Macular Swelling, Edema, Degeneration, Vision Loss
Retina. 1996;16(6):505-9.
Long-term follow-up of chronic Lyme neuroretinitis.
Karma A1, Stenborg T, Summanen P, Immonen I, Mikkilä H, Seppälä I.
Abstract
PURPOSE:
The authors report sequential fluorescein angiographic and color photographic
findings of the fundi and response to treatment in a patient with chronic Lyme neuroretinitis.
METHODS:
A Lyme enzyme-linked immunosorbent assay with purified 41-kd flagellin as antigen was used to detect immunoglobulin G and immunoglobulin M antibodies to Borrelia burgdorferi in serum, cerebrospinal fluid, and vitreous. The changes were documented by fluorescein angiography and color photography tests performed during a 5 1/2 year follow-up.
RESULTS:
The diagnosis of Lyme neuroretinitis was based on the history of erythema migrans and positive Lyme enzyme-linked immunosorbent assay tests from cerebrospinal fluid and vitreous and by the exclusion of other infectious and systemic diseases and uveitis entities. Fluorescein angiography results disclosed bilateral chronic neuroretinal edema with areas of cystoid, patchy, and diffuse hyperfluorescence peripapillary and in the macular areas. The hyperfluorescent lesions enlarged despite a 9-month period of antibiotic therapy.
CONCLUSION:
Lyme borreliosis may cause neuroretinitis with unusual angiographic findings. Chronic Lyme neuroretinitis may be unresponsive to antibiotic therapy.
http://www.ncbi.nlm.nih.gov/pubmed/9002133
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Graefes Arch Clin Exp Ophthalmol. 2008 Mar;246(3):457-8. doi: 10.1007/s00417-007-0740-0. Epub 2008 Jan 12.
Intravitreal triamcinolone for macular edema in Lyme disease.
Reibaldi M1, Faro S, Motta L, Longo A.
Abstract
BACKGROUND:
To describe the outcome in a patient with macular edema caused by Lyme disease treated with injection of 4 mg intravitreal triamcinolone.
METHODS:
The patient, 2 years after systemic Lyme disease treated with doxycycline for 4 weeks, developed macular edema with serous retinal detachment in one eye (visual acuity: 0.6).
After unsuccessful therapy with intravenous ceftriaxone, indomethacin and acetazolamide, 4 mg intravitreal triamcinolone (IVTA) was injected via the pars plana.
RESULTS:
Visual acuity improved to 1.0 and macular thickness recovered over 1 month. No changes were found in intraocular pressure. No recurrence of macular edema was seen after 2 years.
CONCLUSIONS:
IVTA can restore visual acuity and reduce macular thickness in macular edema caused by Lyme disease. However, since borreliosis is a systemic disease, previous systemic antibiotic treatment is recommended.
http://www.ncbi.nlm.nih.gov/pubmed/18193264
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Klin Monbl Augenheilkd. 1989 Aug;195(2):91-4.
[Borrelia burgdorferi infection with bilateral optic neuritis and intracerebral demyelinization lesions].
[Article in German]
Bialasiewicz AA1, Huk W, Druschky KF, Naumann GO.
Abstract
In September, 1987, the authors saw a 25-year-old female patient with retinal perivasculitis, cystoid macular edema and papilledema in her right eye. The left eye was normal. Visual acuity was 0.2 (OD), 1.2 (OS).
After conventional infections had been ruled out systemic methylprednisolone therapy was instituted, but the patient's condition deteriorated.
In May 1988 she presented with papilledema and a "neuroretinitis"-like finding in her left eye; in her right eye advanced optic nerve atrophy; visual acuity was 0.1 (OD) and 0.07 (OS).
The laboratory workup revealed an acute phase of a chronic Borrelia burgdorferi infection, with total immunoglobulins (immunofluorescence test) of 1:1280 and an IgM of 1:650 (normal ranges: total Ig up to 1.80, IgM up to 1:40).
MRI showed multiple paraventricular and subcortical demyelinating lesions. However, the cranial CT scan was normal. After 14 days' treatment with doxycycline 200 mg/d, visual fields and acuity improved to sc 0.2 (OD) and sc 0.1 (OS) (July, 1988).
This case of intracranial demyelinizating lesions associated with bilateral optic neuritis in a serologically determined Borrelia burgdorferi infection is the first of its kind described in the literature. http://www.ncbi.nlm.nih.gov/pubmed/2796241