

    2012-01-01

    Ocular following responses (OFRs) are tracking eye movements elicited at ultrashort latency by the sudden movement of a textured pattern. Here we report the results of our study of their dependency on the spatial arrangement of the motion stimulus. Unlike previous studies that looked at the effect of stimulus size, we investigated the impact of stimulus location and how two distinct stimuli, presented together, collectively determine the OFR. We used as stimuli vertical gratings that moved in the horizontal direction and that were confined to either one or two 0.58 high strips, spanning the width of the screen. We found that the response to individual strips varied as a function of the location and spatial frequency (SF) of the stimulus. The response decreased as the stimulus eccentricity increased, but this relationship was more accentuated at high than at low spatial frequencies. We also found that when pairs of stimuli were presented, nearby stimuli interacted strongly, so that the response to the pair was barely larger than the response to a single strip in the pair. This suppressive effect faded away as the separation between the strips increased. The variation of the suppressive interaction with strip separation, paired with the dependency on eccentricity of the responses to single strips, caused the peak response for strip pairs to be achieved at a specific separation, which varied as a function of SF. PMID:22523400

  3. [Internal astigmatism with other ocular lesions].

    PubMed

    Limaiem, R; Baba, A; Bouraoui, R; Mghaieth, F; El Matri, L

    2012-04-01

    Astigmatism is a refractive defect whose origin is not always purely corneal, and is sometimes the result of corneal, crystalline lens or mixte contributions. The aim of our study is to report, through two cases, ocular lesions associated with a lenticular astigmatism and their evolution after treatment. In the first observation, it is a 25-year-old patient with a unilateral extra corneal astigmatism within the framework of the "tilted disc syndrome" associated with bilateral myopia. This patient has received treatment by Lasik. The postoperative course was good with a decline of 5 ans. The second observation is that of a patient aged 35 years without having a general history with a posterior lenticonus associated with keratoconus responsible for a major mixed astigmatism. She received combined surgery: penetrating keratoplasty with lens extraction and implantation of an artificial lens. The evolution was good with good visual recovery. The balance of internal astigmatism must include the systematic achievement of a subjective and objective refraction under cycloplegia and corneal topography. The search for etiology is critical to screen for eye or general disease and guide the therapeutic strategy. Knowledge of the refractive power of the cornea and crystalline lens of astigmatism separately would be important for surgery refractive and crystalline lens surgery. PMID:22424808

  4. Blood-ocular barrier permeability in monkeys.

    PubMed

    Yoshida, A; Ishiko, S; Kojima, M; Lipsky, S N

    1992-02-01

    The permeability of the blood-ocular barrier was investigated in five monkeys using vitreous fluorophotometry (VFP). Inward permeability (Pin) of the blood-retinal barrier was calculated by a computer simulation method. Kinetic VFP was performed after intravitreal injection of fluorescein (F) or fluorescein monoglucuronide (FG). The estimated mean value of Pin (x10(-6) cm/min) was 4.8 (SD 1.2). The mean rates of loss (per hour) of F from the anterior chamber (Ka) and the vitreous (Kv) were 0.11 (SD 0.01) and 0.13 (SD 0.03), respectively, which were approximately three and four times greater than those of FG (0.04 (SD 0.01) and 0.03 (SD 0.01), respectively). Probenecid administered intraperitoneally decreased both the Ka and the Kv of F significantly but had no effect on the Ka or the Kv of FG, suggesting that F was excreted from the eye with the aid of the active transport mechanism. The results of comparative studies of the rates of loss of F from the anterior chamber (Ka) and from the vitreous (Kv) suggested that active transport was more predominant in the blood-retinal barrier than in the blood-aqueous barrier. PMID:1739721

  5. Infrared system for determining ocular position

    SciTech Connect

    Rinard, G.A.; Matteson, R.W.; Quine, R.W.; Tegtmeyer, R.S.

    1980-01-01

    Bioengineering research in the Electronics Division of the Denver Research Institute has centered around the development of an ocular controlled communications device for the severely handicapped. The means for accurate determination of eye position for use in communication/control applications have been investigated by various groups for at least ten years. A highly satisfactory device for eye tracking has been developed in our laboratories and is currently undergoing clinical evaluation as part of a communications system. An infrared LED is mounted on the nose pad of an ordinary pair of eyeglass frames. This LED floods the cornea with light after reflection from the inside surface of an unground eyeglass lens in the frames. The cornea acts as a convex mirror and reflects the light (via the inside surface of the eyeglass (lens) into an image transducer mounted on the bow of the frames. The image transducer is a 32 x 32 cell (1k) dynamic RAM. Utilizing TTL scanning circuitry, the position of the eye can be determined from the address of the illuminated cell of the RAM.

  6. Ocular Leishmaniasis Treated by Intralesional Amphotericin B

    PubMed Central

    Nikandish, Malihe; Goyonlo, Vahid Mashayekhi; Taheri, Ahmad Reza; Kiafar, Bita

    2016-01-01

    Leishmaniasis is a group of diseases with varied clinical manifestations. Ocular involvement is an unusual presentation of leishmaniasis, and the eyelid is not a common site of cutaneous lesions, likely due to the mobility of the lids. Some case reports of conjunctival involvement are either a contiguous dissemination from lid margin or in the setting of disseminated leishmaniasis in an immunocompromised host. To our knowledge, isolated involvement of the bulbar conjunctiva has not been reported. We present the first case in the literature of a patient with an erythematous fibrovascular lesion in the interpalpebral zone that was clinically diagnosed as pterygium, but recurred at the site of surgical excision. After histopathologic diagnosis, the lesion was treated with intralesional injection of amphotericin B and improved completely within a few weeks. An accurate diagnosis of leishmaniasis in the eye may be challenging in many clinical settings. To our knowledge, an isolated pterygium.like lesion has not been reported in literature. In addition, intralesional injection of amphotericin B is a novel treatment method in this setting.

  7. Ocular abnormalities in multi-transfused beta-thalassemia patients

    PubMed Central

    Jafari, Reza; Heydarian, Samira; Karami, Hosein; Shektaei, Mohammad Momeni; Dailami, Kiumars Noruzpour; Amiri, Ahmad Ahmadzadeh; Rezaee, Majid Reza Sheikh; Far, Asad Allah Farrokh

    2015-01-01

    Aims: The aim of this study was to assess ocular changes in thalassemia patients who have received multiple transfusions and chelate binding therapy in order to avoid iron accumulation. Settings and Design: A cross-sectional study. Subjects and Methods: A total of 54 thalassemia major patients were selected as case group, and 54 age- and sex-matched healthy subjects were regarded as a control group. Ocular examination included visual acuity, refraction testing, slit lamp examination, funduscopy, tonometry, perimetry, tear break-up time test, and color vision testing were performed for all the participants. We computed the frequency and duration of blood transfusion, the mean serum ferritin level, pretransfusion hemoglobin concentration, and type, duration, and daily dose of chelation therapy for thalassemia patients based on their records. Statistical Analysis Used: All data analysis was performed using SPSS, version 19. Results: All the thalassemic patients were asymptomatic, but abnormal ocular findings (dry eye (33.3%), cataract (10.2%), retinal pigment epithelium degeneration (16.7%), color vision deficiency (3.7%), and visual field defects (33.7%)) were seen in 68.5% of thalassemic group. The prevalence of ocular abnormalities in normal group was 19.4%, which was significantly lower than that in thalassemia patients (P = 0.000). No significant correlation was found between ocular abnormalities and mean serum ferritin level (P = 0.627) and mean hemoglobin concentration (P = 0.143). Correlation of number of blood transfusion with the presence of ocular abnormalities was found to be statistically significant (P = 0.005). Conclusions: As life expectancy for beta-thalassemia patients extends, regular ophthalmological evaluation to detect early changes in their ocular system is recommended. PMID:26632126

  8. Modulating ocular dominance in the adult in real time.

    PubMed

    Hess, Robert; Zhou, Jiawei; Reynaud, Alexandre

    2015-09-01

    Using a dichoptic spatial phase combination paradigm that assesses the relative contribution that each eye makes to the binocular percept (ocular dominance), we have shown previously that 2.5 hours of patching, be it opaque or translucent, can result in a short-term enhancement of the patched eye's contribution to binocularity. This suggests that it is differential pattern deprivation, rather than the differential luminance deprivation that is driving this ocular dominance change. Here we ask what aspects of the pattern stimulation are important for ocular dominance. Observers dichoptically viewed movies of 2-3 hrs duration in which the spatial information in one eye's view had been altered (pattern deprivation). We measured each eye's contribution to the binocular percept before and after movie viewing using the dichoptic spatial phase task. Scrambling the spatial phases in one eye's view had no effect on ocular dominance, suggesting features constructed from phase-aligned components are unimportant in this regard. At the level at which these changes in dominance occurs only the Fourier amplitude spectrum is important. To verify this we show that graded changes to the magnitude of the amplitude spectrum result in graded changes in ocular dominance. To ascertain whether different parts of the amplitude spectrum are more important than others, we compared highpass with lowpass filtering and show that only the latter affects dominance. Finally, the ocular dominance change is not orientationally-dependent, suggesting the underlying mechanism is isotropic. Short-term changes in ocular dominance in adults can be obtained by altering the contrast of isotropic, high spatial frequency components seen by one eye. Meeting abstract presented at VSS 2015. PMID:26326515

  9. Risk Factors for Ocular Chlamydia after Three Mass Azithromycin Distributions

    PubMed Central

    Ayele, Berhan; Gebre, Teshome; Moncada, Jeanne; House, Jenafir I.; Stoller, Nicole E.; Zhou, Zhaoxia; Porco, Travis C.; Gaynor, Bruce D.; Emerson, Paul M.; Schachter, Julius; Keenan, Jeremy D.

    2011-01-01

    Background An important component of the World Health Organization's comprehensive trachoma elimination strategy is the provision of repeated annual mass azithromycin distributions, which are directed at reducing the burden of ocular chlamydia. Knowledge of characteristics associated with infection after mass antibiotic treatments could allow trachoma programs to focus resources to those most likely to be infected with ocular chlamydia. Methodology/Principal Findings We monitored 12 communities in rural Ethiopia that had received 3 annual mass azithromycin treatments as part of a cluster-randomized trial for trachoma. One year after the third treatment, a random sample of children from each village received conjunctival examination for follicular trachomatous inflammation (TF) and intense trachomatous inflammation (TI), conjunctival swabbing for chlamydial RNA and DNA, and a household survey. The primary outcome for this study was RNA evidence of ocular chlamydia, which we detected in 41 of 573 swabbed children (7.2%, 95%CI 2.7–17.8). In multivariate mixed effects logistic regression models, ocular chlamydial RNA was significantly associated with ocular discharge (OR 2.82, 95%CI 1.07–7.42), missing the most recent mass azithromycin treatment (OR 2.49, 95%CI 1.02–6.05), having a sibling with ocular chlamydia (OR 4.44, 95%CI 1.60–12.29), and above-median community population (OR 7.81, 95%CI 1.56–39.09). Ocular chlamydial infection was also independently associated with TF (OR 3.42, 95%CI 1.56–7.49) and TI (OR 5.39, 95%CI 2.43–11.98). Conclusions/Significance In areas with highly prevalent trachoma treated with multiple rounds of mass azithromycin, trachoma programs could consider continuing mass azithromycin treatments in households that have missed prior mass antibiotic treatments, in households with clinically active trachoma, and in larger communities. PMID:22180804

  10. Ocular immune privilege and ocular melanoma: parallel universes or immunological plagiarism?

    PubMed

    Niederkorn, Jerry Y

    2012-01-01

    Evidence of immune privilege in the eye was recorded almost 140?years ago, yet interest in immune privilege languished for almost a century. However, the past 35?years have witnessed a plethora of research and a rekindled interest in the mechanisms responsible for immune privilege in the anterior chamber of the eye. This research has demonstrated that multiple anatomical, structural, physiological, and immunoregulatory processes contribute to immune privilege and remind us of the enormous complexity of this phenomenon. It is widely accepted that immune privilege is an adaptation for reducing the risk of immune-mediated inflammation in organs such as the eye and brain whose tissues have a limited capacity to regenerate. Recent findings suggest that immune privilege also occurs in sites where stem cells reside and raise the possibility that immune privilege is also designed to prevent the unwitting elimination of stem cells by immune-mediated inflammation at these sites. Uveal melanoma arises within the eye and as such, benefits from ocular immune privilege. A significant body of research reveals an intriguing parallel between the mechanisms that contribute to immune privilege in the eye and those strategies used by uveal melanoma cells to evade immune elimination once they have disseminated from the eye and establish metastatic foci in the liver. Uveal melanoma metastases seem to have "plagiarized" the blueprints used for ocular immune privilege to create "ad hoc immune privileged sites" in the liver. PMID:22707951

  11. Prospective Observational Study of Ocular Health in ISS Crews - The Ocular Health Study

    NASA Technical Reports Server (NTRS)

    Otto, C.; Barr, Y.; Platts, S.; Ploutz-Snyder, R.; Sargsyan, A.; Alexander, D.; Riascos, R.; Gibson, C.; Patel, N.

