Macular Swelling
Part 2
Eur J Ophthalmol. 2009 Mar-Apr;19(2):307-9.
Bartonellosis causing bilateral Leber neuroretinitis: a case report.
Hernandez-Da-Mota S1, Escalante-Razo F.
1Clínica David, Unidad Oftalmológica, Morelia, Michoacan and General Hospital "Dr. Miguel Silva," SSA, Morelia, Michoacan - Mexico. tolodamota@yahoo.com.mx
Abstract
PURPOSE:
Bartonella henselae is the causal agent of cat scratch disease and one variation in its presentation is Leber neuroretinitis. The unilateral presence of exudation as a macular star and papilledema represent its most common presentation.
METHODS:
Observational case report. A 7-year-old girl presented a sudden decrease of visual acuity and bilateral macularexudation (macular star) as well as choroiditis.
RESULTS:
A complete recovery of visual acuity was seen after a 6-week follow-up. Erythromycin plus deflazacort treatment was given.
CONCLUSIONS:
The present case represents an unusual variety of cat scratch disease. This represents a challenge in the differential diagnosis of diseases such as Lyme disease and tuberculosis among others.
http://www.ncbi.nlm.nih.gov/pubmed/19253255
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Mayo Clin Proc. 1996 Dec;71(12):1162-6.
Optic disk edema with a macular star.
Abstract
Optic disk edema with a macular star is a descriptive term encompassing a heterogeneous group of disorders. The clinical features include sudden visual loss, swelling of the optic disk, peripapillary and macular exudates that may occur in a star pattern, and cells in the vitreous. Herein we describe the clinical features, potential etiologic factors, differential diagnosis, work-up, and natural history of this entity.
Although optic disk edema with a macular star is usually idiopathic, infectious causes, especially syphilis, Lyme disease, cat-scratch disease, and toxoplasmosis, should be considered.
The macular exudate likely results from primary optic nerve disease, not from inflammation of the retina; therefore, we prefer the term "idiopathic optic disk edema with a macular star" for idiopathic cases rather than "neuroretinitis."
When optic disk swelling and macular star are associated with focal or multifocal inflammatory lesions in the retina (retinitis), especially if an infectious cause is documented, the term "neuroretinitis" is appropriate. The prognosis for visual recovery is usually good, but residual visual loss may be severe in a few cases.
Patients with a recurrent type of the disease may not experience pronounced improvement in optic nerve function.
The macular exudate may not develop in cases of disk edema until 2 weeks after the patient's initial assessment; thus, patients who have acute papillitis with a normal macula should be reexamined within 2 weeks for development of a macular star.
The presence of a macular star militates strongly against subsequent development of multiple sclerosis.
http://www.ncbi.nlm.nih.gov/pubmed/8945487
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Bull Soc Belge Ophtalmol. 1995;259:205-14.
Retinal vasculitis in Lyme borreliosis.
Leys AM1, Schönherr U, Lang GE, Naumann GO, Goubau P, Honore A, Valvekens F.
Abstract
We observed retinal vasculitis in seven patients with clinical and serologic evidence of Borrelia burgdorferi infection.
Three patients presented with abrupt loss of vision due to acute retinal vasculitis. Funduscopy demonstrated engorged veins, hemorrhages, perivenous infiltrates and retinal white spots. Fluorescein angiography showed leakage from the veins, from the white spots and from the optic disc.
Moreover arterial occlusions were observed in two patients.
Four patients had signs of chronic uveitis with vitritis, cystoid macular oedema and retinal vasculitis, which was associated with neovascularization and vitreous hemorrhage in one patient, and with optic neuritis in another patient.
Six patients received antibiotic treatment and three patients received systemic corticosteroids.
Marked improvement in the three acute retinal vasculitis cases occurred within several weeks, the fundus changes disappeared in another few months, and no recurrences were observed.
The final visual acuity was excellent in these patients, although optic disc pallor and visual field loss persisted in one case.
In the four patients with chronic uveitis visual blurring improved following antibiotic treatment and the retinal vasculitis and vitritis slowly regressed. The proliferative retinopathy of one patient required panretinal laser treatment.
http://www.ncbi.nlm.nih.gov/pubmed/8936779
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Eur J Ophthalmol. 1994 Oct-Dec;4(4):223-7.
Intermediate uveitis: what is the natural course of the disease and its relationship with other systemic diseases?
Palimeris G1, Marcomichelakis N, Konstantinidou V, Trakaniari AN.
Abstract
This study examined the natural course of intermediate uveitis, to find a possible correlation with systemic diseases and to identify the ocular complications. Patients were classified according to follow-up time in three groups: A (1-5 years) 12 pts, B (6-10 years) 10 pts, C (11-15 years or more) 6 pts for a total of 28 patients (52 eyes).
We studied the recurrences, the complications of the disease and the overall prognosis. Eight patients were found to be suffering from systemic diseases: sarcoidosis 2, Adamantiades-Behcet 2, multiple sclerosis 3 and Lyme disease 1.
Cataract was found in 21 eyes (40.5%) and macular changes in 20 eyes (38.4%) but chronic cystoid macular edema persisted in only six cases (12.5%).
Group C presented more complications than group B. Group A had the fewest. The frequency of recurrences was 1-5 for group A. 1-3 for group B and 1-2 for group C.
Four patients received no therapy, 15 received steroids and nine received cyclosporine and steroids. In this series intermediate uveitis was bilateral in 85.8% of patients and related with systemic diseases in 28.5%.
Recurrences appeared mainly during the first five years. The longer the presence of the disease the more frequent were complications and the final visual acuity depended mostly on the severity of the initial attack and the number of exacerbations.