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Uveitis10,11 Flashcards

1
Q

Ophthalmic manifestations of HIV?

A

1)microangiopathy of the retina
2)opportunistic infections
3)Kaposi sarcoma
4)lymphoma
5)SCC of the conjunctiva
6)anterior or intermediate uveitis that is not
responsive to corticosteroids but improves with antiretroviral therapy

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2
Q

شایع ترین یافته چشمی در بیماران آلوده به HIV؟

A

HIV retinopathy

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3
Q

تظاهرات HIV retinopathy؟

A

retinal hemorrhages
microaneurysms
CWS

“MHC in HIV retinopathy”

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4
Q

پاتوفیزیولوژی درگیری چشمی در HIV؟

A

۱)آنتی ژن آن در سلولهای اندوتلیال رتین یافت شده و این امر باعث ایجاد CWS و سایر اختلالات عروقی می شود.
۲)accelerated aging may be a part of HIV-associated eye disease, with earlier onset of macular degeneration and
cataracts

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5
Q

عفونت هایی که در بیمار مبتلا به HIV دیده می شود

A 
CMV
HZV
Toxoplasma gondii
Mb tuberculosis
Mb avium-intracellulare
Cryptococcus neoformans
Pneumocystis jirovecii
Histoplasma capsulatum
Candida species
molluscum contagiosum 
microsporidia
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6
Q

CMV Retinitis

A

CD4=50 cells/µL or less

the most common opportunistic ocular infection in patients with AIDS

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7
Q

گرچه رتینیت CMVنادر است ولی مشکل روبه رشدی به ویژه در….. است

A

Southeast Asia

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8
Q

What is Immune recovery uveitis (IRU)

A

previous CMV retinitis(just CMV)+ immune
status improves with combination antiretroviral therapy
=increase in the CD4 count of at least 50 cells/µL to at
least 100 cells/µL.

anterior or intermediate uveitis

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9
Q

ریسک ایجاد IRU متناسب است با؟

A

1)the surface area of retina involved
IRU was associated with a CMV retinitis surface area of 25% or more
2)The likelihood of developing IRU was greater (odds ratio, 10.6) in patients who had ever been treated
with cidofovir.

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10
Q

چند درصد بیماران HIV با سابقه رتینیت CMV با درمان و بهبود ایمنیدچار IRU می شوند؟

A

۱۰ درصد

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11
Q

عواقب IRU؟

A

more likely to have macular edema or ERM

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12
Q

درمان ادم ماکولا در IRU؟

A

sub-Tenon injections of depot corticosteroids
such injections do not seem to cause reactivation of CMV infection
ادم ماکولا به تزریق های ساب تنون مقاوم است

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13
Q

آیا برای درمان ادم ماکولا در IRU می توان از تزریق اینتراویتره استرویید استفاده کرد

A

خیر

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14
Q

آیا IRU به تکثیر ویروس CMV ،ادامه یا قطع درمان anti-CMVارتباطی دارد؟

A

خیر

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15
Q

چند درصد بیماران با CMV retinitis دچار RD می شوند؟

A

50%

It may occur during active disease or after successful treatment

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16
Q

RF for RD after CMV retinitis?

A

1) involvement of all 3 retinal zones
2) lower CD4 count
3) more extensive retinitis

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17
Q

چرا درمانRDدربیماران CMV retinitis دشوار است؟

A

because of extensive retinal necrosis and multiple, often posterior, hole formation. Most of these detachment
require PPvitx with long-term SO tamponade

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18
Q

چند درصد RDهای بعد از CMV retinitisبعد از درمان از نظر آناتومیک attach می شوند؟

A

90%

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19
Q

Necrotizing Herpetic Retinitis in Pt with AIDS

A

تطاهرات آن بسته به میزان سرکوب ایمنی بیمار دارد
🎈PORN
در مراحل اولیه افتراق PORN از peripheral CMV retinitisدشوار است.PORN پیشرفت سریع دارد و نسبتا فاقد التهاب ویتره می باشد و این امر به افتراق آن از رتینیت CMV و همچنین ARN کمک می کند

🎈PORN is associated with a high incidence of RD, and bilateral involvement is common.