    2015-01-01

    INTRODUCTION: The Visual Impairment Intracranial Pressure (VIIP) syndrome is currently NASA's number one human space flight risk. The syndrome, which is related to microgravity exposure, manifests with changes in visual acuity (hyperopic shifts, scotomas), changes in eye structure (optic disc edema, choroidal folds, cotton wool spots, globe flattening, and dilated optic nerve sheaths), and in some cases with documented increased intracranial pressure (ICP) postflight. While the eye appears to be the main affected end organ of this syndrome, the ocular effects are thought to be related to underlying changes in the vascular system and the central nervous system. The leading hypotheses for the development of VIIP involve microgravity-induced head-ward fluid shifts along with a loss of gravity-assisted drainage of venous blood from the brain, leading to cephalic congestion, decreased CSF resorption and increased ICP. Since 70% of ISS crewmembers have manifested clinical signs or symptoms of the VIIP syndrome, it is assumed that the majority have some degree of ICP elevation in-flight compared to the ground. Prolonged elevations of ICP can cause long-term reduced visual acuity and loss of peripheral visual fields, and have been reported to cause mild cognitive impairment in the analog terrestrial population of Idiopathic Intracranial Hypertension (IIH). These potentially irreversible health consequences underscore the importance of identifying the factors that lead to this syndrome and mitigating them. METHODS: The Ocular Health study expands on the required in-flight medical testing required of long-duration crewmembers assigned to an International Space Station (ISS) mission, to include 13 sessions over a three-year period. Pre- and postflight evaluations include functional eye exams (visual testing), structural eye exams (fundoscopy, ocular ultrasound, optical coherence tomography, optical biometry and biomicroscopy), intraocular pressure (IOP, tonometry), cardiovascular compliance (via ultrasound with concurrent ECG and blood pressure), noninvasive intracranial pressure (via pulsatility index, measured by transcranial Doppler), and Magnetic Resonance Imaging (MRI) to assess brain anatomy. In-flight evaluations include visual testing, optical coherence tomography, fundoscopy, tonometry, cardiovascular compliance and transcranial Doppler. RESULTS: Preflight, in-flight and postflight data will be presented for five Ocular Health subjects. These data will include: visual acuity, refraction, fundoscopy, OCT, ocular ultrasound, vascular compliance, TCD, IOP and MRI. One-year postflight data will be presented for two of these subjects. Data indicates that vascular compliance, retro-orbital pressure and IOP affect retinal nerve fiber layer swelling. DISCUSSION: This prospective study aims to understand the etiology of the VIIP syndrome, establish preflight baseline characteristics, define the temporal sequence for the appearance of signs and symptoms, characterize the nature of in-flight changes, document the postflight time course for recovery to baseline, and determine the impact of prolonged changes on crew health. Data from this study will improve the understanding of VIIP incidence, signs, symptoms, susceptibilities, timeline for development and recovery, and aid in guiding the development of countermeasures and targeted treatments for preventing the VIIP syndrome and its complications.

  12. Pathophysiology of ocular surface squamous neoplasia

    PubMed Central

    Gichuhi, Stephen; Ohnuma, Shin-ichi; Sagoo, Mandeep S.; Burton, Matthew J.

    2014-01-01

    The incidence of ocular surface squamous neoplasia (OSSN) is strongly associated with solar ultraviolet (UV) radiation, HIV and human papilloma virus (HPV). Africa has the highest incidence rates in the world. Most lesions occur at the limbus within the interpalpebral fissure particularly the nasal sector. The nasal limbus receives the highest intensity of sunlight. Limbal epithelial crypts are concentrated nasally and contain niches of limbal epithelial stem cells in the basal layer. It is possible that these are the progenitor cells in OSSN. OSSN arises in the basal epithelial cells spreading towards the surface which resembles the movement of corneo-limbal stem cell progeny before it later invades through the basement membrane below. UV radiation damages DNA producing pyrimidine dimers in the DNA chain. Specific CC → TT base pair dimer transformations of the p53 tumour-suppressor gene occur in OSSN allowing cells with damaged DNA past the G1-S cell cycle checkpoint. UV radiation also causes local and systemic photoimmunosuppression and reactivates latent viruses such as HPV. The E7 proteins of HPV promote proliferation of infected epithelial cells via the retinoblastoma gene while E6 proteins prevent the p53 tumour suppressor gene from effecting cell-cycle arrest of DNA-damaged and infected cells. Immunosuppression from UV radiation, HIV and vitamin A deficiency impairs tumour immune surveillance allowing survival of aberrant cells. Tumour growth and metastases are enhanced by; telomerase reactivation which increases the number of cell divisions a cell can undergo; vascular endothelial growth factor for angiogenesis and matrix metalloproteinases (MMPs) that destroy the intercellular matrix between cells. Despite these potential triggers, the disease is usually unilateral. It is unclear how HPV reaches the conjunctiva. PMID:25447808

  13. Pathophysiology of ocular surface squamous neoplasia.

    PubMed

    Gichuhi, Stephen; Ohnuma, Shin-ichi; Sagoo, Mandeep S; Burton, Matthew J

    2014-12-01

    The incidence of ocular surface squamous neoplasia (OSSN) is strongly associated with solar ultraviolet (UV) radiation, HIV and human papilloma virus (HPV). Africa has the highest incidence rates in the world. Most lesions occur at the limbus within the interpalpebral fissure particularly the nasal sector. The nasal limbus receives the highest intensity of sunlight. Limbal epithelial crypts are concentrated nasally and contain niches of limbal epithelial stem cells in the basal layer. It is possible that these are the progenitor cells in OSSN. OSSN arises in the basal epithelial cells spreading towards the surface which resembles the movement of corneo-limbal stem cell progeny before it later invades through the basement membrane below. UV radiation damages DNA producing pyrimidine dimers in the DNA chain. Specific CC ? TT base pair dimer transformations of the p53 tumour-suppressor gene occur in OSSN allowing cells with damaged DNA past the G1-S cell cycle checkpoint. UV radiation also causes local and systemic photoimmunosuppression and reactivates latent viruses such as HPV. The E7 proteins of HPV promote proliferation of infected epithelial cells via the retinoblastoma gene while E6 proteins prevent the p53 tumour suppressor gene from effecting cell-cycle arrest of DNA-damaged and infected cells. Immunosuppression from UV radiation, HIV and vitamin A deficiency impairs tumour immune surveillance allowing survival of aberrant cells. Tumour growth and metastases are enhanced by; telomerase reactivation which increases the number of cell divisions a cell can undergo; vascular endothelial growth factor for angiogenesis and matrix metalloproteinases (MMPs) that destroy the intercellular matrix between cells. Despite these potential triggers, the disease is usually unilateral. It is unclear how HPV reaches the conjunctiva. PMID:25447808

  14. [Ocular motor abnormalities in progressive supranuclear palsy].

    PubMed

    Okuma, Y; Nagashima, T; Hirose, K; Tanabe, H; Tsubaki, T; Mizuno, M

    1989-02-01

    Eleven patients, 7 males and 4 females, of progressive supranuclear palsy (PSP) were examined neuro-otologically for the purpose of elucidating the characteristics of ocular motor abnormalities. All cases were admitted to our hospital and age at onset was from 52 to 71 years old, duration of illness was 2 to 11 years. Range of voluntary eye movements and abnormal eye movements including nystagmus were examined on naked eyes and with electronystagmography (ENG). Smooth pursuit movements and saccadic eye movements were tested both horizontally and vertically by using visual tracking method with ENG recordings. Optokinetic nystagmus test and caloric test with visual suppression test were also performed. These neurotological examinations were made repetitively in 5 cases and their progressions were observed. Vertical gaze palsy and convergence palsy were observed in all cases as the initial symptom. In this study downward gaze was more severely disturbed than upward gaze. Using ENG, saccadic eye movements (saccades) were disturbed earlier than smooth pursuit movements. Hypometric saccades and decreased saccadic velocity were common abnormalities. In the later stage of the disease, horizontal eye movements were also disturbed. In four cases bilateral adduction palsy was added to vertical gaze paralysis so that the lesion of the MLF to oculomotor nucleus was suggested to exist. These voluntary eye movements were worsened gradually as the disease progressed. By using ENG we could find so called abnormal eye movements more frequently than the previous reports. Eight patients demonstrated horizontal gaze nystagmus, and rebound nystagmus were observed in four cases.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2736143

  15. Diabetic retinopathy - ocular complications of diabetes mellitus

    PubMed Central

    Nentwich, Martin M; Ulbig, Michael W

    2015-01-01

    In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the working-age population. In the next 15 years, the number of patients suffering from diabetes mellitus is expected to increase significantly. By the year 2030, about 440 million people in the age-group 20-79 years are estimated to be suffering from diabetes mellitus worldwide (prevalence 7.7%), while in 2010 there were 285 million people with diabetes mellitus (prevalence 6.4%). This accounts for an increase in patients with diabetes in industrialized nations by 20% and in developing countries by 69% until the year 2030. Due to the expected rise in diabetic patients, the need for ophthalmic care of patients (i.e., exams and treatments) will also increase and represents a challenge for eye-care providers. Development of optimized screening programs, which respect available resources of the ophthalmic infrastructure, will become even more important. Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy. Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels. Additionally, regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy. In this way, the risk of blindness can considerably be reduced. In advanced stages of diabetic retinopathy, pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment. In recent years, the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema. PMID:25897358

  16. Ocular disease in American crocodiles (Crocodylus acutus) in Costa Rica.

    PubMed

    Rainwater, Thomas R; Millichamp, Nicholas J; Barrantes, Luz Denia Barrantes; Barr, Brady R; Montero, Juan R Bolaos; Platt, Steven G; Abel, Mike T; Cobb, George P; Anderson, Todd A

    2011-04-01

    Beginning in early 2006, an ocular disease of unknown etiology was routinely observed in American crocodiles (Crocodylus acutus) inhabiting the highly polluted Tarcoles River in west-central Costa Rica. We examined the nature and incidence of ocular disease in Tarcoles crocodiles and assessed the possible association between the disease and accumulation of chemical pollutants in diseased individuals. During 12-15 September and 12-13 December 2007, crocodiles were captured and examined for ocular disease and sampled to determine environmental contaminant accumulation. Three of 11 (27.3%) crocodiles captured (all males) exhibited unilateral ocular disease, primarily characterized by corneal opacity and scarring, anterior synechia, and phthisis bulbi. Multiple pollutants were detected in crocodile caudal scutes (organochlorine pesticides [OCPs] and metals), crocodile blood (OCPs), and sediments (OCPs and metals) from the Tarcoles, but no associations were found between contaminant accumulation and the incidence of eye disease. On the basis of the limited number of diseased animals examined and the potential exposure of crocodiles to pathogens and other pollutants not targeted in this study, we cannot rule out infection or chemical toxicosis as causes of the eye lesions. However, circumstantial evidence suggests that the observed ocular disease is likely the result of injury-induced trauma (and possibly secondary infection) inflicted during aggressive encounters (e.g., territorial combat) among large adult crocodiles living at relatively high densities. PMID:21441195

