C4 glomerulopathy is a recently introduced entity that presents with bright C4d staining and minimal or absent immunoglobulin and C3 staining. We report a case of a 62-year-old man with C4 glomerulonephritis (GN) and uveitis. He presented to the nephrology department with proteinuria and hematuria. The patient also had intermediate uveitis along with proteinuria and hematuria. A kidney biopsy that was performed in light of continuing proteinuria and hematuria showed a focal proliferative, focal sclerotic glomerulopathy pattern on light microscopy, absent staining for immunoglobulin or C3 by immunofluorescence microscopy, with bright staining for C4d on immunohistochemistry, and electron-dense deposits on electron microscopy. Consequently, C4 GN was suggested as the pathologic diagnosis. Although laser microdissection and mass spectrometry for glomerular deposit and pathologic evaluation of the retinal tissue were not performed, this is the first report of C4 GN in Korea and the first case of coexisting C4 GN and uveitis in the English literature.
Biopsy ; Diagnosis ; Glomerulonephritis* ; Hematuria ; Humans ; Immunoglobulins ; Immunohistochemistry ; Kidney ; Korea ; Mass Spectrometry ; Microdissection ; Microscopy ; Microscopy, Electron ; Microscopy, Fluorescence ; Middle Aged ; Nephrology ; Proteinuria ; Retinaldehyde ; Uveitis ; Uveitis, Intermediate*

PURPOSE: To report a case of candida endogenous endophthalmitis in healthy women who had received extraction of wisdom tooth. CASE SUMMARY: A 65-year-old medically healthy woman who had received extraction of wisdom tooth two weeks ago, presented with floater symptoms in her left eye. Best-corrected visual acuity was 20/40 and intraocular pressure was 17 mmHg in her left eye. Inflammatory cells were found in the anterior chamber and vitreous. Fluorescein angiography showed multiple hypofluorescence without vascular leakage. With provisional diagnosis of intermediate uveitis, she was prescribed oral steroid for two weeks. After that, inflammatory cells in anterior chamber was reduced but vitreous imflammatory cell was increased and fundus examination detected newly developed infiltrated lesion at superotemporal area. The patient was presumed to have fungal endophthalmitis and immediate intravitreal voriconazole injection was performed. Three days after intravitreal voriconazole injection, diagnostic vitrectomy and intravitreal voriconazole injection were performed. Vitreous cultures revealed the growth of Candida albicans. Despite the treatment, inflammatory response in anterior chamber and vitreous rapidly increased and visual acuity was decreased to hand movement. We changed anti-fungal agent, voriconazole to Amphotericin B. Additional three-time intravitreal injection was done and therapeutic vitrectomy with oil injection were performed. After treatment, the patient's fundus markedly improved and inflammatory response was decreased. CONCLUSIONS: This case report shows candida endophthalmitis in healthy woman who had received extraction of wisdom tooth. So to diagnose endophthalmitis, patient's medical history should carefully be checked including dental care history who presented with vitreous inflammation and inflammatory infiltrated lesion at fundus.
Aged ; Amphotericin B ; Anterior Chamber ; Candida ; Candida albicans ; Dental Care ; Diagnosis ; Endophthalmitis ; Female ; Fluorescein Angiography ; Hand ; Humans ; Inflammation ; Intraocular Pressure ; Intravitreal Injections ; Molar, Third ; Uveitis, Intermediate ; Visual Acuity ; Vitrectomy ; Voriconazole

Sarcoidosis is a granulomatous disease which frequently involves eyes and adnexal tissues. Its prevalence of ocular involvement is reported as about 20%, although it varies widely according to authors, from 12% to 73%. Ocular sarcoidosis is present as various forms - uveitis, conjunctival involvement, optic nerve involvement, and orbital involvement. All the forms of uveitis - anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis - can be shown in sarcoidosis. Because clinical manifestation, prognosis and treatment are determined by the location of uveitis, it is important to classify uveitis. Conjunctival involvement is not a sight-threatening condition in general, its diagnostic value may be of use. Optic nerve is the most commonly involved cranial nerve, which can impair vision. Subjects with visual impairment without any evidence of uveitis, optic nerve involvement should be suspected. Orbital involvement, especially lacrimal gland involvement is common, and it may cause mass-effect. Besides systemic administration of drugs, there are several localized treatments for ocular sarcoidosis - topical eye drops, intra/peri-ocular injection of agents.
Cranial Nerves ; Granuloma ; Lacrimal Apparatus ; Ophthalmic Solutions ; Optic Nerve ; Orbit ; Panuveitis ; Prevalence ; Prognosis ; Sarcoidosis* ; Uveitis ; Uveitis, Anterior ; Uveitis, Intermediate ; Uveitis, Posterior ; Vision Disorders

