Posterior Segment Inflammation
Leo Semes, OD
I. Perspective – Posterior Ocular Inflammatory Disorders
II. Infections
A. Viral
1. HSV
2. HZV
3. Rubella
B. Bacterial
1. Strep . & Staph .sp.
2. Syphilis
3. Bartonella henselae …
4. TB
5. Nocardiosis
6. Lyme disease (Borrelia burgdorferi)
C. Fungal
1. Candida endophthalmitis
2. Histoplasma capsulatum
a. Treatment
i. Amphotericin B, ketoconazole for systemic involvement
ii. Intravitreal amphotericin B + pars plana vitrectomy
iii. PDT
D. Protozoa (Toxoplasmosis gondii)
1. Case Initial presentation
2. Fundus appearance
3. Differential diagnoses
4. Initial treatment
5. Follow-up treatment
6. Discussion - Contemporary Management of Ocular Toxoplasmosis
III. Inflammations of Alternative Etiology
A. CMV retinitis [full thickness retinal whitening & hemorrhage]
B. Acute Retinal Necrosis
C. Roth’s spots
IV. Case
1.
2.
3.
– Bartonela Henselae
History / RFV
Findings
Differential diagnoses
a. Toxoplasmosis
b. Histoplasmosis
c. Toxocariasis
d. Cat-scratch neuroretinitis
4. Treatment
5. Discussion
a. Optic nerve swelling as an early sign in cat-scratch disease
b. Serology to confirm diagnosis
c. Resolution is sometimes spontaneous without ocular consequences
V. Other Case Examples
Inactive Toxo Lesion
Active Toxo Lesion
VI. Nematodes (visceral/ocular larval migrans)
A. Toxocara canis, catis (roundworm)
B. Epidemiology
C. Infestation
D. Ocular Mnaifestations ( Ocular Toxicariasis
E. Therapy (depends on visual potential and extent of involvement)
1. Antihelmenthics
2. Antibiotics
3. Corticosteroids
4. Vitrectomy
VII. Onchocerciasis ( [infected] black fly bite)
VIII. Exclusive Ocular Inflammatory Conditions
A. AMPPPE (acute multifocal posterior placoid pigment epitheliopathy)
B. Birdshot retinochoriodopathy
C. MEWDS (multiple evanescent white-dot syndrome)
D. Serpiginous choroidopathy
E. Sympathetic ophthalmia
IX. Ocular
A.
B.
C.
D.
E.
F.
Inflammatory Conditions with Systemic Involvement
V-K-H syndrome (uveomeningitic syndrome)
Sarcoidosis
SLE (systemic lupus erythematosus)
Bechet’s disease
AIDS
Iatrogenic inflammation
X. Relavent Literature
1. Mai ELC, et al. Update on therapy of parasitic retina infection. Ophthalmology Clin North
Am 1999; 12: 123-144.
2. Sabrosa NA, et al. Nematode infections of the eye: toxocariasis, onchocerciasis, diffuse
unilateral subacute neuroretinitis, and cysticercosis. Ophthalmology Clin North Am 2002; 15:
1-8.
3. Wade NK, Levi L, Jones MR, et al. Optic disk edema associated with peripapillary serous
retinal detachment: an early sign of systemic Bartonella henselae infection. Am J
Ophthalmol 2000; 130: 327-334.
4. Hamza HS, et al. Ocular Infections: Update on therapy. Fungal retinitis and
endophthalmitis. Ophthalmol Clin North Am 1999; 12:1-22
5. Levinson RD, et al. Birdshot retinochoroidopathy: immunopathogenesis, evaluation, and
treatment.Ophthalmology Clin North Am 2002; 15(3): 343-50.
6. Opremcak EM. Scales DK. Sharpe MR. Trimethoprim-sulfamethoxazole therapy for ocular
toxoplasmosis. Ophthalmology 1992; 99:920-5.
7. Bosch-Driessen LH. Verbraak FD. Suttorp-Schulten MS. van Ruyven RL. Klok AM. Hoyng CB.
Rothova A. A prospective, randomized trial of pyrimethamine and azithromycin vs
pyrimethamine and sulfadiazine for the treatment of ocular toxoplasmosis. Am J
Ophthalmol 2002; 134:34-40.
8. Ocular Toxoplasmosis Clinical Features and Prognosis of 154 Patients. Bosch-Driessen LEH,
Berendschot TTJM, Ongkosuwito JV, Rothova A. Ophthalmology 2002;109:869–878.