  17. Optical Coherence Tomography as a Tool for Ocular Dynamics Estimation

    PubMed Central

    Siedlecki, Damian; Kowalik, Waldemar; Kasprzak, Henryk

    2015-01-01

    Purpose. The aim of the study is to demonstrate that the ocular dynamics of the anterior chamber of the eye can be estimated quantitatively by means of optical coherence tomography (OCT). Methods. A commercial high speed, high resolution optical coherence tomographer was used. The sequences of tomographic images of the iridocorneal angle of three subjects were captured and each image from the sequence was processed in MATLAB environment in order to detect and identify the contours of the cornea and iris. The data on pulsatile displacements of the cornea and iris and the changes of the depth of the gap between them were retrieved from the sequences. Finally, the spectral analysis of the changes of these parameters was performed. Results. The results of the temporal and spectral analysis manifest the ocular microfluctuation that might be associated with breathing (manifested by 0.25 Hz peak in the power spectra), heart rate (1–1.5 Hz peak), and ocular hemodynamics (3.75–4.5 Hz peak). Conclusions. This paper shows that the optical coherence tomography can be used as a tool for noninvasive estimation of the ocular dynamics of the anterior segment of the eye, but its usability in diagnostics of the ocular hemodynamics needs further investigations. PMID:26557659

  18. Reproducibility of Neonate Ocular Circulation Measurements Using Laser Speckle Flowgraphy

    PubMed Central

    Matsumoto, Tadashi; Itokawa, Takashi; Shiba, Tomoaki; Katayama, Yuji; Arimura, Tetsushi; Mizukaki, Norio; Yoda, Hitoshi; Hori, Yuichi

    2015-01-01

    Measuring the ocular blood flow in neonates may clarify the relationships between eye diseases and ocular circulation abnormalities. However, no method for noninvasively measuring ocular circulation in neonates is established. We used laser speckle flowgraphy (LSFG) modified for neonates to measure their ocular circulation and investigated whether this method is reproducible. During their normal sleep, we studied 16 subjects (adjusted age of 34–48 weeks) whose blood flow could be measured three consecutive times. While the subjects slept in the supine position, three mean blur rate (MBR) values of the optic nerve head (ONH) were obtained: the MBR-A (mean of all values), MBR-V (vessel mean), and MBR-T (tissue mean), and nine blood flow pulse waveform parameters in the ONH were examined. We analyzed the coefficient of variation (COV) and the intraclass correlation coefficient (ICC) for each parameter. The COVs of the MBR values were all ≤10%. The ICCs of the MBR values were all >0.8. Good COVs were observed for the blowout score, blowout time, rising rate, falling rate, and acceleration time index. Although the measurement of ocular circulation in the neonates was difficult, our results exhibited reproducibility, suggesting that this method could be used in clinical research. PMID:26557689

  19. Nanocarriers in ocular drug delivery: an update review.

    PubMed

    Wadhwa, Sheetu; Paliwal, Rishi; Paliwal, Shivani Rai; Vyas, S P

    2009-01-01

    Controlled drug delivery to eye is one of the most challenging fields of pharmaceutical research. Low drug-contact time and poor ocular bioavailability due to drainage of solution, tear turnover and its dilution or lacrimation are the problems associated with conventional systems. In addition, anatomical barriers and physiological conditions of eye are also important parameters which control designing of drug delivery systems. Nanosized carriers like micro/nano-suspensions, liposome, niosome, dendrimer, nanoparticles, ocular inserts, implants, hydrogels and prodrug approaches have been developed for this purpose. These novel systems offer manifold advantages over conventional systems as they increase the efficiency of drug delivery by improving the release profile and also reduce drug toxicity. Conventional delivery systems get diluted with tear, washed away through the lacrimal gland and usually require administering at regular time intervals whereas nanocarriers release drug at constant rate for a prolonged period of time and thus enhance its absorption and site specific delivery. This review presents an overview of the various aspects of the ocular drug delivery, with special emphasis on nanocarrier based strategies, including structure of eye, its barriers, delivery routes and the challenges/limitations associated with development of novel nanocarriers. The recent progresses in therapy of ocular disease like gene therapy have also been included so that future options should also be considered from the delivery point of view. Recent progress in the delivery of proteins and peptides via ocular route has also been incorporated for reader benefit. PMID:19689343

  20. Science and Art of Cell-Based Ocular Surface Regeneration.

    PubMed

    Singh, Vivek; Shukla, Sachin; Ramachandran, Charanya; Mishra, Dilip Kumar; Katikireddy, Kishore R; Lal, Ikeda; Chauhan, Sunil K; Sangwan, Virender S

    2015-01-01

    The potential cause of blindness worldwide includes diseases of the cornea, ocular surface (limbal stem cell deficiency, allergic conjunctivitis, dry eye diseases), and retinal diseases. The presence of stem cells (limbal stem cells) in the basal region of the limbus makes it an important tool for the ocular regeneration and also in maintaining the transparency of eye by replacing the corneal epithelium continuously. Various surgical modalities have been developed like cultured limbal epithelial transplantation, cultured oral mucosal epithelial transplantation, simple limbal epithelial transplantation, etc., utilizing the cell-based regenerative properties to treat limbal disorder. Cell-based therapies for ocular repair and regeneration comprise a major hope by therapies involving the mesenchymal stem cells, embryonic stem cells, and limbal stem cells for the restoration of vision in individuals whose ocular tissue has been irreversibly damaged by disease or trauma. This review explores critical needs in human disease mainly the ocular problem where cell-based therapeutics is exceptionally well suited and also the use of animal models, various artificial scaffolds, as well as advancement in clinical technique to challenge the current demand to overcome corneal blindness. PMID:26404466

  1. Design of an Implantable Device for Ocular Drug Delivery

    PubMed Central

    Lee, Jae-Hwan; Pidaparti, Ramana M.; Atkinson, Gary M.; Moorthy, Ramana S.

    2012-01-01

    Ocular diseases, such as, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, and retinitis pigmentosa require drug management in order to prevent blindness and affecting million of adults in USA and worldwide. There is an increasing need to develop devices for drug delivery to address ocular diseases. This study focuses on the design, simulation, and development of an implantable ocular drug delivery device consisting of micro-/nanochannels embedded between top and bottom covers with a drug reservoir made from polydimethylsiloxane (PDMS) which is silicon-based organic and biodegradable polymer. Several simulations were carried out with six different micro-channel configurations in order to see the feasibility for ocular drug delivery applications. Based on the results obtained, channel design of osmotic I and osmotic II satisfied the diffusion rates required for ocular drug delivery. Finally, a prototype illustrating the three components of the drug delivery design is presented. In the future, the device will be tested for its functionality and diffusion characteristics. PMID:22919500

  2. Ocular vergence measurement in projected and collimated simulator displays.

    PubMed

    Morahan, P; Meehan, J W; Patterson, J; Hughes, P K

    1998-09-01

    The purpose of this study was to investigate electrooculography (EOG) as a measurement of ocular vergence in both collimated and projected simulator environments. The task required participants to shift their gaze between a central fixation point and a target appearing at one of three eccentricities. EOG was effective in recording ocular vergence. The EOG results were similar between collimated and projected displays, except for differences in vergence changes during lateral movement of the eyes, and ocular excursions downward elicited a greater EOG response than the reverse upward movement. The computer-based technique of recording vergence was found to produce measurable traces from a majority of participants. The technique has potential for further development as a tool for measuring ocular vergence in virtual environments where methods that require the wearing of head-mounted apparatus to track ocular structures (e.g., the pupil), which cannot be worn at the same time as a flight or flight-simulator helmet, are unsuitable. PMID:9849100

  3. Ocular Surface Temperature in Age-Related Macular Degeneration

    PubMed Central

    Sodi, Andrea; Giacomelli, Giovanni; Corvi, Andrea; Menchini, Ugo

    2014-01-01

    Background. The aim of this study is to investigate the ocular thermographic profiles in age-related macular degeneration (AMD) eyes and age-matched controls to detect possible hemodynamic abnormalities, which could be involved in the pathogenesis of the disease. Methods. 32 eyes with early AMD, 37 eyes with atrophic AMD, 30 eyes affected by untreated neovascular AMD, and 43 eyes with fibrotic AMD were included. The control group consisted of 44 healthy eyes. Exclusion criteria were represented by any other ocular diseases other than AMD, tear film abnormalities, systemic cardiovascular abnormalities, diabetes mellitus, and a body temperature higher than 37.5°C. A total of 186 eyes without pupil dilation were investigated by infrared thermography (FLIR A320). The ocular surface temperature (OST) of three ocular points was calculated by means of an image processing technique from the infrared images. Two-sample t-test and one-way analysis of variance (ANOVA) test were used for statistical analyses. Results. ANOVA analyses showed no significant differences among AMD groups (P value >0.272). OST in AMD patients was significantly lower than in controls (P > 0.05). Conclusions. Considering the possible relationship between ocular blood flow and OST, these findings might support the central role of ischemia in the pathogenesis of AMD. PMID:25436140

  4. Ocular surface temperature in age-related macular degeneration.

    PubMed

    Sodi, Andrea; Matteoli, Sara; Giacomelli, Giovanni; Finocchio, Lucia; Corvi, Andrea; Menchini, Ugo

    2014-01-01

    Background. The aim of this study is to investigate the ocular thermographic profiles in age-related macular degeneration (AMD) eyes and age-matched controls to detect possible hemodynamic abnormalities, which could be involved in the pathogenesis of the disease. Methods. 32 eyes with early AMD, 37 eyes with atrophic AMD, 30 eyes affected by untreated neovascular AMD, and 43 eyes with fibrotic AMD were included. The control group consisted of 44 healthy eyes. Exclusion criteria were represented by any other ocular diseases other than AMD, tear film abnormalities, systemic cardiovascular abnormalities, diabetes mellitus, and a body temperature higher than 37.5°C. A total of 186 eyes without pupil dilation were investigated by infrared thermography (FLIR A320). The ocular surface temperature (OST) of three ocular points was calculated by means of an image processing technique from the infrared images. Two-sample t-test and one-way analysis of variance (ANOVA) test were used for statistical analyses. Results. ANOVA analyses showed no significant differences among AMD groups (P value >0.272). OST in AMD patients was significantly lower than in controls (P > 0.05). Conclusions. Considering the possible relationship between ocular blood flow and OST, these findings might support the central role of ischemia in the pathogenesis of AMD. PMID:25436140

  5. Liposomes and nanotechnology in drug development: focus on ocular targets

    PubMed Central

    Honda, Miki; Asai, Tomohiro; Oku, Naoto; Araki, Yoshihiko; Tanaka, Minoru; Ebihara, Nobuyuki

    2013-01-01

    Poor drug delivery to lesions in patients eyes is a major obstacle to the treatment of ocular diseases. The accessibility of these areas to drugs is highly restricted by the presence of barriers, including the corneal barrier, aqueous barrier, and the inner and outer bloodretinal barriers. In particular, the posterior segment is difficult to reach for drugs because of its structural peculiarities. This review discusses various barriers to drug delivery and provides comprehensive information for designing nanoparticle-mediated drug delivery systems for the treatment of ocular diseases. Nanoparticles can be designed to improve penetration, controlled release, and drug targeting. As highlighted in this review, the therapeutic efficacy of drugs in ocular diseases has been reported to be enhanced by the use of nanoparticles such as liposomes, micro/nanospheres, microemulsions, and dendrimers. Our recent data show that intravitreal injection of targeted liposomes encapsulating an angiogenesis inhibitor caused significantly greater suppression of choroidal neovascularization than did the injection of free drug. Recent progress in ocular drug delivery systems research has provided new insights into drug development, and the use of nanoparticles for drug delivery is thus a promising approach for advanced therapy of ocular diseases. PMID:23439842

