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No part of this publication should be reproduced, stored in a retrieval system , or transmitted In any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent errorts). In case of anv diSDute al1leoal matters to be settled under Delhi iurisdiction onlv. First Edition: 2005 ISBN 81-8061-466-2 Typeset at JPBMP typesetting unit Printed at Paras Offset Pvt Ltd., C 176 Naraina Industrial Area, Phase 1, New Delhi 110028 FOREWORD Several uveitic entities are recognized based on their clinical features and! or pathogenesis; such entities include Toxoplasma retinochoroiditis, Pars pianitis, Serpiginous choroiditis and several others. In many instances however, determining exactly what initiated the process of uveitis has been a challenge, particularly when the trigger is an infectious agent. The detection process is complicated by the diverse clinical manifestations of uveitis that are induced by the infectious agent, by the unavailability of infected tissue for examination and by the lack of specific and sensitive diagnostic tests. For example, Mycobacterium tuberculosis can present with an anterior or posterior uveitis, with or without granulomas. Moreover this agent can induce a hypersensitivity reaction with clinical features of retinal vasculitis. iridocyclitis or multifocal choroiditis or with features suggestive of Serpiginous choroiditis. In such a clinical spectrum. Mycobacterium tuberculosis can be isolated from the granulomatous lesions, but such samples rarely become available. In hypersensitivity reactions such as retinal vasculitis. the infectious organisms appear to be absent from the retina, yet some patients respond positively to antituberculous agents suggesting that mycobacterium does indeed have a role in this entity. Sputum analysis and chest X-ray findings may not help pinpoint the diagnosis in these patients. In recent years, molecular diagnostic procedures have detected infectious agents in some cases wherein organisms could not be cultured or detected by other microbiological procedures. Among the various molecular procedures used, the analysis of intraocular fluid by polymerase chain reaction (PCR) in uveitis has shown great promise in detecting traces of an infectious agent in the form of a microbial specific DNA sequence. This procedure has been successfully used by several laboratories including laboratory of Sankara Nethralaya to detect bacteria, viruses and protozoa in intraocular inflammation. Based on well documented clinical findings. laboratory investigations including PCR analysis. the authors of this well illustrated atlas provide succinctly main clinical diagnostic features and management of various uveitic entities. The authors profusely illustrate clinical examples of both anterior and posterior uveitis and scleral inflammation seen in their practice over a decade. This atlas should be valuable to ophthalmologists in clinical practice and to postgraduate students who are in the process of acquiring knowledge in the field of uveitis, a leading cause of blindness in the developing world. Narsing A Rao MD Los Angeles. California USA PREFACE Uveitis is an emerging subspeciality of ophthalmology that presents with a constellation of clinical findings. Accurate diagnosis of uveitis and successful treatment of these patients remain a challenge. The field of uveitis has been revolutionized over the past 50 years. OUf understanding of ocular inflammatory diseases has progressed rapidly and we can accurately diagnose and treat these diseases. Basic science and research in immunology has led to new therapeutic approaches to the patient with uveitis and scleritis. This atlas gives the reader a concise overview of the clinical manifestations, investigations, diagnosis and management of uveitis and scleritis. We emphasize on careful clinical assessment and accurate diagnosis. This book is not intended to be a textbook but a practical guide to the diagnosis, in obtaining appropriate investigations and management. The uvea department has a team of four consultants and we examine about a thousand new cases of uveitis every year. The emphasis on maintaining good clinical record with digital archiving was an excellent source for selecting pictures for this atlas. All cases included were patients seen at Sankara Nethralaya, Chennai. Authors ‘0 ACKNOWLEDGEMENTS – ‘ Dr SS Badrinath has been the driving force behind this atlas. Without his encouragement, this book would not have come into existence. We are deeply indebted to him for his active support. We are very grateful to Mr SP Govindarajan, Mr 5 Jayaraman. Mr Anand and Ms Lakshmi (Nursing Staff) in photography department at Sankara Nethralaya. Special thanks to Dr Rajesh FogJa and Dr Mani Baskaran for their help in taking digital slit lamp photographs of the anterior segment. We would like to give our special thanks to Mr V MuraU, Mr Mohan and Mr Elango in our multimedia department who helped us in scanning the images. We also extend our sincere thanks to our corresponding secretaries. We also acknowledge the efforts of Jaypee Brothers Medical Publishers (P) Ltd for their technical assistance, printing and publishing this atlas on time. [n particular, we like to thank Shri J P Vij, Chairman and Managing Director of Jaypee Brothers and Mr R Jayanandan, author Co-ordinator of Chennai branch. Finally, we thank aU our patients for trusting us and allowing us to participate in the management of their ocular problems.
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