🎈Tx➡️ intravitreous ganciclovir, foscarnet, or acyclovir

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20
Q

Toxoplasmosis in patients with AIDS differs from toxoplasmosis in immunocompetent patients

A

1)the lesions are larger in people with AIDS
2)up to 40% of cases have bilateral disease
🎈Solitary, multifocal, and miliary patterns of retinitis have been observed
3)vitreous reaction may be less in AIDS
به طور کلی واکنش التهابی رتین،کورویید و ویتره کمتره
4)Trophozoites and cysts can be observed in greater numbers within areas of retinitis, and organisms can occasionally be noted invading the choroid, a finding
not present in immunocompetent patients.
5)The diagnosis of ocular toxoplasmosis may also be
more difficult
6)Preexisting scars are rare (present in 6% of patients at most)
7)the condition inevitably progresses if left untreated, in contrast to the self-limiting disease in immunocompetent patients
8)ocular toxoplasmosis in
immunocompromised patients may be associated with cerebral or disseminated toxoplasmosis
۳۰ درصد بیماران با کوریورتینیت توکسو بیماری CNS دارند

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21
Q

شایع ترین فرم ابتلا به توکسو در بیماران ایدز؟

A

Newly acquired T gondii infections or dissemination from nonocular sites are the most likely causes among
patients with AIDS, although reactivation of quiescent
toxoplasmosis also occurs.

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22
Q

تشخیص افتراقی های توکسو چشمی در بیماران ایدز؟

A

1)ARN
2)necrotizing herpetic retinitis
3)syphilitic retinitis.
Dx may require aqueous and vitreous samples for culture and PCR

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23
Q

Antitoxoplasmic therapy

A 
combinations of 
pyrimethamine
sulfadiazine
azithromycin
atovaquone
clindamycin  
آزیتا پسر کلینتون رو ببین اخماتو واکن
🎈Corticosteroids should be used with caution and only in the presence of appropriate antimicrobial cover because of the risk of further immunosuppression
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24
Q

toxic effects on bone marrow

A

pyrimethamine

sulfadiazine

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25
Q

The clinical presentations Syphilitic Chorioretinitis

A

1)uveitis
2)optic neuritis
3)nonnecrotizing retinitis
🎈unilateral or bilateral, pale-yellow, placoid retinal
lesions that preferentially involve the macula (syphilitic posterior placoid chorioretinitis).ERD may also be present
4)Some ➡️dense vitritis without clinical evidence of chorioretinitis. In these patients, vitritis can be the first
manifestation of syphilis

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26
Q

The course of syphilis may be more aggressive in HIV-infected patients

A

Correct

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27
Q

درمان سیفلیس در بیمار HIV

A

18–24 million units of IV penicillin G administered daily for 10–14 days,
followed by 2.4 million units of IM benzathine penicillin G administered weekly for 3weeks.
🎈Monitoring of results from the RPR test is recommended
🎈رژیم درمانی نوروسیفلیس نیز همین است

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28
Q

عفونت PCP در بیماران ایدز به ندرت می تواند در …….. ارتشاح یابد

A

کوروئید

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29
Q

What is Fundus changes that are characteristic of P jirovecii choroiditis?

A

1) slightly elevated,plaquelike, yellow-white lesions located in the choroid
2) minimal vitritis

FA: hypo in the early phase and hyper in the later phases

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30
Q 
Treatment of P jirovecii choroiditis?
Penta(5)×4
20×prim
100×SMZ
3w
3w-3m
A

3w regimen of intravenous trimethoprim (20
mg/kg/day) and sulfamethoxazole (100 mg/kg/day) or
pentamidine (4 mg/kg/day).

Within 3–12 weeks, most of the yellow-white lesions disappear, leaving mild overlying pigmentary changes.