  6. PEDIATRIC OCULAR TOXOCARIASIS IN JIANGSU PROVINCE, EASTERN CHINA.

    PubMed

    Zhang, Hai-Fang; Hua, Hai-Yong; Wang, Wei

    2015-01-01

    Ocular toxocariasis is caused by migration of a Toxocara larva through the posterior eye. We report the first case of pediatric ocular toxocariasis caused by T. canis in Jiangsu Province, eastern China. A 6-year-old girl presented to Suzhou Municipal Children's Hospital with a complaint of right eye redness, minimal white discharge, no photophobia, eye pain, visual impairment, fever or arthralgia. She was initially diagnosed as having conjunctivitis; however, a 2-month treatment with lomefloxacin 0.3% eye drops gave no improvements. The diagnosis was made based on medical history (contact with dogs), clinical features and detection of T. canis IgG antibodies with an enzyme-linked immunosorbent assay (ELISA). Anthelmintic therapy with albendazole in combination with prednisolone resulted in improvement of the ocular symptoms. Ocular toxocariasis is rarely reported in China. However, the rapid economic development in China, could mean an increase in pet dogs with the potential increased risk of contracting toxocariasis if no control measures are taken. Disposal of pet litter, deworming of infected pets, complete cooking of meats, thorough rinsing of fruits and vegetables, and good hand-washing may help prevent human infections. Ocular toxocariasis should be considered in the differential diagnosis of patients with conjunctivitis that does not resolve with treatment. PMID:26513899

  7. Acute ocular complications from self-administered topical kermes.

    PubMed

    Al-Ghadeer, Huda A

    2010-10-01

    To report severe ocular complications and their management after self-administered topical kermes dye eye drops. A case report of a 55-year-old man who suffered severe ocular surface damage after application of topical kermes eye drops to his left eye. Active compounds of the kermes eye drops were studied for their composition. Patient reported decreased vision in the affected eye and the external eye examination revealed complete corneal abrasion, cicatrization of the conjunctiva, and symblepharon formation. The patient required immediate cleansing of the ocular surface along with irrigation. He was treated with topical corticosteroids and frequent lubrication. Gas chromatography/mass spectrometry analysis of the retrieved topical material revealed the presence of acid. The patient's visual acuity improved from 20/200 before treatment to 20/25 after treatment. Topically administered kermes eye drops may cause severe ocular injuries. Public education, early recognition of such injuries, and timely intervention may prevent permanent damage to the ocular adnexae. PMID:21180445

  8. Acute Ocular Complications from Self-Administered Topical Kermes

    PubMed Central

    Al-Ghadeer, Huda A.

    2010-01-01

    To report severe ocular complications and their management after self-administered topical kermes dye eye drops. A case report of a 55-year-old man who suffered severe ocular surface damage after application of topical kermes eye drops to his left eye. Active compounds of the kermes eye drops were studied for their composition. Patient reported decreased vision in the affected eye and the external eye examination revealed complete corneal abrasion, cicatrization of the conjunctiva, and symblepharon formation. The patient required immediate cleansing of the ocular surface along with irrigation. He was treated with topical corticosteroids and frequent lubrication. Gas chromatography/mass spectrometry analysis of the retrieved topical material revealed the presence of acid. The patients visual acuity improved from 20/200 before treatment to 20/25 after treatment. Topically administered kermes eye drops may cause severe ocular injuries. Public education, early recognition of such injuries, and timely intervention may prevent permanent damage to the ocular adnexae. PMID:21180445

  9. Ocular manifestations of graft-versus-host disease.

    PubMed

    Nassar, Amr; Tabbara, Khalid F; Aljurf, Mahmoud

    2013-07-01

    Allogeneic hematopoietic stem cell transplantation (HSCT) has evolved over the past two decades to become the standard of care for hematologic and lymphoid malignancies. Major ocular complications after allogeneic HSCT have been increasing in number and severity. Graft-versus-host disease (GVHD) remains a major cause of ocular morbidity after allogeneic HSCT. The main objective of this review is to elucidate the ocular complications in patients developing GVHD following HSCT. Ocular complications secondary to GVHD are common and include dry eye syndrome, acquisition of ocular allergy from donors with allergic disorders. Eyelid changes may occur in GVHD leading to scleroderma-like changes. Patients may develop poliosis, madarosis, vitiligo, lagophthalmos, and entropion. The cornea may show filamentary keratitis, superficial punctate keratitis, corneal ulcers, and peripheral corneal melting which may lead to perforation in severe cases. Scleritis may also occur which can be anterior or posterior. Keratoconjunctivis sicca appears to be the most common presentation of GVHD. The lacrimal glands may be involved with mononuclear cell infiltration of both the major and accessory lacrimal glands and decrease in tear production. Severe dry eye syndrome in patients with GVHD may develop conjunctival scarring, keratinization, and cicatrization of the conjunctiva. Therapy of GVHD includes systemic immunosuppression and local therapy. Surgical treatment in refractory cases includes surgical intervention to improve the manifestation of GVHD of the eye. This may include tarsorrhapy, prose lenses, punctal occlusions and corneal transplantation. PMID:24227989

  10. A survey on computer aided diagnosis for ocular diseases

    PubMed Central

    2014-01-01

    Background Computer Aided Diagnosis (CAD), which can automate the detection process for ocular diseases, has attracted extensive attention from clinicians and researchers alike. It not only alleviates the burden on the clinicians by providing objective opinion with valuable insights, but also offers early detection and easy access for patients. Method We review ocular CAD methodologies for various data types. For each data type, we investigate the databases and the algorithms to detect different ocular diseases. Their advantages and shortcomings are analyzed and discussed. Result We have studied three types of data (i.e., clinical, genetic and imaging) that have been commonly used in existing methods for CAD. The recent developments in methods used in CAD of ocular diseases (such as Diabetic Retinopathy, Glaucoma, Age-related Macular Degeneration and Pathological Myopia) are investigated and summarized comprehensively. Conclusion While CAD for ocular diseases has shown considerable progress over the past years, the clinical importance of fully automatic CAD systems which are able to embed clinical knowledge and integrate heterogeneous data sources still show great potential for future breakthrough. PMID:25175552

  11. The role of nitric oxide in ocular surface cells.

    PubMed

    Kim, Jae Chan; Park, Gun Sic; Kim, Jin Kook; Kim, Young Myeong

    2002-06-01

    The role of nitric oxide (NO) in the ocular surface remains unknown. We investigated the conditions leading to an increase of NO generation in tear and the main sources of NO in ocular surface tissue. We evaluated the dual action (cell survival or cell death) of NO depending on its amount. We measured the concentration of nitrite plus nitrate in the tears of ocular surface diseases and examined the main source of nitric oxide synthase (NOS). When cultured human corneal fibroblast were treated with NO producing donor with or without serum, the viabilities of cells was studied. We found that the main sources of NO in ocular surface tissue were corneal epithelium, fibroblast, endothelium, and inflammatory cells. Three forms of NOS (eNOS, bNOS, and iNOS) were expressed in experimentally induced inflammation. In the fibroblast culture system, the NO donor (SNAP, S-nitroso-N-acetyl-D, L-penicillamine) prevented the death of corneal fibroblast cells caused by serum deprivation in a dose dependent manner up to 500 micrometer SNAP, but a higher dose decreased cell viability. This study suggested that NO might act as a double-edged sword in ocular surface diseases depending on the degree of inflammation related with NO concentration. PMID:12068145

  12. The Great Imitator: Ocular Syphilis Presenting as Posterior Uveitis

    PubMed Central

    Kuo, Alan; Ziaee, Saba M.; Hosseini, Hamid; Voleti, Vinod; Schwartz, Steven D.; Kim, Nam U.; Ge, Phillip S.

    2015-01-01

    Patient: Female, 34 Final Diagnosis: Ocular syphilis Symptoms: Painful unilateral vision loss Medication: Benzylpenicillin Clinical Procedure: Lumbar puncture Specialty: Infectious Diseases Ophthalmology Objective: Rare disease Background: Syphilis is often known as the Great Imitator. The differential diagnosis of posterior uveitis is broad with ocular syphilis being particularly challenging to diagnose as it presents similarly to other ocular conditions such as acute retinal necrosis. Case Report: A 34-year-old woman with multiple sexual partners over the past few years presented with painful and progressively worsening unilateral vision loss for 2 weeks. Several months prior, she had reported non-specific symptoms of headache and diffuse skin rash. Despite treatment with oral acyclovir for 3 weeks, her vision progressively declined, and she was referred to the university ophthalmology clinic for further evaluation. On examination, there was concern for acute retinal necrosis and she was empirically treated with parenteral acyclovir while awaiting further infectious disease study results. Workup ultimately revealed ocular syphilis, and neurosyphilis was additionally confirmed with cerebrospinal fluid studies. Treatment with intravenous penicillin was promptly initiated with complete visual recovery. Conclusions: Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis, especially with a history of headache and skin rashes. However, given that acute retinal necrosis is a more common cause of posterior uveitis and can rapidly result in permanent vision loss, it should be empirically treated whenever it is suspected while simultaneous workup is conducted to evaluate for alternative diagnoses. PMID:26151369

  13. Structural and Mechanical Mechanisms of Ocular Tissues Probed by AFM

    NASA Astrophysics Data System (ADS)

    Ziebarth, Noël M.; Rico, Felix; Moy, Vincent T.

    In recent years, the atomic force microscope (AFM) has become an important tool in ophthalmic research. It has gained popularity largely because AFM is not restricted by the diffraction limits of light microscopy and can be applied to resolve images with molecular resolution. AFM is a minimally invasive technique and can be used to visualize molecular structures under near-physiological conditions. In addition, the AFM can be employed as a force apparatus to characterize the viscoelastic properties of biomaterials on the micron level and at the level of individual proteins. In this article, we summarize recent AFM studies of ocular tissues, while highlighting the great potential of AFM technology in ophthalmic research. Previous research demonstrates the versatility of the AFM as high resolution imaging technique and as a sensitive force apparatus for probing the mechanical properties of ocular tissues. The structural and mechanical properties of ocular tissues are of major importance to the understanding of the optomechanical functions of the human eye. In addition, AFM has played an important role in the development and characterization of ocular biomaterials, such as contact lenses and intraocular lenses. Studying ocular tissues using Atomic Force Microscopy has enabled several advances in ophthalmic research.

  14. Genetics Home Reference: Short stature, hyperextensibility, hernia, ocular depression, Rieger anomaly, and teething ...

    MedlinePLUS

    ... disorder catalog Conditions > Short stature, hyperextensibility, hernia, ocular depression, Rieger anomaly, and teething delay (often shortened to ... is SHORT syndrome? Short stature, hyperextensibility, hernia, ocular depression, Rieger anomaly, and teething delay, commonly known by ...

