The Experts below are selected from a list of 192 Experts worldwide ranked by ideXlab platform
Chi-chao Chan - One of the best experts on this subject based on the ideXlab platform.
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ophthalmic manifestations cytology immunohistochemistry and molecular analysis of intraocular metastatic t cell lymphoma report of a case and review of the literature
Survey of Ophthalmology, 2008Co-Authors: Grace A Levyclarke, David Greenman, Gordon Byrnes, Pamela C Sieving, Robert B Nussenblatt, Defen Shen, Chi-chao ChanAbstract:We report a case of T-cell lymphoma metastatic to the eye, with an accompanying review of the literature. A 78-year-old white male with bilateral vitritis was diagnosed with primary cutaneous peripheral T-cell lymphoma unspecified, via Vitreous Biopsy. The tumor was found to be clonally related to the prior cutaneous malignancy using cytology, immunophenotyping, and molecular analysis. The vast majority of primary intraocular lymphomas are malignant B-cells, whereas intraocular T-cell lymphomas are uncommon. This case demonstrates the utility of immunophenotyping and molecular analysis with microdissection and polymerase chain reaction, as critical adjunctive studies, in patients presenting with a masquerade syndrome, and later diagnosed with T-cell intraocular lymphomas. Vitreo-retinal without uveal involvement in this case, similar to many ocular metastatic T-cell lymphomas reported in the literature, is particularly intriguing becuase the uvea, not retina, is the typical ocular tissue involvement in the majority of metastatic B-cell lymphomas.
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il 10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma
Investigative Ophthalmology & Visual Science, 2007Co-Authors: N Cassoux, Chi-chao Chan, Alain Giron, B Bodaghi, Thi Ha Chau Tran, Sylvie Baudet, Frederic Davy, P Lehoang, Helene MerleberalAbstract:Primary intraocular lymphoma (PIOL) is a subset of primary central nervous system lymphoma (PCNSL). It is an aggressive, diffuse, large B-cell lymphoma and is generally restricted to the eye and central nervous system (CNS) compartments.1-3 Ocular involvement occurs in 20% to 25% of patients with PCNSL. Of those patients initially affected by PIOL, 56% to 85% later develop a cerebral tumor.4,5 PCNSL presents 4% to 6% of all primary cerebral tumors and 1% to 2% of extranodal lymphomas. Within the past two decades, the incidence of PCNSL has approximately tripled in the United States.6 Patients with PIOL typically report blurred vision and floaters. These symptoms are frequently attributed to chronic vitritis or uveitis over the course of several months or even years. The gold standard for diagnosis is cytologic examination of the Vitreous after a diagnostic vitrectomy. However, cytologic diagnosis is difficult because of the fragility of lymphoma cells.7 False-negative cytology results have been reported in approximately 30% of Vitreous Biopsy specimens collected from a referral center.8 New tools (i.e., cytokine assessment and various other molecular techniques) have recently been developed to improve the diagnostic yield.3 B lymphoma cells are characterized by the production of several cytokines—in particular, IL-10.9 An increase of IL-10 levels in the Vitreous or an increase in the IL-10/IL-6 ratio to greater than 1 has been reported in the Vitreous of patients with PIOL.5,10-12 In contrast, in an early study on the subject, Akpek et al.13 reported that this ratio may not always be associated with PIOL. PCNS lymphoma remains a disease of poor prognosis, especially if the eye is involved. Recent data suggest that early diagnosis and treatment result in better disease control and in a longer survival period.14 In most series, diagnosis is made after a mean period of 12 to 24 months.8,13,14 To reduce this period for diagnosis, we studied the value of IL-10 measurements after an anterior chamber tap, or paracentesis (ACP), as a potential screening test. The samples were collected prospectively. IL-10 measurements were performed in sample lots of 20 every 15 days, and data were then examined once they were all pooled. Clinical data were extracted retrospectively from patients’ files at the end of enrollment. An increase of IL-10 levels may indicate to clinicians that an earlier diagnostic vitrectomy may be needed to confirm a diagnosis of PIOL. If PIOL is diagnosed earlier, CNS involvement, a poor prognostic sign, may be prevented.14
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triple viral retinitis diagnosed by polymerase chain reaction of the Vitreous Biopsy in a patient with richter syndrome
American Journal of Ophthalmology, 1998Co-Authors: Ralph D Levinson, John J Hooks, Yun Wang, Mark T Chiu, Judianne Kellaway, Chi-chao ChanAbstract:Abstract PURPOSE: To report the evaluation and identification of herpes viruses associated with retinitis in a patient with Richter syndrome. METHODS: Diagnostic vitrectomy was performed on a patient with systemic leukemia and retinitis. The Vitreous sample was evaluated by cytology, analysis of cytokines by ELISA, and detection of virus by polymerase chain reaction. RESULTS: The Vitreous Biopsy specimen showed no malignant cells but predominant CD8 + lymphocyte infiltration with elevated interferon gamma and interleukin-6. DNA amplification and Southern blot analysis demonstrated DNA of herpes simplex, varicella-zoster, and cytomegalovirus. CONCLUSION: Retinitis associated with multiple viruses in the Vitreous Biopsy may mimic leukemic infiltration in the eye.