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31
Q

Vision is usually not affected in PCP choroiditis

A

Correct

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32
Q

عفونت قارچی Cryptococcus neoformans در بیماران ایدز کدام قسمت چشم را درگیر میکند؟

A

۱)کورویید بصورت multifocal choroiditis

۲)عصب اپتیک ثانویه به درگیری CSF یا invasion مستقیم ارگانیسم به عصب(در مورد دوم کاهش دید سریع تر رخ می دهد)

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33
Q

بعضی از بیماران با عفونت کریپتوکوکی ضایعات کورویید را قبل از بروز بیماری منتشر نشان می دهند

A

ص

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34
Q

درمان کوروئیدیت کریپتوکوکی؟

کام فلو

A

amphotericin

flucytosine

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35
Q

علل عفونی زیادی می توانند باعث multifocal choroiditis در بیماران ایدز شوند.

A 
ضایعات multifocal choroiditis در ۱۰ درصد بیماران مبتلا به ایدز دیده می شود
علل شایع:
PCP
C. neoformans
Mb Tb
Atypic Mb
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36
Q

محل شایع در گیری در عفونت های فرصت طلب در چشم بیماران ایدز؟

A

کوروئید

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37
Q

What is the cause of Ocular Adnexal Kaposi Sarcoma?

How many types?

A

HHV8
Two aggressive variants of this tumor
1)an endemic variety especially prevalent
in Kenya and Nigeria and
2)epidemic Kaposi sarcoma, which was first noted in renal transplant recipients and in patients with AIDS

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38
Q

AIDS associated Kaposi sarcoma

A

۱)در ارگان های احشایی تا ۵۰ درصد بیماران

۲)در ocular adnexa(قبل از ایجاد داروهای آنتی ویرال) تا ۲۰ درصد

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39
Q

Histologic investigation of kaposi sarcoma?

A

spindle cells mixed with vascular structures

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40
Q

Treatment of Kaposi sarcoma?

A

excision
cryotherapy
radiation
combination

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41
Q

Molluscum Contagiosum lesions in

immunocompetent individuals

A

few
unilateral
involve the eyelids

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42
Q

Molluscum Contagiosum in patients with AIDS

A

numerous
bilateral

🎈If molluscum contagiosum lesions in patients
with AIDS are symptomatic or cause conjunctivitis, surgical excision may be necessary

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43
Q

در بیمار زیر ۵۰ سال با ضایعات HZV صورت و پلک به فکر…… باشید

A

HIV

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44
Q

آیا عفونت HIV بیماران را مستعد کراتیت باکتریال می کند؟خیر

A

گرچه کراتیت باکتریایی و قارچی می تواند در بیماران ایدز بدون فاکتور مستعد کننده مثل تروما یا مصرف استروئید رخ دهد
شدت عفونت در بیمار ایدز بیشتر بوده و احتمال پرفوراسیون قرنیه نیز بالاتر است

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45
Q

آیا کراتیت HSV،کراتیت باکتریایی و کراتیت قارچی شیوع بیشتری در بیماران ایدز دارد؟

A

خیر

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46
Q

HSV keratitis does not appear to have a higher incidence in patients with AIDS

A

but it may have a prolonged course or multiple recurrences and involve the limbus

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47
Q

Clinical presentation of Microsporidial keratitis?

Dx?

A

coarse, punctate epithelial keratitis with minimal conjunctival reaction in patients

Dx:Electron microscopy of epithelial scrapings has revealed the organism, which is an
obligate, intracellular, protozoal parasite

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48
Q

What are the causes of Solitary granulomatous conjunctivitis in HIV Pt?

A

1) cryptococcal infection
2) mycotic infection
3) tuberculosis

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49
Q

orbital and intraocular lymphomas in AIDS?

mostly large B-cell lymphomas

A

Conjunctival SCC have been reported in AIDS and

spindle cells with frequent abnormal mitotic figures

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50
Q

What are complications of uveitis?

A 
Calcific band keratopathy
Cataract
Glaucoma
Hypotony
CME
Vitreous Opacification and Vitritis
RRD
Retinal and Choroidal Neovascularization
51
Q

What is calcific band keratopathy?etio?