  15. Undefined role of mucus as a barrier in ocular drug delivery.

    PubMed

    Ruponen, Marika; Urtti, Arto

    2015-10-01

    Mucus layer covers the ocular surface, and soluble mucins are also present in the tear fluid. After topical ocular drug administration, the drugs and formulations may interact with mucus layer that may act as a barrier in ocular drug delivery. In this mini-review, we illustrate the mucin composition of the ocular surface and discuss the influence of mucus layer on ocular drug absorption. Based on the current knowledge the role of mucus barrier in drug delivery is still undefined. Furthermore, interactions with mucus may prolong the retention of drug formulations on the ocular surface. Mucus may decrease or increase ocular bioavailability depending on the magnitude of its role as barrier or retention site, respectively. Mechanistic studies are needed to clarify the role of mucin in ocular drug delivery. PMID:25770770

  16. PCR-based detection of Toxoplasma gondii DNA in blood and ocular samples for diagnosis of ocular toxoplasmosis.

    PubMed

    Bourdin, C; Busse, A; Kouamou, E; Touafek, F; Bodaghi, B; Le Hoang, P; Mazier, D; Paris, L; Fekkar, A

    2014-11-01

    PCR detection of Toxoplasma gondii in blood has been suggested as a possibly efficient method for the diagnosis of ocular toxoplasmosis (OT) and furthermore for genotyping the strain involved in the disease. To assess this hypothesis, we performed PCR with 121 peripheral blood samples from 104 patients showing clinical and/or biological evidence of ocular toxoplasmosis and from 284 (258 patients) controls. We tested 2 different extraction protocols, using either 200 ?l (small volume) or 2 ml (large volume) of whole blood. Sensitivity was poor, i.e., 4.1% and 25% for the small- and large-volume extractions, respectively. In comparison, PCR with ocular samples yielded 35.9% sensitivity, while immunoblotting and calculation of the Goldmann-Witmer coefficient yielded 47.6% and 72.3% sensitivities, respectively. Performing these three methods together provided 89.4% sensitivity. Whatever the origin of the sample (ocular or blood), PCR provided higher sensitivity for immunocompromised patients than for their immunocompetent counterparts. Consequently, PCR detection of Toxoplasma gondii in blood samples cannot currently be considered a sufficient tool for the diagnosis of OT, and ocular sampling remains necessary for the biological diagnosis of OT. PMID:25210066

  17. Toll-Like Receptors in Ocular Surface Disease

    PubMed Central

    Redfern, Rachel L.; McDermott, Alison M.

    2010-01-01

    The ability of the ocular surface to mount an immune response is in part attributed to a family of proteins called toll-like receptors (TLRs). The latter are evolutionary conserved receptors that recognize and respond to various microbes and endogenous ligands. In addition to their recognition function, TLR activation triggers a complex signal transduction cascade that induces the production of inflammatory cytokines and co-stimulatory molecules, thus initiating innate and adaptive immunity. Toll-like receptor expression at the ocular surface is modulated during infection (e.g. Herpes simplex, bacterial keratitis and fungal keratitis) as well as during various inflammatory conditions (allergic conjunctivitis and dry eye syndrome). Here recent findings regarding TLR expression and their involvement in various ocular surface diseases are discussed. PMID:20346359

  18. Prosthetic Rehabilitation of Ocular Defect resulting from Pediatric Retinoblastoma

    PubMed Central

    Janya, Suma; Gubrellay, Priyanka; Khanna, Shally

    2014-01-01

    ABSTRACT% Ocular defects result from tumor, congenital anomaly and external injury not only lead to serious impairment of function and esthetics but also make the patient psychologically disabled. Prosthetic rehabilitation attempts to restore these disfgurements may improve esthetic, level of function, general psychologic improvement and quality of life. This clinical report details an attempt to rehabilitate a pediatric patient who has undergone orbital enucleation resulting from retinoblastoma with the aid of custom ocular prosthesis using commercially available prefabricated eye shell. How to cite this article: Janya S, Gubrellay P, Purwar A, Khanna S. Prosthetic Rehabilitation of Ocular Defect resulting from Pediatric Retinoblastoma. Int J Clin Pediatr Dent 2014; 7(3):209-212. PMID:25709304

  19. Liposomes as a potential ocular delivery system of distamycin A.

    PubMed

    Chetoni, Patrizia; Monti, Daniela; Tampucci, Silvia; Matteoli, Barbara; Ceccherini-Nelli, Luca; Subissi, Alessando; Burgalassi, Susi

    2015-08-15

    Liposomes containing Distamycin A (DA) may be clinically useful in the treatment of ocular HSV infections, especially in acyclovir-resistant HSV keratitis. This study evaluated the in vitro and in vivo performance of a topical controlled release liposomal formulation containing DA (DA-Lipo) aimed at reducing the toxicity of the encapsulated active agent and improving drug uptake by ocular tissues. The bioavailability of DA in the tear fluid and the DA uptake into the cornea were increased after instillation of DA-Lipo in rabbits, reaching the DA corneal concentration corresponding to IC50 values against HSV without any sign of transcorneal permeation of drug. DA-Lipo was definitely less cytotoxic then plain DA in rabbit corneal epithelial cells. These results provide new insights into the correlation between the in vitro data and the drug kinetics following ocular applications of liposomal vesicles. PMID:26183332

  20. Hypercholesterolemia-induced ocular disorder: Ameliorating role of phytotherapy.

    PubMed

    El-Sayyad, Hassan I H; Elmansi, Ahmed A; Bakr, Eman H M

    2015-01-01

    The ocular region is a complex structure that allows conscious light perception and vision. It is of ecto-mesodermal origin. Cholesterol and polyunsaturated fatty acids are involved in retinal cell function; however, hypercholesterolemia and diabetes impair its function. Retinal damage, neovascularization, and cataracts are the main complications of cholesterol overload. Dietary supplementation of selected plant products can lead to the scavenging of free reactive oxygen species, thereby protecting the ocular regions from the damage of hypercholesterolemia. This review illustrates the dramatic effects of increased cholesterol levels on the ocular regions. The effect of phytotherapy is discussed in relation to the different regions of the eye, including the retina, cornea, and lens. PMID:26429651

  1. Macular optical coherence tomography findings following blunt ocular trauma

    PubMed Central

    Oladiwura, Dilys; Lim, Lik Thai; Ah-kee, Elliott Yann; Scott, James Angus

    2014-01-01

    This case report describes the optical coherence tomography (OCT) results of Berlins edema in a male subject following blunt ocular trauma from a soccer ball. A 27-year-old male presented with blurred vision in his left eye following blunt trauma. On admission, he underwent a complete eye examination and an OCT of the macula. Fundoscopy revealed commotio retinae, observed as an abnormal cream-colored discoloration of the fovea. The OCT showed outer photoreceptor segment disruption, retinal pigment epithelium inter-digitation, and intra-retinal edema of the outer nuclear layer. Following initial management, a repeat OCT after 3 months showed near complete resolution. OCT can be a useful adjunct for monitoring the progress of Berlins edema secondary to blunt ocular trauma because Berlins edema may present similarly clinically to other ocular trauma, but can affect different layers of the retina depending on the type of injury to the eye. PMID:24899795

  2. An overview of current techniques for ocular toxicity testing.

    PubMed

    Wilson, Samantha L; Ahearne, Mark; Hopkinson, Andrew

    2015-01-01

    Given the hazardous nature of many materials and substances, ocular toxicity testing is required to evaluate the dangers associated with these substances after their exposure to the eye. Historically, animal tests such as the Draize test were exclusively used to determine the level of ocular toxicity by applying a test substance to a live rabbit's eye and evaluating the biological response. In recent years, legislation in many developed countries has been introduced to try to reduce animal testing and promote alternative techniques. These techniques include ex vivo tests on deceased animal tissue, computational models that use algorithms to apply existing data to new chemicals and in vitro assays based on two dimensional (2D) and three dimensional (3D) cell culture models. Here we provide a comprehensive overview of the latest advances in ocular toxicity testing techniques, and discuss the regulatory framework used to evaluate their suitability. PMID:25445805

  3. Ocular circulatory responses to exhaustive exercise in humans.

    PubMed

    Ikemura, Tsukasa; Hayashi, Naoyuki

    2012-09-01

    It is unclear whether exhaustive dynamic exercise increases ocular blood flow, although we have reported that submaximal exercise increases ocular blood flow. We hypothesized that ocular blood flow decreases at exhaustion, since exhaustion causes hyperventilation, which induces a reduction in PaCO(2). To test this hypothesis, ocular blood flow, blood pressure, and respiratory measurements were made in 12 healthy male subjects during cycle ergometer exercise at 75% of maximal heart rate, until exhaustion. Blood flows in the retinal and choroidal vasculature (RCV), the superior temporal retinal arteriole (STRA), and the superior nasal retinal arteriole (SNRA) were measured with the aid of laser-speckle flowgraphy every 3 min during the exercise. The conductance index (CI) in the ocular vasculature was calculated by dividing the blood flow by the mean arterial pressure (MAP). The mean arterial partial pressure of CO(2) (PaCO(2)) was estimated from tidal volume and end-tidal CO(2) partial pressure. MAP significantly increased from the resting baseline throughout the exercise, while PaCO(2) was significantly decreased at exhaustion and during the recovery period. By 6 min after the onset of exercise, blood flow velocity in the RCV significantly increased by 32 6% (mean SD) from the resting baseline value. At exhaustion, blood flow velocity in the RCV did not differ significantly from the resting baseline value, and the STRA blood flow was significantly decreased by 13 4%. The CIs in the RCV, STRA, and SNRA were significantly decreased compared to baseline at exhaustion. These findings suggest that ocular blood flow is increased by submaximal exercise, whereas it is suppressed by the hypocapnia associated with exhaustion. PMID:22262011

  4. Biotypes and serotypes of Haemophilus influenzae ocular isolates

    PubMed Central

    Alrawi, A M; Chern, K C; Cevallos, V; Lietman, T; Whitcher, J P; Margolis, T P; Cunningham, E T

    2002-01-01

    Aim: To determine which subtypes of Haemophilus influenzae are most commonly associated with ocular disease, and whether the site of ocular H influenzae infection is correlated with specific subtypes of the organism. Methods: The biotypes and serotypes of ocular H influenzae isolates collected at the Francis I Proctor Foundation between March 1989 and January 2000 were examined. A total of 62 ocular isolates were retrieved from frozen storage and plated on chocolate agar. Biotypes were assigned based upon the ability of the isolates to produce indole, urease, and ornithine decarboxylase. Capsular subtypes af were determined by slide agglutination using commercially available subtype specific antisera. Identified biotypes and serotypes were then analysed with regard to site of infection. Results: Patient age ranged from 1 to 92 years with a median age of 45 years. 38 (61%) of the isolates were biotype II, 23 (37%) were biotype III, and one (2%) was biotype VII. All of the isolates were non-encapsulated and thus serologically non-typable. H influenzae biotype II was found in 28 of 48 (58%) conjunctivitis cases, five of eight (63%) keratitis cases, and two of two (100%) endophthalmitis cases. Biotype III was found in 20 of 48 (42%) conjunctivitis cases, two of eight (25%) keratitis cases, and a single case of dacryocystitis. Biotype VII was associated with one of eight (13%) keratitis cases. Conclusion: Most ocular H influenzae isolates appear to be serologically non-typable strains from biotypes II and III, less virulent subtypes that frequently colonise the nasopharynx. In addition, the site of ocular H influenzae infections appears to be largely independent of species subtype. PMID:11864881

  5. Wavelet Representation of the Corneal Pulse for Detecting Ocular Dicrotism

    PubMed Central

    Melcer, Tomasz; Danielewska, Monika E.; Iskander, D. Robert

    2015-01-01

    Purpose To develop a reliable and powerful method for detecting the ocular dicrotism from non-invasively acquired signals of corneal pulse without the knowledge of the underlying cardiopulmonary information present in signals of ocular blood pulse and the electrical heart activity. Methods Retrospective data from a study on glaucomatous and age-related changes in corneal pulsation [PLOS ONE 9(7),(2014):e102814] involving 261 subjects was used. Continuous wavelet representation of the signal derivative of the corneal pulse was considered with a complex Gaussian derivative function chosen as mother wavelet. Gray-level Co-occurrence Matrix has been applied to the image (heat-maps) of CWT to yield a set of parameters that can be used to devise the ocular dicrotic pulse detection schemes based on the Conditional Inference Tree and the Random Forest models. The detection scheme was first tested on synthetic signals resembling those of a dicrotic and a non-dicrotic ocular pulse before being used on all 261 real recordings. Results A detection scheme based on a single feature of the Continuous Wavelet Transform of the corneal pulse signal resulted in a low detection rate. Conglomeration of a set of features based on measures of texture (homogeneity, correlation, energy, and contrast) resulted in a high detection rate reaching 93%. Conclusion It is possible to reliably detect a dicrotic ocular pulse from the signals of corneal pulsation without the need of acquiring additional signals related to heart activity, which was the previous state-of-the-art. The proposed scheme can be applied to other non-stationary biomedical signals related to ocular dynamics. PMID:25906236

  6. Topical Ocular Hypotensive Medication and Lens Opacification: Evidence from the Ocular Hypertension Treatment Study (OHTS)

    PubMed Central

    Herman, David C.; Gordon, Mae O.; Beiser, Julia A.; Chylack, Leo T.; Lamping, Kathleen A.; Schein, Oliver D.; Soltau, Joern B.; Kass MD, Michael A.

