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Upalne stanice u prednjoj komori (cells in anterior chamber)

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 PostPoslano: 13-12-2010 12:11  Citiraj (i odgovori)  
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GRADING OF AQUEOUS CELLS

0 No Cells
1-5 1/2+ (TRACE)
6-15 1+
16-25 2+
26-60 3+
Greater than 60 4+


CELLS, A MEASURE OF UVEITIS ACTIVITY

Ophthalmologists use the term "cells" to refer to white blood cells (leukocytes) that can be observed during the slit lamp examination of the front of the eye (the anterior chamber). Cells are a byproduct of inflammation. If structures in the front of the eye have inflammation, cells are shed into the fluids in the front chamber of the eye (into the aqueous humor), and can be observed and counted in the narrow beam of light from the slit lamp. This cell count forms the basis for grading the severity of inflammation at any given point in time. The number of white blood cells is used as a measure of uveitis activity, and is scaled from 1 to 4, depending on the severity (1 being the least severe inflammation and 4 being the most severe inflammation). The right hand table is the grading of aqueous cells in anterior uveitis used by most uveitis specialists. Inflammatory cells in the anterior chamber are usually a result of inflammation of the iris. Cells are difficult to capture in photographs and, thus, we do not have a picture to show you. If you have ever noticed dust in the air as light passes through a shutter, you have a bit of an idea of what "cell" look like floating in the front of the eye.

Cells can also be observed in the vitreous (the middle chamber of the eye) on dilated examination. Inflammatory cell accumulation in the vitreous is the result of inflammatory process in other parts of the eye such as the ciliary body, retina, and choroid.

Cells in the vitreous can be living or dead, and both can become immutably affixed to vitreous fibers. Only live, active cells are graded in the MERSI rating system. Vitreous cells are rated on a scale of 1-4 , as follows: 1/2+=1-10 cells. 1+=11-20 cells. 2+=20-30 cells. 3+=30-100 cells. 4+=grater than 100 cells. Other institutions use other rating systems to grade vitreous cells.

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Pitanje: Brought my daughter (the one who doesn't have uveitis) for a routine eye exam yesterday to a local optometrist. He said eyes looked good and a little near sighted but probably not enough to warrant glasses yet. I mentioned that my youngest has uveitis and asked if he could double check just in case. He did say that he saw one or two cells but there was not sign of inflammation and that some people just have one or two cells sometimes and it was nothing to worry about since all other tests were just fine. Just wanted to double check with you if this is correct that some people do have one or two cells with no problems. He said to come back in one year.

Odgovor: That can be true. But given your concern, given your family history, I believe that you will be more secure and certain and comforted if you arrange for her to see an Eye MD, an ophthalmologist, just as a triple check.
Dr. Foster

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 PostPoslano: 13-12-2010 12:17  Citiraj (i odgovori)  
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Pitanje: Low grade inflammation
Just wondering what your definition of "low grade inflammation" is? We have come a long way since this all started last Nov. (4+ both eyes) but we have yet to have an appt. with no cells in both eyes. At best we have had 0 cells one eye and 2 cells in the other. M daughter is on oral Mtx and durezol gtts. Seems everytime we try and wean the gtts, we get a slight flare and have to go back up. Any info would be greatly appreciated! Thanks!

Odgovor: So long as steroid is part of the treatment, you have no idea where things stand with respect to being in remission OFF STEROIDS. And that is the key to everything. Without achieving steroid-free remission, there is no chance that your child's case will turn out any better than all the others reported over the past 25 years with steroid therapy as part of the treatment. I consider less than 1+ cells to be O.K., and I do not treat more aggressively. But you will know whether or not that is the case with your child only after Durezol and any other steroid is out of the picture.

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 PostPoslano: 13-12-2010 12:22  Citiraj (i odgovori)  
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Pitanje:

Someone from another support group asked me whether any cells in a uveitic eye are really an issue, if the count is trace or rare. I know my opthalmologist considers this to be a remissive state.

"Can people not diagnosed with uveitis have trace amounts of cells floating around in their eyes, or do these cells occur only in patients with uveitis?"

Odgovor dr. Fostera:

I do not treat cells less than 1+ (što znači više od 5 stanica). It's a balance between treating inflammation that can be damage and over treating inflammation that can be tolerated with no consequence
Yes, they can , in the absence of uveitis or a history of uveitis.