Suzanne M Mitchell - One of the best experts on this subject based on the ideXlab platform.
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acute retinal necrosis a national population based study to assess the incidence methods of diagnosis treatment strategies and outcomes in the uk
British Journal of Ophthalmology, 2007Co-Authors: Manickam Nick Muthiah, Michel Michaelides, Chris Child, Suzanne M MitchellAbstract:Aim: To determine the incidence, methods of diagnosis, treatment strategies and outcomes for acute retinal necrosis (ARN) in the UK. Methods: A 12-month active case ascertainment study was carried out between March 2001 and March 2002 to record cases of ARN presenting to ophthalmologists via the British Ophthalmological Surveillance Unit (BOSU) reporting system. Questionnaires were sent to the reporting consultants, requesting data on patient characteristics, presentation, clinical findings, investigations and treatment. Diagnosis was made using the American Uveitis Society diagnostic criteria. Further questionnaires were sent at 2 weeks and 6 months to assess outcome and therapies. Results: 74 cases of ARN were reported by 58 consultants between March 2001 and March 2002. Questionnaires were returned for 49 cases (66.2%), of which 18 (36.7%) were excluded. Of the 31 cases included, 22 (71.0%) were male and 9 (29.0%) were female. The age range was 13 to 85 years (mean 54.3 years). 28 cases (90.3%) were unilateral, with 3 patients (9.7%) presenting with bilateral ARN. An aqueous or Vitreous Biopsy was performed in only 18 patients, with one patient having both. Herpes viral DNA analysis was performed on all 19 biopsies, with identification of the viral DNA in 16; results from 3 biopsies were not documented. Varicella zoster virus (VZV) was the commonest cause identified in 10 patients (56%). Of the 31 subjects, 27 (87.1%) were treated for ARN with systemic antiviral treatment: with intravenous antiviral in 23 cases (85.2%) and oral antiviral in 4 cases (14.8%). 21 of these patients went on to receive oral antiviral maintenance therapy. In addition to antiviral treatment, systemic steroids were given to 16 subjects (51.6%). Surgical intervention for retinal detachment was performed on 5 patients. Conclusions: During the 12-month study period, 31 cases of ARN met the diagnostic criteria set by the American Uveitis Society. The incidence in the UK based on this study is approximately 1 case per 1.6 to 2.0 million population per year. We have ascertained that the management of ARN throughout the UK is variable, suggesting that national guidelines would be of benefit.
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Vitreous fluid sampling and viral genome detection for the diagnosis of viral retinitis in patients with aids
Journal of Medical Virology, 1994Co-Authors: Suzanne M Mitchell, J D Fox, Richard S Tedder, Brian Gazzard, Susan LightmanAbstract:Cytomegalovirus (CMV) causes severe necrotizing retinitis in patients with the acquired immune deficiency syndrome (AIDS) and other herpesviruses have been implicated in the acute retinal necrosis syndrome (ARN), seen in both the immunocompetent and the immunosuppressed. At present the diagnosis of viral retinitis relies solely on clinical appearances. In order to assess whether the detection of herpesvirus-specific DNA in cell-free Vitreous Biopsy samples could be useful in the early diagnosis of viral retinitis, Vitreous fluid samples were taken from 100 patients. Fifty patients had AIDS as defined by the Centers for Disease Control, (MMWR 36 (suppl 1S):1S-15S, 1987) and retinal disease. The remainder were not known to be HIV infected and had no clinical evidence of retinal infection. Each sample was tested for the presence of CMV, herpes simplex virus 1 (HSV-1), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV6), by amplification of viral DNA using a sensitive and specific nested polymerase chain reaction (PCR). The presence of detectable CMV or VZV DNA was clearly associated with clinical disease whereas the presence of HSV-1, EBV, and HHV6 sequences were not. Clinical discrimination between CMV- and VZV-associated retinitis was greatly enhanced when the PCR results were taken into consideration. (C) 1994 Wiley-Liss, Inc.
James T. Rosenbaum - One of the best experts on this subject based on the ideXlab platform.
