OphthoDeck.com

How does the inflammation differ between VKH and sympathetic ophthalmia?

admin — Sun, 22 Jun 2008 16:15:05 +0000

VKH involves the choroid and retina, while sympathetic spares the choriocapillaris. One mneumonic is: “Sympathetic Spares”

This point is occasionally tested, however, the difference may be false. Eyes with sympathetic ophthalmia tend to be enucleated earlier and may not have had time to involve all levels of the choroid.

At what level do Dalen Fuches nodules occur?

admin — Sun, 22 Jun 2008 16:09:46 +0000

Between Bruch’s and RPE.

What is the HLA association with VKH?

admin — Sun, 22 Jun 2008 16:06:30 +0000

DR4. However, this is not helpful for making a diagnosis. DR4 is also associated with sympathetic ophthalmia.

How do you detect VKH?

admin — Sun, 22 Jun 2008 16:03:32 +0000

There is no good test, but symptoms can point you in the right direction. Early on these pateints have CNS findings, tinnitus, headaches, menengial signs, and fever. This is followed by skin and hair findings.

Ocular findings include a cherry red disk, exudative detachments (with the fluid often forming around the optic nerve). Late retinal findings include pigment changes, a “sunset glow” fundus, and subretinal neovascular membranes.

An FA workup includes early pinpoint hyperfluorescences with late subretinal pooling and disk leakage (findings look similar to posterior scleritis).

How do you treat Behcets disease?

admin — Sun, 22 Jun 2008 15:57:47 +0000

High-dose steroids while waiting for more effective treatments like the TNF inhibitor like Remicade/ infliximab.

What blood test might you consider with suspected Behcet’s disease?

admin — Sun, 22 Jun 2008 15:54:04 +0000

You can check for HLA-B5. Not many perform the classic pathergy test … where you inject saline under the skin and have the patient return the next day to check for a blister.

How do you treat toxoplasmosis in pregnancy?

admin — Sun, 22 Jun 2008 15:50:46 +0000

The treatment of choice is Spiramycin, a macrolide which is not actually available in US but available in France and on boards. Remember that you only transmit newly acquired disease to fetus, not reactivation. Also, remember that you can’t use pyrimethamine in pregmant or lactating women. Always consult an obstetrician and document this with any treatment.

How do you treat toxoplasmosis?

admin — Sun, 22 Jun 2008 15:48:03 +0000

There are no definite treatments, as there are several ways to do this. For example, you can treat with:
- pyrimethamine (note that you need to supplement with FOLINIC acid … not folic acid)
- sulfadiazine (pts can become photosensitive and develop Stevens Johnson)
- clindamycin (C. Dif)
- then give prednisone a few days after you treat the infection.

Some people use bactrim DS bid, or azithromycin, though these single agents might not work as well as a triple therapy.

What disease looks like bilateral macular toxoplasmosis scars?

admin — Sun, 22 Jun 2008 15:43:36 +0000

North Carolina macular dystrophy has impressive macular findings that can look like toxoplasmosis. However, unlike a toxo scar, these patients have pretty good vision, no cells, and a family history.

What’s the most common cause of posterior uveitis in the immuno-competent patient?

admin — Sun, 22 Jun 2008 15:41:56 +0000

Toxoplasmosis is the most common cause with a rate of 25 to 30% of the time. IF you have a posterior uveitis, and aren’t sure of the diagnosis, then toxo is a good guess.