    2007-01-01

    Purpose To determine whether topical ocular hypotensive medication is associated with refractive changes, visual symptoms, decreased visual function, or increased lens opacification. Design Multicenter clinical trial Methods We compared the medication and observation groups of OHTS during 6.3 years of follow-up with regard to the rate of cataract and combined cataract/filtering surgery, and change from baseline in visual function, refraction and visual symptoms. A one-time assessment of lens opacification was done using the Lens Opacities Classification System III (LOCS III) grading system. Results An increased rate of cataract extraction and cataract/filtering surgery was found in the medication group (7.6%) compared to the observation group (5.6%) (HR 1.56; 95% CI 1.052.29). The medication and observation groups did not differ with regard to changes from baseline to June 2002 in Humphrey visual field mean deviation, Humphrey visual field foveal sensitivity, Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, refraction and visual symptoms. For the medication and observation groups, LOCS III readings were similar for nuclear color, nuclear opalescence and cortical opacification. There was a borderline higher mean grade for posterior subcapsular opacity in the medication group (0.43 0.6 SD) compared to the observation group (0.36 0.6 SD) (p=0.07). Conclusion We noted an increased rate of cataract extraction and cataract/filtering surgery in the medication group as well as a borderline higher grade of posterior subcapsular opacification in the medication group on LOCS III readings. We found no evidence for a general effect of topical ocular hypotensive medication on lens opacification or visual function. PMID:17056362

  7. Ocular manifestations in lipoid proteinosis: A rare clinical entity

    PubMed Central

    Kamath, Sumana J; Marthala, HimaBindu; Manapragada, BinduMadhavi

    2015-01-01

    Lipoid proteinosis is a rare autosomal recessive genodermatosis with abnormal lipid protein complexes deposition in different parts of the body, especially in the skin and mucus membranes of the upper aerodigestive tract. Though ocular involvement in lipoid proteinosis is rare, ophthalmologists may encounter diverse ocular complications accompanying this syndrome in clinical practice. We describe a case of lipoid proteinosis involving bilateral eyelids with pathognomonic moniliform blepharosis in a 33-year-old gentleman who presented with the complaints of itching of eye lids on and off since 10 years. PMID:26655007

  8. Krypton red laser photocoagulation of the ocular fundus. 1982.

    PubMed

    Yannuzzi, Lawrence A; Shakin, Jeffrey L

    2012-02-01

    The theoretical rationale, the histopathologic evidence, and the preliminary clinical studies related to krypton red laser (KRL) photocoagulation of the ocular fundus are reviewed. The authors report on their experience with currently available laser systems using this wavelength (647.1 nm) for photocoagulation of retinal vascular proliferative diseases and chorioretinal diseases associated with exudative manifestations. A histopathologic and clinical comparison of argon blue-green laser (ABGL), the pure argon green laser (AGL), and the krypton yellow laser (KYL), with reference to photocoagulation treatment of the ocular fundus is also discussed. PMID:22451947

  9. Raman and FT-IR studies of ocular tissues

    NASA Astrophysics Data System (ADS)

    Ozaki, Yukihiro; Mizuno, Aritake

    1991-05-01

    Two examples of Raman and FT-IR studies of the ocular tissues are reviewed in this paper. The first example treats Raman studies on cataract development cataract-related lens hydration and structural changes in the lens proteins monitored in situ by Raman spectroscopy are described. The second example is concerned with FT-IR studies on the ocular tissues contain ing collagen nondestructive identification of Type I and IV collagen in the tissues and their structural differences elucidated by infrared spectroscopy are discussed. 1 .

  10. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

    PubMed Central

    Demartini Jr., Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha Jr., Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis

    2015-01-01

    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.

  11. Ocular inflammation induces trigeminal pain, peripheral and central neuroinflammatory mechanisms.

    PubMed

    Launay, Pierre-Serge; Reboussin, Elodie; Liang, Hong; Kessal, Karima; Godefroy, David; Rostene, William; Sahel, Jose-Alain; Baudouin, Christophe; Melik Parsadaniantz, Stéphane; Reaux Le Goazigo, Annabelle

    2016-04-01

    Ocular surface diseases are among the most frequent ocular pathologies, with prevalence ranging from 20% of the general population. In addition, ocular pain following corneal injury is frequently observed in clinic. The aim of the study was to characterize the peripheral and central neuroinflammatory process in the trigeminal pathways in response to cornea alteration induced by chronic topical instillations of 0.2% benzalkonium chloride (BAC) in male C57BL/6J mice. In vitro BAC induced neurotoxicity and increases neuronal (FOS, ATF3) and pro-inflammatory (IL-6) markers in primary mouse trigeminal ganglion culture. BAC-treated mice exhibited 7days after the treatment reduced aqueous tear production and increased inflammatory cell infiltration in the cornea. Hypertonic saline-evoked eye wipe behavior was enhanced in BAC-treated animals that exhibited increased FOS, ATF3 and Iba1 immunoreactivity in the trigeminal ganglion. Ocular inflammation is associated with a significant increase in IL-6 and TNF-α mRNA expression in the trigeminal ganglion. We reported a strong increase in FOS and Iba1 positive cells in particular in the sensory trigeminal complex at the ipsilateral interpolaris/caudalis (Vi/Vc) transition and Vc/upper cervical cord (Vc/C1) regions. In addition, activated microglial cells were tightly wrapped around activated FOS neurons in both regions and phosphorylated p38 mitogen-activated protein kinase was markedly enhanced specifically in microglial cells during ocular inflammation. Similar data were obtained in the facial motor nucleus. These neuroanatomical data correlated with the increase in mRNA expression of pro-inflammatory (TNF-α, IL-6, CCL2) and neuronal (FOS and ATF3) markers. Interestingly, the suppression of corneal inflammation 10days following the end of BAC treatment resulted in a marked attenuation of peripheral and central changes observed in pathological conditions. This study provides the first demonstration that corneal inflammation induces activation of neurons and microglial p38 MAPK pathway within sensory trigeminal complex. These results suggest that this altered activity in intracellular signaling caused by ocular inflammation might play a priming role in the central sensitization of ocular related brainstem circuits, which represents a significant factor in ocular pain development. PMID:26747211

  12. Polarization microscopy for characterizing fiber orientation of ocular tissues

    PubMed Central

    Jan, Ning-Jiun; Grimm, Jonathan L.; Tran, Huong; Lathrop, Kira L.; Wollstein, Gadi; Bilonick, Richard A.; Ishikawa, Hiroshi; Kagemann, Larry; Schuman, Joel S.; Sigal, Ian A.

    2015-01-01

    Characterizing the collagen fiber orientation and organization in the eye is necessary for a complete understanding of ocular biomechanics. In this study, we assess the performance of polarized light microscopy to determine collagen fiber orientation of ocular tissues. Our results demonstrate that the method provides objective, accurate, repeatable and robust data on fiber orientation with µm-scale resolution over a broad, cm-scale, field of view, unaffected by formalin fixation, without requiring tissue dehydration, labeling or staining. Together, this shows that polarized light microscopy is a powerful method for studying collagen architecture in the eye, with applications ranging from normal physiology and aging, to pathology and transplantation. PMID:26713188

  13. Gelatin-based particulate systems in ocular drug delivery.

    PubMed

    Hathout, Rania M; Omran, Mohamed K

    2016-05-01

    Despite all scientists efforts exerted over the past years, the ocular delivery of drugs remains a great challenge due to several barriers and hurdles faced by this kind of administration. The exploitation of gelatin that has a long history of safe use in pharmaceuticals and which is considered as a GRAS (Generally Regarded As Safe) material by the FDA was not fully achieved in this field. This review summarizes the recent studies and findings where gelatin-based micro- and nanoparticles were used for successful ocular delivery aiming at drawing the attention of researchers and scientists to this valuable biomaterial that has not been fully explored. PMID:25567143

  14. Polarization microscopy for characterizing fiber orientation of ocular tissues.

    PubMed

    Jan, Ning-Jiun; Grimm, Jonathan L; Tran, Huong; Lathrop, Kira L; Wollstein, Gadi; Bilonick, Richard A; Ishikawa, Hiroshi; Kagemann, Larry; Schuman, Joel S; Sigal, Ian A

    2015-12-01

    Characterizing the collagen fiber orientation and organization in the eye is necessary for a complete understanding of ocular biomechanics. In this study, we assess the performance of polarized light microscopy to determine collagen fiber orientation of ocular tissues. Our results demonstrate that the method provides objective, accurate, repeatable and robust data on fiber orientation with µm-scale resolution over a broad, cm-scale, field of view, unaffected by formalin fixation, without requiring tissue dehydration, labeling or staining. Together, this shows that polarized light microscopy is a powerful method for studying collagen architecture in the eye, with applications ranging from normal physiology and aging, to pathology and transplantation. PMID:26713188

  15. [The influence of ocular surgery for lacrimal secretion].

    PubMed

    Samoil?, O; Stan, Cristina; Vi?an, Oana; Cr?ciun, Alexandra; Dican, Lucia; Mera, Mihaela

    2007-01-01

    Dry eye syndrome remains a constant health problem while more and more patients are being involved and final data concerning the etiopathology is still missing. This study investigates the hypothesis that ocular surgery inflicts damage on the tear production (regarding quantity, quality or the compositional aspect). Ocular symptoms were registered with the help of a questionnaire. Lacrimal tests were applied before and after surgery at 6 weeks. Basic and reflex tear secretion was differentiated through Schirmer tests and tear quality was assessed with BUT. Proteomic analysis (global proteins, electrophoresis) and conjunctival biopsy was realized before surgery. Open eye surgery altered tear secretion in 91% of the 22 patients examined. PMID:18064960

  16. Ocular safety limits for 1030nm femtosecond laser cataract surgery

    NASA Astrophysics Data System (ADS)

    Wang, Jenny; Sramek, Christopher; Paulus, Yannis M.; Lavinsky, Daniel; Schuele, Georg; Anderson, Dan; Dewey, David; Palanker, Daniel V.

    2013-03-01

    Application of femtosecond lasers to cataract surgery has added unprecedented precision and reproducibility but ocular safety limits for the procedure are not well-quantified. We present an analysis of safety during laser cataract surgery considering scanned patterns, reduced blood perfusion, and light scattering on residual bubbles formed during laser cutting. Experimental results for continuous-wave 1030 nm irradiation of the retina in rabbits are used to calibrate damage threshold temperatures and perfusion rate for our computational model of ocular heating. Using conservative estimates for each safety factor, we compute the limits of the laser settings for cataract surgery that optimize procedure speed within the limits of retinal safety.

