mycophenolic-acid and Blindness

To describe the clinical features and course of 2 patients with autoimmune diseases and their experience with the Boston keratoprosthesis. To draw on general medical literature to try to better understand recurrent complications.. Retrospective review of 2 patients treated with Boston keratoprostheses. The clinical histories, examinations, and other diagnostics were reviewed. A literature review was performed.. The first patient presented with end-stage ocular disease secondary to toxic epidermal necrolysis (TENS). The second patient presented with end-stage ocular disease secondary to mucous membrane pemphigoid (MMP). Both patients underwent treatment with the Boston keratoprosthesis. Both patients suffered numerous corneal melts requiring multiple repeat implantations.. Patients with corneal blindness secondary to autoimmune disease often fare poorly with available surgical treatments. Study of existing literature on prosthetic device complications in autoimmune diseases may help uncover common mechanisms of tissue destruction to establish perioperative immunomodulatory regimens targeted to specific underlying diseases.

Topics: Adult; Alternaria; Anti-Inflammatory Agents; Antibodies, Monoclonal; Autoimmune Diseases; Blindness; Corneal Diseases; Female; Humans; Infliximab; Male; Middle Aged; Mycophenolic Acid; Mycoses; Pemphigoid, Benign Mucous Membrane; Prednisolone; Prostheses and Implants; Prosthesis Implantation; Stevens-Johnson Syndrome; Treatment Outcome; Visual Acuity

A 25-year-old male patient presented to the emergency department with the chief complaint of sudden blindness and was found to have suffered bilateral central retinal artery occlusion (CRAO). This process is most commonly the result of a thrombus or embolus that occludes the retinal artery, and normally presents in a single eye in patients older than 65 who are predisposed to vascular disease. Diagnosis relies most heavily upon funduscopic exam. Potential treatments involve ocular massage, acetazolamide, anterior chamber paracentesis and systemic or local fibrinolysis. Despite these interventions vision is often significantly and permanently impaired. This case underscores the importance of the emergency physician's ability to promptly perform and interpret the funduscopic exam in order to diagnose and evaluate CRAO.

Topics: Adult; Anti-Inflammatory Agents; Antibiotics, Antineoplastic; Blindness; Humans; Male; Mycophenolic Acid; Prednisone; Retinal Artery Occlusion; Thrombolytic Therapy; Tomography, Optical Coherence; Treatment Outcome

Central retinal artery occlusion (CRAO) is uncommon among children and young adults. Bilateral CRAO before the age of 18 years are extremely rare. We present a case of an idiopathic bilateral CRAO in a young healthy female.

Topics: Adolescent; Blindness; Enzyme Inhibitors; Female; Fibrinolytic Agents; Fluorescein Angiography; Glucocorticoids; Humans; Magnetic Resonance Imaging; Methylprednisolone; Mycophenolic Acid; Retinal Artery Occlusion; Tissue Plasminogen Activator; Tomography, Optical Coherence; Vision, Low; Visual Acuity

Topics: Adult; Antiviral Agents; Blindness; Bone Marrow Transplantation; Cytomegalovirus Retinitis; Diagnosis, Differential; Drug Therapy, Combination; Fluorescein Angiography; Humans; Immunosuppressive Agents; Leukemia, Myeloid, Acute; Male; Mycophenolic Acid; Retinal Artery Occlusion; Retinal Vasculitis; Visual Acuity

Topics: Administration, Oral; Blindness; Cyclophosphamide; Drug Therapy, Combination; Eye Enucleation; Eye Pain; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Ophthalmia, Sympathetic; Retinal Diseases; Visual Acuity

Topics: Adult; Blindness; Diagnosis, Differential; Drug Therapy, Combination; Humans; Male; Methylprednisolone; Mycophenolic Acid; Optic Neuritis; Prednisone