A

chronic uveitis
especially children
Ca deposition along the epithelial BM and the Bowman layer
arise within months of onset of the uveitis
in the interpalpebral zone

52
Q

اندیکاسیون های درمان calcific band keratopathy؟درمان؟

A

1) become visually significant when it extends into the visual axis
2) symptoms of FB sensation

🎈epithelial debridement followed by chelation with disodium ethylene diamine tetraacetic acid (EDTA)

🎈Recurrences may require repeat EDTA treatments.
Photorefractive keratotomy can also be considered

53
Q

توصیه های لازم قبل از جراحی کاتاراکت در بیماران یووییت؟

A

“best control possible”

No flare-ups for at least 3 months prior to cat Sx

54
Q

آیا مواردی هست که بتوان علیرغم آنکه یووئیت برای حداقل ۳ ماه کنترل نبوده catرا جراحی کرد؟

A

1) eyes with mild uveitis without sequelae
2) disorders that have a good surgical prognosis (FHI)
3) under special circumstances such as len-induced uveitis or the need to view the posterior segment (eg, to repair a RRD)

55
Q

چنانچه التهاب در بیمار یووئیت برای حداقل ۳ ماه کنترل بوده و کاندید جراحی است،اقدام؟

A

1)PreOP pulsing with oral corticosteroids (0.5–1.0
mg/kg/day, usually for 3 days) and/or intensive
topical corticosteroid treatment
🎈Dosages may be tapered over weeks to months
after surgery, based on the ۱.severity of the underlying uveitis before surgery and ۲.the postoperative
inflammatory response.
2)Postoperative use of NSAIDs has not
been studied in eyes with uveitis but is frequently employed in nonuveitic eyes that are undergoing
cataract surgery, with the goal of preventing CME
🎈Corneal toxicity from topical NSAIDs used concurrently with topical corticosteroids is a concern 3)Patients with certain infectious uveitides may
require perioperative prophylactic antimicrobial therapy to prevent surgically induced recurrence
🎈in such situations, preoperative oral corticosteroids are usually not given

56
Q

برای جراحی cat در بیمار یووئیت چه wound ای ارجح است؟

A

clear corneal approach

خصوصا در بیمارانی که اسکلریت دارند

57
Q

continuous curvilinear capsulorrhexis is preferred in uveitic patients,y?

A

1)reduce PS formation
2)reduces the risk of posterior capsular tear
3)facilitates placement of IOL haptics in the
capsular bag

58
Q

What do you do for cat Sx in a uveitic patient with fibrotic anterior capsule and zonular insufficiency?

A

pars plana lensectomy and vitrectomy and avoid placing an IOL because of the lack of capsular support or zonular dehiscenc

59
Q

What is the preferable IOL for uveitic Pt?

A

hydrophobic acrylic posterior chamber IOLs placed in the capsular bag

60
Q

در کدام مورد vitrectomy and aphakiaپیامد بهتری دارد؟

A

JIA-associated uveitis

61
Q

کنترااندیکاسیون های نسبی گذاشتن IOL؟

A

1)The prior development of rubeosis
2)a history of extensive membrane formation
3) hypotony
4)controversy regarding IOL placement in children with JIA-associated uveitic cataracts.
If IOLs are used, in-the-bag implantation of acrylic IOLs and primary posterior capsulorrhexis are preferred in children. Some surgeons may also perform a core anterior vitrectomy through the posterior capsulorrhexis prior to IOL placement.
Administration of intraocular corticosteroids at the end of the procedure is extremely useful for
controlling postoperative inflammation and CME.
75% of patients will obtain a visual acuity of better than 20/40.

62
Q

شایع ترین علت کاهش دید به دنبال فیکو در بیماران یووییت؟

A

CME

63
Q

چگونه می توان postop CME بعد از جراحی cat در بیماران یووئیت را کاهش داد؟

A

perioperative corticosteroids

delay of surgery until the uveitis has been controlled for at least 3 months.