  17. Ocular side effects of anti-rheumatic medications: what a rheumatologist should know.

    PubMed

    Peponis, V; Kyttaris, V C; Chalkiadakis, S E; Bonovas, S; Sitaras, N M

    2010-05-01

    Nearly every drug may cause changes to ocular tissues through a variety of mechanisms. Medication overdoses, drug-drug interactions but also chronic administration of medications at the recommended doses may lead to ocular toxicity. The ocular side effects, screening for eye toxicity and treatment guidelines for anti-inflammatory and immunosuppressive drugs commonly used by rheumatologists are reviewed herein. PMID:20144965

  18. Clinical study on Hypotony following blunt ocular trauma

    PubMed Central

    Ding, Chun; Zeng, Jun

    2012-01-01

    AIM To evaluate the incidence and risk factors of hypotony in patients with blunt ocular trauma. METHODS The medical records of 145 patients with blunt ocular trauma were reviewed. Hypotony was defined as an average intraocular pressure (IOP) of 5mmHg or less for three times. RESULTS Among these 145 patients, hypotony was noted in 10 (6.9%) patients. The rate of hypotony in patients with ciliochoroidal detachment was 66.7% (2 out of 3 eyes), and 5.6% (8 out of 142 eyes) in patients without ciliochoroidal detachment, the difference was statistically significant (P=0.003). The rate of hypotony in patients with traumatic retinal detachment was 18.5% (5 out of 27 eyes), and 4.2% (5 out of 118 eyes) in patients without traumatic retinal detachment, the difference was statistically significant (P=0.026). The rate of hypotony in the patients with anterior proliferative vitreoretinopathy was 42.9% (3 out of 7 eyes) and 5.1% (7 out of 138 eyes) in the patients without anterior proliferative vitreoretinopathy, the difference was statistically significant (P=0.002). CONCLUSION Ocular hypotension is a complication of blunt ocular trauma. The risk factors include ciliochoroidal detachment, traumatic retinal detachment, and anterior proliferative vitreoretinopathy. PMID:23275915

  19. Consensus Statement on the Immunohistochemical Detection of Ocular Lymphatic Vessels

    PubMed Central

    Schroedl, Falk; Kaser-Eichberger, Alexandra; Schlereth, Simona L.; Bock, Felix; Regenfuss, Birgit; Reitsamer, Herbert A.; Lutty, Gerard A.; Maruyama, Kazuichi; Chen, Lu; Ltjen-Drecoll, Elke; Dana, Reza; Kerjaschki, Dontscho; Alitalo, Kari; De Stefano, Maria Egle; Junghans, Barbara M.; Heindl, Ludwig M.; Cursiefen, Claus

    2014-01-01

    There is currently considerable controversy about existence and classification of lymphatic vessels in the eye. Some of the confusion is certainly caused by inappropriate use (or nonuse) of the correct immunohistochemical markers. Many experts in the field expressed the need for a consensus statement, and, in this perspective, authors offer arguments and solutions to reliably continue with immunohistochemical ocular lymphatic research. PMID:25315233

  20. Systane lubricant eye drops in the management of ocular dryness

    PubMed Central

    Benelli, Umberto

    2011-01-01

    The understanding of dry eye disease has advanced recently through increasing recognition that the etiology of the condition involves both tear evaporation and insufficient tear production, and that tear film instability and inflammation play roles in the various stages of the disease. Of significance, it has been recognized that lipid layer thickness correlates with tear film stability. The management of dry eye involves various strategies and therapeutic approaches that address one or more etiopathological components of the disease. The purpose of this review is to outline the characteristics and clinical utility of the Systane ocular lubricants that contain hydroxypropyl-guar and one or both of the demulcents, ie, polyethylene glycol 400 and propylene glycol. Clinically, these products are safe and are indicated for the temporary relief of burning and irritation due to dryness of the eye. In particular, this review describes the formulations, mechanisms of action, and clinical utility of the newest additions to this topical ocular lubricant family, Systane Ultra and Systane Balance. Both of these ocular products are formulated with an intelligent delivery system and both provide symptomatic relief to patients with dry eye. However, Systane Balance is a novel formulation that contains both polymer and lipid components designed to protect the ocular surface and replenish tear film lipids simultaneously, a factor that is of particular relevance to patients who have dry eye associated with meibomian gland dysfunction. PMID:21750611

  1. [Nutritional status of vitamin A in preschoolers with ocular diseases].

    PubMed

    Villaseor-Fierro, Emma T; Vsquez-Garibay, Edgar; Romero-Velarde, Enrique; Kumazawa-Ichikawa, Miguel; Villalpando-Hernndez, Salvador; Vlez-Gmez, Ezequiel

    2009-09-01

    The purpose was to evaluate the nutritional status of vitamin A in preschool children with ocular diseases attending to the Hospital Civil of Guadalajara. In a cross sectional design 100 preschool children between 24 and 71 mo of age with ocular diseases were included. Vitamin A intake was evaluated by 24 h dietetic recall, plasma Retinol concentration by high pressure liquid chromatography (HPLC); and, conjunctiva impression cytology (CIC) was carried out by a trained pathologist. ANOVA and U Mann Whitney tests, and also Spearman correlations were estimated. There were 44.1% females and 55,9% males. Strabismus was the most common disease (41,9%), conjunctivitis (19,4%), and congenital diseases (17,2%). The mean intake of Vitamin A was 374 microg/d +/- 706 and the serum concentration of retinol was of 30 microg/dL +/- 7,6; CIC was normal in 75,6%. The percentage of vitamin A deficiency was 3,2% according to the serum concentration of Retinol and 3,5% to the CIC criteria. It was not association between the nutritional status of vitamin A and ocular diseases. A positive correlation between vitamin A intake and weight/height index (r = 0,244) was found. In conclusion, most preschool children covered the dietary reference intake recommendation of vitamin A; deficiency of this vitamin was lower and, it was not associated to ocular diseases. PMID:19886511

  2. Newer approaches for optimal bioavailability of ocularly delivered drugs: review.

    PubMed

    Kesavan, K; Balasubramaniam, J; Kant, S; Singh, P N; Pandit, J K

    2011-03-01

    Eye diseases can cause discomfort and anxiety in patients, with the ultimate fear of loss of vision and facial disfigurement. Many regions of the eye are relatively inaccessible to systemically administered drugs and, as a result, topical drug delivery remains the preferred route in most cases. Drugs may be delivered to treat the precorneal region for conjunctivitis and blepharitis, or to provide intraocular diseases such as glaucoma, uveitis, and cytomegalovirus retinitis. Most of the ophthalmic formulation strategies aim at maximizing ocular drug permeability through prolongation of the drug residence time in the cornea and conjunctival sac, as well as minimizing precorneal drug loss. The conventional topical ocular drug delivery systems show drawbacks such as increased precorneal elimination and high variability in efficacy. Attempts have been made to overcome these problems and enhance ocular bioavailability by the development of newer drug delivery systems. This review is concerned with classification, recent findings and applications and biocompatibility of newer drug delivery systems for the treatment of ocular diseases. PMID:21235476

  3. Motion artefacts simulation in the imaging of the ocular media

    NASA Astrophysics Data System (ADS)

    Zakharov, P.; Talary, M. S.; Boss, D.; Mrochen, M.

    2015-07-01

    A general simulation framework has been developed for characterising eye motion artefacts in the ophthalmic imaging of ocular media. The optimisation of the scanning strategy for an optical coherence tomography of the anterior eye chamber has been presented as the first example of an application for the simulator.

  4. Light sensors in ocular fluorescence imaging: assessment of parameters

    NASA Astrophysics Data System (ADS)

    Domingues, Jose P.; Correia, Carlos M.; Cunha-Vaz, Jose G.

    1995-01-01

    Ocular fluorometry has been recognized as a relevant noninvasive technique in ophthalmology diagnosis and research. Fluorometric methods are widely used namely for measuring some of the major physiological parameters of clinical significance: measurement of corneal epithelial and endothelial permeability, use of sodium fluorescein (a well known exogenous fluorophore) to estimate the aqueous flow, and, most important, to measure the permeability of blood-ocular barriers that can give an early indication of diabetic retinopathy, etc. Ocular fluorometry instrumentation relies on the performance of light detectors based on different technologies. The trend, over the past few years, seems to be the increasing use of solid state ones, namely the so-called photodiode arrays (PDA). Good quantum efficiency, wide spectral range, inherent spatial resolution, good reproducibility and low dark current make them appropriate to measure ocular fluorescence light intensity distribution along the eye optical axis. When the light levels to be measured are very low, special care must be focused on the parameters and the working conditions of these devices so that their quantitative results can be meaningful and reliable. Cooling to reduce dark current, slow data rates to allow for longer exposure times increasing sensitivity, high gain and low noise amplification can be listed as some of the operation requirements. The study of the specific nonuniformity profile of the sensor used is another important procedure.

  5. Attempt of quantitative determination of ocular deviation using a pupillometer

    NASA Astrophysics Data System (ADS)

    Iwata, Yo; Handa, Tomoya; Ishikawa, Hitoshi; Shoji, Nobuyuki; Shimizu, Kimiya

    2015-11-01

    Abstract Purpose To measure the ocular deviation using a binocular open-view type pupillometer. Methods Ocular deviation was measured using a phorometer, a binocular open-view type pupillometer, and the alternate prism cover test (APCT). The mean and confidence interval, and the difference between the two measurements were evaluated using a Bland-Altman Plot. Agreement between them was assessed using the intraclass coefficient (ICC). Results The ocular deviation was -1.341.54 for the phorometer and -2.461.77 for APCT. The two measurements showed moderate agreement (ICC = 0.89). Conclusion Binocular open-view type pupillometer can measure ocular deviation which is not influenced by the examiner.

  6. Cerebral and ocular congenital toxoplasmosis complicated by West syndrome.

    PubMed

    Eballe, Andr Omgbwa; Ellong, Augustin; Zoua, Marie Evodie Akono; Bella, Lucienne Assumpta; Ngeufack, Sraphin; Kouam, Jeanne Mayouego; Melong, Justin

    2010-01-01

    We report a case of a child who presented cerebral and ocular congenital toxoplasmosis associated with West syndrome. He was seen and followed-up in the in patients pediatric and ophthalmologic units at the Gyneco-Obstetric and Pediatric Hospital of Yaound in Cameroon between July 2008 and February 2010. PMID:20714363

  7. Cerebrofacial Venous Anomalies, Sinus Pericranii, Ocular Abnormalities and Developmental Delay

    PubMed Central

    Macit, B.; Burrows, P.E.; Yilmaz, S.; Orbach, D.B.; Mulliken, J.B.; Alomari, A.I.

    2012-01-01

    Summary The clinical implications of venous cerebrovascular maldevelopment remain poorly understood. We report on the association of cerebrofacial venous anomalies (including sinus pericranii), ocular abnormalities and mild developmental delay in two children. In addition, one child had a seizure disorder. Complex cerebrofacial slow-flow vascular anomalies may herald an underlying developmental aberration affecting the cerebrofacial and orbital regions PMID:22681729

  8. Ocular Angiogenesis: Vascular Endothelial Growth Factor and Other Factors.

    PubMed

    Rubio, Roman G; Adamis, Anthony P

    2016-01-01

    Systematic study of the mechanisms underlying pathological ocular neovascularization has yielded a wealth of knowledge about pro- and anti-angiogenic factors that modulate diseases such as neovascular age-related macular degeneration. The evidence implicating vascular endothelial growth factor (VEGF) in particular has led to the development of a number of approved anti-VEGF therapies. Additional proangiogenic targets that have emerged as potential mediators of ocular neovascularization include hypoxia-inducible factor-1, angiopoietin-2, platelet-derived growth factor-B and components of the alternative complement pathway. As for VEGF, knowledge of these factors has led to a product pipeline of many more novel agents that are in various stages of clinical development in the setting of ocular neovascularization. These agents are represented by a range of drug classes and, in addition to novel small- and large-molecule VEGF inhibitors, include gene therapies, small interfering RNA agents and tyrosine kinase inhibitors. In addition, combination therapy is beginning to emerge as a strategy to improve the efficacy of individual therapies. Thus, a variety of agents, whether administered alone or as adjunctive therapy with agents targeting VEGF, offer the promise of expanding the range of treatments for ocular neovascular diseases. PMID:26502333

  9. Systemic and Ocular Hemodynamic Risk Factors in Glaucoma

    PubMed Central

    Choi, Jaewan; Kook, Michael S.