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 PostPoslano: 13-12-2010 12:31  Citiraj (i odgovori)  
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Pitanje:

JIA Related Anterior Uveitis - is there such a thing as a 'mild' case while the inflammation is still on?
My 11 year old daugther was diagnosed with JIA when she was one. She has been on MTX for quite a while (dosing being adjusted now and then), and hasn't had a flare in over a year. However, on her routinary visit to her ped. oph. a year ago, she was diagnosed with anterior uveitis on both eyes, being the left eye, the most affected. She was initiated on Pred Forte 4x daily, and for the first few months, it seemed to be improving all along (the right eye was 'clear') until she was taken off the drops. Unfortunately, 4 months ago, her uveitis had progressed, and the rheum wants to start my kid on Humira along with methrotexate. Honestly I am not thrilled about it, as I wasn't on Enbrel. The JIA is well under control...now almost all the visits are to the ped. oph, who I must admit is very good, but immunology-wise, her expertise falls short, and seems to be too conservative.Based on that, I have a few questions:

1) For how long can Pred Forte be used w/o the related complications? I mean, once it is been tapered, how many times can she go back to the drops? Are steroid injections an option for my daughter?

2) The ped oph says that my child's uveitis is not 'bad', yet the inflammation is still a concern, that it seems to be 'stagnant'...is that good enough, or better said 'wise observation' by a clinician? Guess the comment came from my question on the previous evaluation vs the evaluation she was doing that day.

3) I have reviewed all of the posts on this forum, and one caught my attention: the use of an NSAID along with Methotrexate and topical steroid (Pred Forte)...is that corrrect? She has been on other eye drops like Lotemax 4xdaily, but no progress has been achieved with this drug.

4) I couldn't find a specialist on occular immunology and uveitis on your list with practice in Puerto Rico, where I live. However, I did find one on the local yellow pages, but how can I trust that he has had the right training/expertise? Are there any of these specialists in the Orlando, FLA Area? My sister lives there and it is fairly close to Puerto Rico.

Last, but not least, keep up with this excellent site. I have learned a lot about uveitis due to the resources you have posted. I will appreciate your response to the questions above, that may seem 'silly', but not for a mother that is desperately looking for the welfare of her beloved daughter.

Mrs. Helga Lespier from San Juan, Puerto Rico

Odgovor:

The idea that low grade inflammation (1+ or greater) can be observed while waiting for a child to "outgrow" the uvieitis or for the uveitis to "burn out" is completely retarded and is to be deplored. Thousands of people are blind or visually handicapped today because of such outdated and inappropriate thinking.

Similarly, the idea that one can use topical or injectable or systemic steroids endlessly without serious complications is also retarded. Many, many publications in peer reviewed literature from around the globe show very clearly what the LONG TERM outcomes of such practices are: slow but irrevocable loss of vision. You and your rheumatologist are on the right track. The eyes have now become the main focus and driving force with respect to decisions about vigor of therapy. The idea of Humira plus methotrexate or Humira plus methotrexate plus an oral non-steroidal anti-inflammatory agent is also perfectly acceptable.

THE GOAL must be to have less than 1+ cells in the anterior chamber OFF of all steroids. Unless or until that goal is achieved, your daughter has not chance of being cured. And she absolutely can be cured is therapy is done correctly. CURE= no inflammation off all drugs, someday

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 PostPoslano: 13-12-2010 12:35  Citiraj (i odgovori)  
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Flares when traveling

I am a 44 yr old white male with HLA-B27 spondyloarthropathy. I've had a total of 4 episodes of uveitis in approximately 15 years. My last flare was four years ago when I traveled to Italy for a vacation. Prior to that I was maintained on Celebrex monotherapy for stable spondyloarthropathy. When flying back from vacation I began the worst systemic flare I had had up to that point -- 3 joint effusions plus a severe case of uveitis. As a result of this episode, I was placed on MTX, folate, Celebrex, and Humira. That has been my maintenance regimen for the past 4 years. Uveitis remission was established in about 6 weeks from its presentation, and I have been in remission since then.

Until now. Two days ago I got back from another trip to Italy. While there I developed a pharyngitis; I do not know if it was strep or not. I took antibiotics for that possibility. I got back in the States the day before yesterday. I saw my ophthalmologist today who diagnosed me with mild uveitis (2-3 cells she said she could see). My VA is at baseline.

I find it interesting that my last two flares were while I was in Italy, being in a durable remission in the interim. Is it the travel that is the cause? The diet? The wine? The throat infection?

Odgovor: Stress and new microbes are more likely than diet or climate. Italy is worth it in my book; take a bottle of steroids along each time.

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