64
Q

آیا بروز PCOدر بیماران یووئیتیک شایع تر است؟

A

Yes

Need earlier use of Nd:YAG laser capsulotomy

65
Q

چگونه می توان باعث کاهش رسوب دبری های التهابی روی IOLشد؟(به ویژه درpars planitis)

A

Strict control of inflammation

Long-term administration of topical corticosteroids may be necessary

66
Q

در چند درصد بیماران یووئیتیک که تحت cat Sx قرار گرفته اند ممکن است نیاز به خروج IOLباشد؟

A

5%–10%

67
Q

Elevation of IOP to levels above 24 mm Hg increases the risk of glaucoma

A

Most practitioners tend to treat eyes with IOP greater than 30 mm Hg, even without evidence of glaucomatous optic nerve damage

68
Q

Acute uveitis+High IOP+open angle

=uveitic ocular hypertension

A

Viral
Toxo
در اوایل سیر یووییت OHT باید با استروئید اگرسیو درمان شود و نباید از گلوکوم وابسته به کورتون بترسیم
زیرا افزایش IOP زودهنگامی که همراه با التهاب فعال است همیشه ناشی از التهاب بوده و نیاز به درمان تهاجمی دارد
هایپرتانسیون وابسته به استرویید به ندرت قبل از ۳ هفته دیده می شود

69
Q

Uveitic glaucoma often results from a combination of mechanisms

A

1)secondary angle-closure
2)secondary open-angle glaucoma
3)corticosteroid-induced ocular hypertension and
glaucoma

70
Q 
SAC uveitic glaucoma-acute
Etio?
Exp?
Sign,symp?
Dx?
Tx?
A 
🎈choroidal inflammation results in forward rotation of the CB and lens–iris diaphragm
🎈VKH,SO
🎈no PS,no severe inflammation
🎈UBM
🎈BABA
aggressive steroid
Cycloplegic
🎈no PI
71
Q

SAC uveitic glaucoma-subacute
Etio?
Tx?

A

🎈Chronic or acute recurrent anterior segment inflammation➡️PS➡️PB➡️iris bombe
🎈PI(multiple, created as large as possible)or surgical iridectomy results in resolution of the bombé and angle closure if performed before permanent PAS form.
🎈Exacerbation of inflammation can be anticipated after laser iridotomy in these eyes, making the iridotomies prone to close and requiring re-treatment or surgical iridectomy.
🎈Intensive topical corticosteroid and cycloplegic therapy is given following the procedure.
🎈 If PI is not successful, surgical iridectomy is required. The procedure may be supplemented with goniosynechialysis if PAS have started to develop
خلاصه pIزمانی موثره که PASرخ نداده باشد

72
Q

Chronic or acute recurrent anterior segment inflammation may result in the formation of
circumferential posterior synechiae
بنابراین PSیک پروسه مزمن است

A

PS➡️PB➡️iris bombe

آیریس بمبه یک پروسه حاد است

73
Q

SAC uveitic glaucoma-subacute
Etio?
Tx?

A 
🎈PAS
اغلب همراه با ۱)SOAGو۲)Steroid induced glaucomaاست
🎈Trabx+MMC
goniosynechialysis
AGV
74
Q

SOA uveitic glaucoma-acute
Etio?
Tx?

A

🎈1)trabeculitis
toxo…ARN…HSV,VZV,CMV anterior uveitis (including the Posner-Schlossman type)… sarcoid uveitis…FHI(rubella-associated)
🎈2)when inflammatory debris clogs the angle
🎈topical steroid+ cycloplegic+درمان علت عفونی

75
Q

SOA uveitic glaucoma-chronic
Etio?
Tx?

A

🎈Chronic outflow obstruction is caused by direct damage to the TM.
🎈Tx like POAG+ control of intraocular inflammation through the use of IMT

76
Q

بیمارانی که ایمپلنت فلوسینولون دارند در چند درصد به جراحی گلوکوم نیاز پیدا می کنند؟

A

40%

77
Q

کدام استرویید می تواند در مصرف تاپیکال باعث افزایش شدید و سریع IOPشود؟

A

Difluprednate

78
Q

چگونه می توان اثر استروئید تاپیکال بر افزایش IOP را کاهش داد؟

A

1) use of a less-potent topical corticosteroid

2) less-frequent administration schedule

79
Q

خط اول درمان گلوکوم و OHTبه دنبال یووئیت؟

A

Aqueous suppressants(BABA)

80
Q

آیا در افزایش IOPبه دنبال یووئیت می توان از آنالوگ های PG استفاده کرد؟

A

yes
🎈generally do not exacerbate intraocular inflammation, especially when used concomitantly with IMT and corticosteroids.😲
However, caution should be used in eyes with herpetic uveitis.