PURPOSE: To describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection. METHODS: A total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed. RESULTS: The mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis. CONCLUSIONS: Visual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.
Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; HIV ; Humans ; Inflammation ; Keratitis ; Medical Records ; Optic Neuritis ; Panuveitis ; Penicillins ; Retrospective Studies ; Serologic Tests ; Syphilis* ; Tomography, Optical Coherence ; Uveitis ; Uveitis, Intermediate ; Uveitis, Posterior ; Vision Disorders ; Visual Acuity

PURPOSE: The authors report a Tsutsugamushi patient who has intermediate uveitis and rhegmatogenous retinal detachment without a typical skin eschar, which may be rare. CASE SUMMARY: The authors present a case of a 63-year-old man who complained of fever, chills, and headache, with lymphadenopathy, hepatomegaly, reticulonodular pneumonia, and blurred vision in the right eye after descending a mountain in autumn. Serological findings showed elevated titers for strains of Rickettsia tsutsugamushi, even though no eschar could be found on his body. In addition, the ophthalmologic examination disclosed vitreous opacity as uveitis in his right eye; thus, the patient was treated for Tsutsugamushi disease. However, retinal detachment was found in his right eye even after treatment. Thus, a vitrectomy and intravitreal silicone oil injection was performed, and the patient's best corrected visual acuity improved from hand motion to 0.04 on the 7th day after the operation.
Chills ; Eye ; Fever ; Hand ; Headache ; Hepatomegaly ; Humans ; Lymphatic Diseases ; Middle Aged ; Orientia tsutsugamushi ; Pneumonia ; Retinal Detachment ; Retinaldehyde ; Scrub Typhus ; Silicone Oils ; Skin ; Uveitis ; Uveitis, Intermediate ; Vision, Ocular ; Visual Acuity ; Vitrectomy

The aim of current study was to evaluate the incidence and characteristics of ocular sarcoidosis in a Korean population. We conducted a retrospective study of 104 consecutive patients with biopsy-proven sarcoidosis seen at Asan Medical Center in Seoul, Korea, from 1993 to 2007. Medical records, photographs, and fluorescein angiograms were reviewed. Of 104 patients, 22 (21%) had intraocular involvement with female predominance (86%, M:F=3:19). Of the 39 eyes with ocular involvement, 16 (41%) eyes had isolated anterior uveitis, 12 (31%) eyes had intermediate uveitis, 6 eyes (15%) had panuveitis with retinal vasculitis, and 5 (13%) eyes had panuveitis with punched multifocal choroiditis. Mean duration of ophthalmologic follow-up was 62 months. All ocular inflammation was well managed with topical steroid and/or systemic steroid with relatively good final visual outcomes. Ocular complications such as cataract (12 eyes, 30%), glaucoma (6 eyes, 15%), vitreous opacity (1 eye, 3%), cystoid macular edema (3 eyes, 7%), neovascularization (2 eye, 5%), and epiretinal membrane (4 eye, 10%) were related to ocular sarcoidosis. In Korea, where sarcoidosis is very rare, our study indicates relatively low ocular and predominantly non posterior segment involvement with relatively good visual prognosis.
Adult ; Age Factors ; Asian Continental Ancestry Group ; Choroiditis/diagnosis ; Eye Diseases/*diagnosis/epidemiology/therapy ; Female ; Fluorescein Angiography ; Humans ; Male ; Middle Aged ; Retinal Vasculitis/diagnosis ; Retrospective Studies ; Sarcoidosis/*diagnosis/epidemiology/therapy ; Steroids/therapeutic use ; Uveitis, Anterior/diagnosis ; Uveitis, Intermediate/diagnosis

The aim of current study was to evaluate the incidence and characteristics of ocular sarcoidosis in a Korean population. We conducted a retrospective study of 104 consecutive patients with biopsy-proven sarcoidosis seen at Asan Medical Center in Seoul, Korea, from 1993 to 2007. Medical records, photographs, and fluorescein angiograms were reviewed. Of 104 patients, 22 (21%) had intraocular involvement with female predominance (86%, M:F=3:19). Of the 39 eyes with ocular involvement, 16 (41%) eyes had isolated anterior uveitis, 12 (31%) eyes had intermediate uveitis, 6 eyes (15%) had panuveitis with retinal vasculitis, and 5 (13%) eyes had panuveitis with punched multifocal choroiditis. Mean duration of ophthalmologic follow-up was 62 months. All ocular inflammation was well managed with topical steroid and/or systemic steroid with relatively good final visual outcomes. Ocular complications such as cataract (12 eyes, 30%), glaucoma (6 eyes, 15%), vitreous opacity (1 eye, 3%), cystoid macular edema (3 eyes, 7%), neovascularization (2 eye, 5%), and epiretinal membrane (4 eye, 10%) were related to ocular sarcoidosis. In Korea, where sarcoidosis is very rare, our study indicates relatively low ocular and predominantly non posterior segment involvement with relatively good visual prognosis.
Adult ; Age Factors ; Asian Continental Ancestry Group ; Choroiditis/diagnosis ; Eye Diseases/*diagnosis/epidemiology/therapy ; Female ; Fluorescein Angiography ; Humans ; Male ; Middle Aged ; Retinal Vasculitis/diagnosis ; Retrospective Studies ; Sarcoidosis/*diagnosis/epidemiology/therapy ; Steroids/therapeutic use ; Uveitis, Anterior/diagnosis ; Uveitis, Intermediate/diagnosis

