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Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001

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Congenital systemic involvement

Severity of involvement of fetus depends on duration of gestation at time of maternal infestation


Infestation during late pregnancy	Chorioretinal scarring at macula
may cause hydrocephalus	which may be bilateral

Toxoplasma retinitis

•Recurrence of healed congenital lesion

•Usually between ages 10-35 years.


Unifocal retinitis adjacent to old scar	Vitritis may be severe
- heals within 1 to 4 months	- ‘headlight in fog’

Treatment of toxoplasma retinitis

Indications

•Lesions at posterior pole, near optic disc or major blood vessel

•Very severe vitritis

•AIDS patients irrespective of location or severity

Drugs

1. Systemic steroids

2. Clindamycin

3. Sulphonamides

4. Pyrimethamide

5. Co-trimoxazole

6. Azithromycin

7. Atovaquone

Ocular toxocariasis

Always unilateral

Chronic endophthalmitis

Posterior pole granuloma

Presents between 2 to 9 years.	Presents between 6 to 14 years.
with leukocoria or strabismus	with visual loss

Optic nerve granuloma	Peripheral granuloma

Presents between 6 to14 years.	Presents during adolescence or
with visual loss	adult life with visual loss

Presumed ocular histoplasmosis syndrome

•Fungal infection - Histoplasma capsulatum

•Vitreous is never involved

Atrophic ‘histo’ spots	Peripapillary atrophy


Peripheral streaks	Choroidal
of chorioretinal atrophy	neovascularization

Candidiasis

Infection with yeast-like fungus - Candida albicans

Risk groups

•Drug addicts or compromised host

•Patients with long-term indwelling catheters

	Progression


Unifocal choroiditis		Multifocal retinitis and vitreous
Unifocal choroiditis		‘cotton-ball’ colonies
		‘cotton-ball’ colonies


Endophthalmitis		Vitreoretinal traction

IDIOPATHIC SPECIFIC UVEITIS SYNDROMES

1.Fuchs uveitis syndrome

2.Intermediate uveitis

3.Juvenile chronic iridocyclitis

4.Acute anterior uveitis in young adults

5.Sympathetic ophthalmitis

Signs of Fuchs uveitis syndrome

•Unilateral, chronic anterior uveitis

•Resistant to therapy

• KP - small and scattered • No posterior synechiae

throughout endothelium

• Diffuse iris stromal atrophy

• Feathery fibrin filaments • Occasionally iris nodules

• Iris retroillumination	• Heterochromia iridis -
	affected eye is usually
	hypochromic

Complications of Fuchs uveitis syndrome

Cataract

Angle new vessels

Glaucoma

Very common and	May bleed during	Uncommon but control
frequently	surgery	may be difficult
presenting feature

Intermediate uveitis

•Typically affects children and young adults

•Insidious and chronic

•Frequently bilateral but asymmetrical

•Usually presents with floaters

Vitritis

Vitreous snowballs

Mild peripheral	Snowbanking in pars
periphlebitis	planitis

<<< < Предыдущая 31 32 33 34 35 36 37 38 39 40 41 4243 / 8743 44 45 46 47 48 49 50 51 52 53 54 55 > Следующая >>>

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