81
Q

مصرف کدام دارو در بیماران یووئیت کنترااندیکه است؟ پیلوکارپین یا لاتانوپروست؟

A

پیلوکارپین

1) smaller fixed pupil may be at risk for worsening of PS
2) pilocarpine causes breakdown of the BAB

82
Q

ریسکTrabx failiure در بیماران یووئیت بیشتر است،راهکارها جهت کاهش این ریسک؟

A

using MMC
intensive topical corticosteroids
🎈However, intense and recurrent postoperative inflammation can often lead to failure of filtering surgery in uveitic eyes

83
Q

چند درصد از بیمارانuveitic glaucoma که Trabx شدند، بعد از ۱ سال با۰ یا ۱ دارو IOPکنترل داشتند؟بعد از ۵ سال؟

A

Up to 90%

62%

84
Q

Surgical options for treatment of uveitic glaucoma?

A

1)Trabx+MMC
2)Nonpenetrating deep sclerectomy with or without a drainage implant
موفقیت هر دو ۱ سال بعد از جراحی ۹۰ درصد است
3)AGV
موفقیت بعد ۴ سال ۷۵ درصد است👏👏

85
Q

در بیما uveitic glaucoma یادت نره در زمان Trabx،وقتی پانچ میکنی و سپس PI باید…..

A

the excised trabecular block and iris should be submitted for pathologic evaluation

86
Q

What is the Sx for Mgx of pediatric uveitic glaucoma?success rate?

A

goniotomy ➡️up to a 75% chance of reducing IOP to 21 mm Hg or less after 2 surgeries.

87
Q

عوارض گونیوتومی در درمان pediatric uveitic glaucoma؟

A

1) transient hyphema

2) worsening of the preexisting cataract

88
Q

علل failiure ترابکولودیالیز لیزر sclerostomyدر درمان بیمارانuveitic glaucoma؟

A

recurrent postoperative inflammation

89
Q

کدام بیماران uveitic glaucmaبیش از سایرین به drainage device نیاز دارند؟

A

pseudophakic or aphakic eyes

🎈These devices may be tunneled into the AC or placed through the pars plana directly into the vitreous cavity.

🎈A unidirectional valve design (valve implant) can prevent
Postop hypotony.

90
Q

Which Sx is more likely to control IOP in long term in uveitic glaucomaPt?
AGV or Trabx?

A

AGV

۷۵ درصد بیماران کاهش IOPداشتند و ۷۵ درصد بعد از ۴ سال IOPکنترا با ۰ یا ۱ دارو داشتند

91
Q

Complications of glaucoma-drainage-device surgery

(10%/patient-year)

A

1) shallow AC
2) hypotony
3) suprachoroidal hemorrhage
4) blockage of the drainage device by blood, fibrin, or iris

🎈Long-term complications include

1) device erosion through the conjunctiva
2) valve migration
3) corneal decompensation
4) drainage device–cornea touch
5) RD

92
Q

مزیت AGVبر Trabx در درمان بیمارانuveitic glaucoma چیست؟

A

drainage devices have proven to be robust and continue to function despite chronic, recurrent inflammation; they provide excellent long-term IOP control in eyes with
uveitic glaucoma.

93
Q

Cyclodestructive procedures may worsen ocular inflammation and lead to hypotony and phthisis
bulbi.

A

Laser trabeculoplasty is generally considered ineffective in eyes with uveitis.

94
Q

Etiology of hypotony in acute and chronic uveitis?

A

🎈Acute inflammation of the CB➡️aqueous hyposecretion ➡️ low IOP➡️reversible after inflammation control
🎈chronic inflammation ➡️CB damage and atrophy of the ciliary processes ➡️ permanent hypotony

95
Q

Treatment of hypotony?