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Intraocular Lymphoma: Immunopathologic Analysis of Vitreous Biopsy Specimens
Archives of Ophthalmology, 1992Co-Authors: David J Wilson, Rita M Braziel, James T. RosenbaumAbstract:• Immunologic analysis of cell surface markers (immunophenotyping) has become a standard procedure in the evaluation of systemic lymphomas. However, attempts to apply these techniques to intraocular lymphoma have not been uniformly successful. We successfully immunophenotyped five consecutive cases of intraocular lymphoma using immunoperoxidase surface marker analysis of cytocentrifuged specimens in two cases and flow cytometry in three. In all five cases, a monoclonal B-cell population was unequivocally present. Contrary to previous reports, we found surface marker analysis of Vitreous Biopsy specimens to be helpful in the diagnosis and treatment of intraocular lymphoma. Not only did it support the cytologic diagnosis but it allowed comparison of the immunophenotype of Vitreous infiltrates with that of previous or subsequent lymphomatous lesions from nonocular sites.
Jill Johnson - One of the best experts on this subject based on the ideXlab platform.
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endophthalmitis after intravitreal injection of vascular endothelial growth factor inhibitors management and visual outcomes
Ophthalmology, 2018Co-Authors: Eric K Chin, Steven R Bennett, David F Williams, Edwin H Ryan, Sundeep Dev, Robert A Mittra, Polly A Quiram, John B Davies, Wilkin D Parke, Jill JohnsonAbstract:Purpose We describe the presentation of patients developing endophthalmitis after intravitreal injection with vascular endothelial growth factor (VEGF) inhibitors. Moreover, we evaluate the management by comparing the outcomes of immediate tap and injection of intravitreal antibiotics (TAI) versus initial surgical pars plana vitrectomy (PPV). Finally, we analyze the predictive factors of visual outcomes at 6-month follow-up. Design Retrospective, single-center, nonrandomized interventional study. Participants Patients developing endophthalmitis after receiving an intravitreal injection of anti-VEGF agent between 2006 and 2016. Methods All patients received a Vitreous Biopsy sent for cultures before the initiation of treatment: TAI group versus PPV with intravitreal antibiotics (PPV group). Main Outcome Measures Best-corrected visual acuity (BCVA) at 6-month follow-up after treatment for endophthalmitis. Results A total of 258 357 intravitreal injections occurred over the course of the 10-year period, of which 40 patients (0.016%) had endophthalmitis within 3 weeks after injection. In total, 34 patients (85.0%) had pain and 25 patients (62.5%) had hypopyon on initial examination. Among 24 culture-positive cases, 66.7% of the causative organisms were coagulase-negative Staphylococcus , followed by Streptococcus species (10.0%). The best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) at 6-month follow-up was significantly worse for patients who had a positive culture for Streptococcus species (4.0; standard deviation [SD], 0.8) (approximately light perception) compared with those who had a positive culture for coagulase-negative Staphylococcus (0.4; SD, 0.3) (∼20/50) ( P P = 0.03). There was no statistically significant difference in BCVA at 6-month follow-up between the TAI and PPV groups. Younger age ( Conclusions No significant difference in BCVA at 6-month follow-up was detected between the TAI and PPV groups. Younger age and lower IOP at presentation were associated with better visual outcomes at 6-month follow-up.
Susan Lightman - One of the best experts on this subject based on the ideXlab platform.
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Vitreous fluid sampling and viral genome detection for the diagnosis of viral retinitis in patients with aids
Journal of Medical Virology, 1994Co-Authors: Suzanne M Mitchell, J D Fox, Richard S Tedder, Brian Gazzard, Susan LightmanAbstract:Cytomegalovirus (CMV) causes severe necrotizing retinitis in patients with the acquired immune deficiency syndrome (AIDS) and other herpesviruses have been implicated in the acute retinal necrosis syndrome (ARN), seen in both the immunocompetent and the immunosuppressed. At present the diagnosis of viral retinitis relies solely on clinical appearances. In order to assess whether the detection of herpesvirus-specific DNA in cell-free Vitreous Biopsy samples could be useful in the early diagnosis of viral retinitis, Vitreous fluid samples were taken from 100 patients. Fifty patients had AIDS as defined by the Centers for Disease Control, (MMWR 36 (suppl 1S):1S-15S, 1987) and retinal disease. The remainder were not known to be HIV infected and had no clinical evidence of retinal infection. Each sample was tested for the presence of CMV, herpes simplex virus 1 (HSV-1), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV6), by amplification of viral DNA using a sensitive and specific nested polymerase chain reaction (PCR). The presence of detectable CMV or VZV DNA was clearly associated with clinical disease whereas the presence of HSV-1, EBV, and HHV6 sequences were not. Clinical discrimination between CMV- and VZV-associated retinitis was greatly enhanced when the PCR results were taken into consideration. (C) 1994 Wiley-Liss, Inc.