    2015-01-01

    Primary open angle glaucoma (POAG) is a multifactorial disease characterized by progressive retinal ganglion cell death and visual field loss. It is known that alterations in intraocular pressure (IOP), blood pressure (BP), and ocular perfusion pressure (OPP) can play a significant role in the pathogenesis of the disease. Impaired autoregulatory capacity of ocular blood vessels may render tissues vulnerable to OPP changes and potentially harmful tissue ischemia-reperfusion damage. Vascular risk factors should be considered more important in a subgroup of patients with POAG, and especially in patients with normal tension glaucoma (NTG) with evidence of unphysiological BP response. For example, reduction of BP during the nighttime has an influence on OPP, and increased circadian OPP fluctuation, which might stand for unstable ocular blood flow, has been found to be the consistent risk factor for NTG development and progression. Central visual field may be affected more severely than peripheral visual field in NTG patients with higher 24-hour fluctuation of OPP. This review will discuss the current understanding of allegedly major systemic and ocular hemodynamic risk factors for glaucoma including systemic hypertension, arterial stiffness, antihypertensive medication, exaggerated nocturnal hypotension, OPP, and autonomic dysregulation. PMID:26557650

  10. The ocular skeleton through the eye of evo-devo.

    PubMed

    Franz-Odendaal, Tamara Anne

    2011-09-15

    An evolutionary developmental (evo-devo) approach to understanding the evolution, homology, and development of structures has proved important for unraveling complex integrated skeletal systems through the use of modules, or modularity. An ocular skeleton, which consists of cartilage and sometimes bone, is present in many vertebrates; however, the origin of these two components remains elusive. Using both paleontological and developmental data, I propose that the vertebrate ocular skeleton is neural crest derived and that a single cranial neural crest module divided early in vertebrate evolution, possibly during the Ordovician, to give rise to an endoskeletal component and an exoskeletal component within the eye. These two components subsequently became uncoupled with respect to timing, placement within the sclera and inductive epithelia, enabling them to evolve independently and to diversify. In some extant groups, these two modules have become reassociated with one another. Furthermore, the data suggest that the endoskeletal component of the ocular skeleton was likely established and therefore evolved before the exoskeletal component. This study provides important insights into the evolution of the ocular skeleton, a region with a long evolutionary history among vertebrates. PMID:21506262

  11. Ocular disorders among schoolchildren in Khartoum State, Sudan.

    PubMed

    Rushood, A A; Azmat, S; Shariq, M; Khamis, A; Lakho, K A; Jadoon, M Z; Sial, N; Rushood, A A; Kamil, E A

    2013-03-01

    From December 2005 to June 2007, a total screening of all 1418 government primary schools in Khartoum State, Sudan, was performed to estimate ocular problems among children aged 6-15 years. We screened 671,119 children (56.7% males) for significant refractive error and other eye ailments. Ocular problems were found in 20,321 (3.03%) children. The 3 localities with highest ocular pathology were Karary (26.2%), Ummbada (21.0%) and Jabal Awlia (15.7%). The overall prevalence of refractive error was 2.19%. Myopia was found in 10,064 (1.50%) children while 4661 (0.70%) were hyperopic. Other ocular problems included vernal keratoconjunctivitis, vitamin A deficiency, microbial conjunctivitis, strabismus and corneal opacity. Only 288 (0.04%) children were diagnosed with active trachoma: 86.5% of these were from Ummbada locality, on the periphery ofthe State, where transportation facilities are poor and poverty is widespread. Overall, 99% of the eye ailments identified are either treatable or preventable. To reduce these and to achieve the goals of Vision 2020, an effective and efficient school health programme is needed. PMID:23879081

  12. Consensus statement on the immunohistochemical detection of ocular lymphatic vessels.

    PubMed

    Schroedl, Falk; Kaser-Eichberger, Alexandra; Schlereth, Simona L; Bock, Felix; Regenfuss, Birgit; Reitsamer, Herbert A; Lutty, Gerard A; Maruyama, Kazuichi; Chen, Lu; Ltjen-Drecoll, Elke; Dana, Reza; Kerjaschki, Dontscho; Alitalo, Kari; De Stefano, Maria Egle; Junghans, Barbara M; Heindl, Ludwig M; Cursiefen, Claus

    2014-10-01

    There is currently considerable controversy about existence and classification of "lymphatic vessels" in the eye. Some of the confusion is certainly caused by inappropriate use (or nonuse) of the correct immunohistochemical markers. Many experts in the field expressed the need for a consensus statement, and, in this perspective, authors offer arguments and solutions to reliably continue with immunohistochemical ocular lymphatic research. PMID:25315233

  13. Lyin Eyes: Ocular-motor Measures of Reading Reveal Deception

    PubMed Central

    Cook, Anne E.; Hacker, Douglas J.; Webb, Andrea K.; Osher, Dahvyn; Kristjansson, Sean; Woltz, Dan J.; Kircher, John C.

    2013-01-01

    Our goal was to evaluate an alternative to current methods for detecting deception in security screening contexts. We evaluated a new cognitive-based test of deception that measured participants ocular-motor responses (pupil responses and reading behaviors) while they read and responded to statements on a computerized questionnaire. In Experiment 1, participants from a university community were randomly assigned to either a guilty group that committed one of two mock crimes or an innocent group that only learned about the crime. Participants then reported for testing, where they completed the computer-administered questionnaire that addressed their possible involvement in the crimes. Experiment 2 also manipulated participants incentive to pass the test and difficulty of statements on the test. In both experiments, guilty participants had increased pupil responses to statements answered deceptively; however, they spent less time fixating on, reading, and re-reading those statements than statements answered truthfully. These ocular-motor measures were optimally weighted in a discrimination function that correctly classified 85% of participants as either guilty or innocent. Findings from Experiment 2 indicated that group discrimination was improved with greater incentives to pass the test and the use of statements with simple syntax. The present findings suggest that two cognitive processes are involved in deception -- vigilance and strategy -- and that these processes are reflected in different ocular-motor measures. The ocular-motor test reported here represents a new approach to detecting deception that may fill an important need in security screening contexts. PMID:22545928

  14. Imaging of Adult Ocular and Orbital Pathology - a Pictorial Review

    PubMed Central

    Grech, Reuben; Cornish, Kurt Spiteri; Galvin, Patrick Leo; Grech, Stephan; Looby, Seamus; OHare, Alan; Mizzi, Adrian; Thornton, John; Brennan, Paul

    2014-01-01

    Orbital pathology often presents a diagnostic challenge to the reporting radiologist. The aetiology is protean, and clinical input is therefore often necessary to narrow the differential diagnosis. With this manuscript, we provide a pictorial review of adult ocular and orbital pathology. PMID:24967016

  15. Ocular Manifestations of Acquired Immunodeficiency Syndrome in Korea

    PubMed Central

    Kim, Sang Jin; Park, Sang Jun; Kim, Nam Joong; Jang, Hee-Chang; Oh, Myoung-don

    2012-01-01

    The clinical features of HIV/AIDS-related ocular manifestations in Korean patients were investigated in this study. Data on 200 consecutive Korean patients diagnosed with AIDS who visited the Seoul National University Hospital from January 2003 to June 2008 were reviewed. Fifty-seven patients (28.5%) had ocular manifestations, and they showed significantly lower CD4+ T cell count than patients without ocular manifestations. Among them, 23 (40.3%) patients showed retinal microvasculopathy, and 22 (38.5%) patients showed cytomegalovirus (CMV) retinitis. Other manifestations included retinal vein occlusion (n = 4), herpes zoster ophthalmicus (n = 4), syphilitic uveitis (n = 2), acute retinal necrosis (n = 1), and progressive outer retinal necrosis (n = 1). The mean CD4+ lymphocyte counts of the patients with retinal microvasculopathy and cytomegalovirus retinitis were 108.5 cells/µL and 69.4 cells/µL, respectively. In conclusion, ocular manifestations including CMV retinitis are common complications in Korean patients with AIDS even in the era of highly active anti-retroviral therapy. Compared to previous reports in western countries, prevalence of CMV retinitis is relatively low and CD4+ lymphocytes count at the time of diagnosis is relatively high. PMID:22563221

  16. Successfully Improving Ocular Drug Delivery Using the Cationic Nanoemulsion, Novasorb

    PubMed Central

    Lallemand, Frederic; Daull, Philippe; Benita, Simon; Buggage, Ronald; Garrigue, Jean-Sebastien

    2012-01-01

    Topical ophthalmic delivery of active ingredients can be achieved using cationic nanoemulsions. In the last decade, Novagali Pharma has successfully developed and marketed Novasorb, an advanced pharmaceutical technology for the treatment of ophthalmic diseases. This paper describes the main steps in the development of cationic nanoemulsions from formulation to evaluation in clinical trials. A major challenge of the formulation work was the selection of a cationic agent with an acceptable safety profile that would ensure a sufficient ocular surface retention time. Then, toxicity and pharmacokinetic studies were performed showing that the cationic emulsions were safe and well tolerated. Even in the absence of an active ingredient, cationic emulsions were observed in preclinical studies to have an inherent benefit on the ocular surface. Moreover, clinical trials demonstrated the efficacy and safety of cationic emulsions loaded with cyclosporine A in patients with dry eye disease. Ongoing studies evaluating latanoprost emulsion in patients with ocular surface disease and glaucoma suggest that the beneficial effects on reducing ocular surface damage may also extend to this patient population. The culmination of these efforts has been the marketing of Cationorm, a preservative-free cationic emulsion indicated for the symptomatic treatment of dry eye. PMID:22506123

  17. Role of Protease-Inhibitors in Ocular Diseases.

    PubMed

    Pescosolido, Nicola; Barbato, Andrea; Pascarella, Antonia; Giannotti, Rossella; Genzano, Martina; Nebbioso, Marcella

    2014-01-01

    It has been demonstrated that the balance between proteases and protease-inhibitors system plays a key role in maintaining cellular and tissue homeostasis. Indeed, its alteration has been involved in many ocular and systemic diseases. In particular, research has focused on keratoconus, corneal wounds and ulcers, keratitis, endophthalmitis, age-related macular degeneration, Sorsby fundus dystrophy, loss of nerve cells and photoreceptors during optic neuritis both in vivo and in vitro models. Protease-inhibitors have been extensively studied, rather than proteases, because they may represent a therapeutic approach for some ocular diseases. The protease-inhibitors mainly involved in the onset of the above-mentioned ocular pathologies are: ?2-macroglobulin, ?1-proteinase inhibitor (?1-PI), metalloproteinase inhibitor (TIMP), maspin, SERPINA3K, SERPINB13, secretory leukocyte protease inhibitor (SLPI), and calpeptin. This review is focused on the several characteristics of dysregulation of this system and, particularly, on a possible role of proteases and protease-inhibitors in molecular remodeling that may lead to some ocular diseases. Recently, researchers have even hypothesized a possible therapeutic effect of the protease-inhibitors in the treatment of injured eye in animal models. PMID:25493637

  18. Hydrogels for ocular drug delivery and tissue engineering

    PubMed Central

    Fathi, Marzieh; Barar, Jaleh; Aghanejad, Ayuob; Omidi, Yadollah

    2015-01-01

    Hydrogels, as crosslinked polymeric three dimensional networks, possess unique structure and behavior in response to the internal and/or external stimuli. As a result, they offer great prospective applications in drug delivery, cell therapy and human tissue engineering. Here, we highlight the potential of hydrogels in prolonged intraocular drug delivery and ocular surface therapy using stem cells incorporated hydrogels. PMID:26929918

  19. Method for non-invasive detection of ocular melanoma

    DOEpatents

    Lambrecht, Richard M.; Packer, Samuel

    1984-01-01

    There is described an apparatus and method for diagnosing ocular cancer that is both non-invasive and accurate which comprises two radiation detectors positioned before each of the patient's eyes which will measure the radiation level produced in each eye after the administration of a tumor-localizing radiopharmaceutical such as gallium-67.

  20. Method for non-invasive detection of ocular melanoma

    DOEpatents

    Lambrecht, R.M.; Packer, S.

    1984-10-30

    An apparatus and method is disclosed for diagnosing ocular cancer that is both non-invasive and accurate. The apparatus comprises two radiation detectors positioned before each of the patient's eyes which will measure the radiation level produced in each eye after the administration of a tumor-localizing radiopharmaceutical such as gallium-67. 2 figs.