A

Acute➡️control of inflammation

Chronic➡️1)Prolonged choroidal effusions may require surgical drainage2) Chronic hypotony in long-standing uveitis may be helped by surgery if there is CB traction from a cyclitic membrane that can be released and if
the ciliary processes are preserved (as shown on UBM). If ciliary processes are atrophic, vitrectomy
with intraocular silicone oil or viscoelastic may help maintain ocular anatomy and increase IOP. In
some of these cases, visual improvement after surgery can be significant; these gains may, however,
be transient. Hypotony recurs in nearly one-half of eyes, requiring reinjection of silicone oil between
1 and 3 times over 1 year

96
Q

Etiology of CME in uveitis?

A

1)active intraocular inflammation( mediated by the VEGF, IL6)which cause retinal vascular leakage
and retinal pigment endothelium dysfunction.
2)Less commonly, CME may be caused by mechanical
VMT( differentiated by OCT).

97
Q

آیا شدت CMEالزاما با شدت فعالیت بیماری التهابی زمینه ای مرتبط است؟

A

NO

معمولا CMEآهسته برطرف می شود و عمدتا بعد از رفع التهاب زمینه ای کماکان باقی می ماند

98
Q

سیگار باعث افزایش شیوع CMEمی شود خصوصا در بیماران با intermediate uveitis و panuveitis

A

Correct

99
Q

اولین اقدام جهت درمان CME در بیمار یووییت؟

A

کنترل التهاب داخل چشمی

100
Q

Treatment of CME?

A

1)control of intraocular inflammation
2) superotemporal posterior sub-Tenon injection of 20–40 mg of triamcinolone acetonide.The injections
may be repeated monthly.
3)If CME persists, then 2–4 mg of intravitreal preservative-free triamcinolone may be considered. Intravitreal triamcinolone can be highly effective in reducing CME, particularly in nonvitrectomized eyes, but its effect is time limited; the drug is eliminated more
quickly from the vitreous cavity of vitrectomized eyes.
4)steroid implant
5)Anti VEGF
6)Intravitreal methotrexate (400 µg/0.1 mL)?
7)Oral acetazolamide, 500 mg once or twice
daily( particularly in patients whose inflammation is
well controlled)
8)Systemic interferon therapy has shown efficacy in resolving recalcitrant CME, with complete control in 62.5% of patients in one study
9)PPvitx if there is presence of hyaloidal traction on the macula

101
Q

بیشترین اثر تریامسینولون داخل ویتره در افزایش دید و کاهش CME چه زمانی دیده می شود؟

A

within 4 weeks

هر چه مدت uveitic CME بیشتر بوده باشدو دید در زمان پرزنتاسیون بدتر باشد مقدار visual improvement کمتر خواهد بود

102
Q

چند درصد بیماران به دنبال تزریق اینتراویتره تریامسینولون دچار افزایش IOP می شوند؟

A

40%

especially in those younger than 40 years

103
Q

The risk of ocular hypertension is lower

for the dexamethasone delivery system than for the fluocinolone implant

A

ریسک افزایش IOPدر ایمپلنت فلوسینولون بیشتر از ایمپلنت دگزامتازون است

104
Q

آیا Anti VEGFدر درمان inflammatory CMEموثر است؟

A

Yas, but the action is of short duration and repeat injections are required.

105
Q

Topical NSAIDs can be beneficial in treating pseudophakic CME

A

but their effectiveness in the treatment of uveitic CME has not been well established.

106
Q

چند درصد بیماران یووئیت دچار RRD می شوند؟

A

3%

107
Q

چند درصد بیماران با یووئیت وRRD دچار PVR هستند؟

A

Up to 30%

this percentage is significantly higher than in primary RRD in patients without uveitis

108
Q

در کدام موارد RRDهمراه با یووئیت SB موثر است؟

A

Scleral buckling may still be useful in

cases of RD associated with pars planitis

109
Q

در کدام موارد RRD همراه با یووئیت ترمیم جراحی دشوارتر است؟

A

1) ARN
2) CMV retinitis

🎈difficult to repair because of multiple large
posterior retinal breaks. Prophylactic laser treatment applied as soon as adequate visualization is
possible may be desirable, but the rate of detachment is still high. Pars plana vitrectomy and
endolaser treatment with internal silicone oil tamponade are required to repair the detachment

110
Q

در چه صورت در بیماران RRD همراه با یووئیت ازCombined SB and ppvitxاستفاده می شود؟

A

When PVR is present

111
Q

بروز retinal NVبیش از همه در کدام یک از یووییت ها دیده می شود؟درمان؟

A

1) pars planitis
2) sarcoid panuveitis
3) retinal vasculitis , including Eales disease.