PURPOSE: To investigate the clinical characteristics and treatment of intermediate uveitis under new diagnostic standards. METHODS: Medical records of patients diagnosed with pars planitis or intermediate uveitis were followed for more than 6 months, and retrospectively reviewed. RESULTS: A total of 90 patients and 117 eyes were enrolled in the study. The mean age was 40.1 years, and the mean follow-up period was 43.0 months. Thirty percent of cases were bilateral. The most common initial symptom was decreased visual acuity. Snowbank was detected in 39.3%, snowballs in 15.4%, vitritis in 96.6%, and vasculitis in 56.4%. Common complications includedcystoid macular edema (57.3%), cataracts (43.6%), and epiretinal membrane (36.8%). Therapies included topical steroids (82.9% of cases), posterior sub-Tenon steroid injection (45.3% of cases), systemic steroid administration (67.8% of cases), and immunosuppressants (28.7% of cases). Vitrectomy was performed in 11.1% of patients due to complications such as epiretinal membrane and traction retinal detachment. The mean initial and final visual acuities were 0.67 and 0.74, respectively. CONCLUSIONS: The patients in this study experienced various courses of symptoms that required different treatment plans. Future investigations may corroborate these results.
Cataract ; Epiretinal Membrane ; Eye ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Macular Edema ; Medical Records ; Pars Planitis ; Retinal Detachment ; Retrospective Studies ; Steroids ; Traction ; Uveitis, Intermediate ; Vasculitis ; Visual Acuity ; Vitrectomy

PURPOSE: To evaluate the clinical characteristics, recurrence rate and visual prognosis of intermediate uveitis in terms of cryotherapy and pars plana vitrectomy. METHODS: Medical records of 124 eyes in 110 patients who were diagnosed to have intermediate uveitis from Jan. 1988 to Dec. 2000 were retrospectively reviewed. Clinical features, fluorescein angiographic findings in intermediate uveitis, and therapeutic results of vitrectomy and cryotherapy were analyzed. RESULTS: The mean age of the patients was 39.1 years and the mean follow-up period was 3.6 years (2 months ~ 11 years). Of those patients, 12.7% were bilateral and average recurrence rate was 2.9 per year. And 81.5% of the snowbank was located inferiorly. Fluorescein angiography (FAG) was done in 91 eyes. Cystoid macular edema (CME) was observed in 81.3% (74 eyes), focal leakage in 77.6% (69 eyes), and diffuse leakage in 22.5% (20 eyes). In 11 eyes which had undergone pars plana vitrectomy, the recurrence rate decreased from 2.2 a year to 0.6 a year. In 9 eyes which had undergone cryotherapy, it decreased from 3.6 a year to 0.7, which was statistically significant (p<0.05). The visual acuity improved in 34.7% (43 eyes), did not change in 44.4% (55 eyes), and worsened in 21.0% (26 eyes) at the final follow-up. CONCLUSIONS: This demonstrates the overall favorable visual prognosis in patients with intermediate uveitis. Pars plana vitrectomy and cryotherapy may contribute to reducing the recurrence rate of intermediate uveitis.
Cryotherapy ; Fluorescein ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Macular Edema ; Medical Records ; Prognosis ; Recurrence ; Retrospective Studies ; Uveitis, Intermediate* ; Visual Acuity ; Vitrectomy

PURPOSE: Despite ocular immune privilege, noninfectious chronic uveitis is relatively common. To investigate spontaneous turning on and off of noninfectious chronic uveitis, we examined the nature and apoptosis of infiltrating inflammatory cells from the anterior chamber of patients with chronic uveitis. METHODS: Aqueous humors were obtained with consent from patients with chronic recurrent uveitis at the time of active intraocular inflammation. Apoptosis of the infiltrating cells in aqueous humor was analyzed by flow cytometry, using fluorescence-labeled anti-CD95 antibody, anti-CD95L antibody, and Annexin V. RESULTS: Of total 35 patients recruited, 19 patients had anterior uveitis, 4 patients had intermediate uveitis, and 12 patients had panuveitis. The proportions of Fas+cell and FasL+ cell were over 90% independent of clinical characteristics of uveitis. Annexin V+ cells occupied 31.3% of all cells in aqueous humor. CONCLUSION: The high proportions of CD95+ cell, CD95L+ cell, Annexin+ cell suggest that there is an active apoptosis of inflammatory cells in anterior chamber of noninfectious chronic uveitis.
Annexin A5 ; Anterior Chamber* ; Apoptosis ; Aqueous Humor ; Flow Cytometry ; Humans ; Inflammation ; Panuveitis ; Uveitis* ; Uveitis, Anterior ; Uveitis, Intermediate