Treatment:
🎈The presence of uveitic retinal NV does not always require PRP.
🎈Some cases of sarcoid panuveitis may present with NV of the disc that resolves completely with IMT and corticosteroid therapy alone
🎈treatment must first be directed toward reduction of inflammation.
🎈If ischemia is angiographically extensive, as in
retinal vasculitis or Eales disease, scatter laser photocoagulation in the ischemic areas is therapeutic.
🎈Dramatic regression of neovascularization of the disc and elsewhere in various inflammatory disorders typically occurs after 1 or 2 intravitreal injections of a VEGF inhibitor. This treatment may
be used as an adjunct to IMT and scatter laser photocoagulation.

112
Q

مکانیسم و علت ایجادChoroidal neovascularization (CNV) در یووئیت؟شیوع آن چقدره؟علائم بیمار؟درمان؟

A

🎈result of a disruption of the Bruch membrane from choroidal inflammation and the presence of inflammatory cytokines that promote angiogenesis.
🎈The prevalence of CNV varies among different entities (up to 10% of patients with VKH )
🎈Patients present with metamorphopsia and scotoma 🎈Treatment should be directed toward reducing inflammation as well as anatomical ablation of the CNV. Focal laser photocoagulation of peripapillary, extrafoveal, and juxtafoveal CNV may be performed. Treatment of subfoveal CNV is accomplished with VEGF inhibitors; results of one study showed that 2–3 intravitreal injections improved vision and reduced the size of subfoveal CNV in nearly all patients. PDT
with verteporfin may also be a useful adjunct in some cases. Control of inflammation in these cases
may reduce the risk of recurrence of CNV and the need for repeated intravitreal injections

113
Q

اقدام اصلی جهت جلوگیری از عود CNV در بیمارن یووئیت با CNV که تحت درمان قرار گرفته اند؟

A

کنترل التهاب

114
Q

در آمریکا چند درصد کوری به دلیل عدم درمان کافی یوئیت است؟

A

10%

115
Q

اندیکاسیون های ارجاع جهت بازتوانی بینایی؟

A

۱)دید کمتر از ۲۰/۴۰در چشم بهتر
۲)کاهش حساسیت کنتراست
۳)وجود glare ناتوان کننده
۴)کاهش VF سنترال یا پریفرال

116
Q

بیمار HIV با نورورتینیت،تشخیص؟

A

سیفلیس

117
Q

اقدامات لازم در شك به عفونت منتشر pcp

A

CXR
ABG
LFT
abdominal CT

118
Q

كوروئيديت PCP به ندرت در بيماران ايدزي منتشر مي شود

A

دقت كن

به ندرت

119
Q

چند درصد از بیماران ایدز با رتینوکوروئیدیت توکسو ضایعهCNSدارند؟

A

30 درصد

120
Q

کوروئیدیت PCP در ایدز

A

دید درگیر نمی شود💍💍

121
Q

در کوروئیدیت PCP ضایعات کوروئید ممکن است حاوی ارگانیسم مسئول بیماری باشد

A

در کوروییدیت PCP طی ۳ هفته تا ۳ ماه ضایعات ناپدید می شوند

دید درگیر نمی شود

122
Q

بیمار با رتینیت CMV
درمان شده
روی درمان نگهدارنده بوده تا CD4بالای ۱۰۰ رسیده

A

در این بیمار می توان درمان نگهدارنده را قطع کرد ولی باید با فواصل ۳ ماه F/Uشود چون ریسک عود CMVوجود دارد

123
Q

شدت زوستر در بیماران ایدز فرق نداره ولی عود بیشتره

A

سیفلیس در بیماران ایدز اگرسیوتره

AAO (45 decks)

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