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Recurrent pregnancy loss
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Christine E. Ryan, Danny J. Schust
Uterine synechiae may occur after uterine infection, intrauterine curettage, or other uterine instrumentation. Synechiae have been found in 5% of patients with RPL. Hysteroscopy is typically recommended to lyse these adhesions, although strong data to support this treatment are lacking.
Habitual Abortion
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
Dwight D. Pridham, Christine L. Cook
Uterine synechiae (intrauterine adhesions, Asherman’s syndrome) are detected incidentally in 2 to 3% of women having the uterine cavity evaluated by hysterosalpingography or hysteroscopy for indications other than habitual abortion.20 This rate may be as high as 8% in patients evaluated for HAB.14 Conversely, up to 15% of patients with synechiae present with recurrent abortions.21 Synechiae are thought both to alter the uterine cavity contour and to cause abnormal distribution of the endometrium and vascular supply over the myometrium. This can cause abnormal placentation resulting in SAB or placenta accreta. Common etiologies of synechiae include endometrial curettage later than one week after delivery or miscarriage, endometritis, retained products of conception, hypoestrogenemia, or uterine surgery (myomectomy, cesarean section), although some patients have no history of these. Intrauterine adhesions occur in more than 20% of women after SAB; these resolve gradually and can be detected in less than 1% of patients three to four weeks later.22 Diagnostic studies should therefore be performed at least two months after the last miscarriage.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
A rare abnormality of the shape of the pupil. Congenital causes include persistent pupillary membranes, iris coloboma, iris hypoplasia and ectopia lentis et pupillae (see below). Acquired causes include posterior synechiae seen in iritis or trauma.
Laser Flare Photometry: A Useful Tool for Monitoring Patients with Juvenile Idiopathic Arthritis-associated Uveitis
Published in Ocular Immunology and Inflammation, 2022
Raphaëlle Orès, Céline Terrada, Marie-Hélène Errera, Jennifer E. Thorne, Raphaël Doukhan, Nathalie Cassoux, Benjamin Penaud, Phuc LeHoang, Pierre Marie Quartier, Bahram Bodaghi
In regards to the best final visual outcome and the complication rate results at the final visit, we found a final low BCVA outcome of 28%, similar to published series, ranging from 0%50 to 36%.15 However, we found complication rates in patients with JIA-associated uveitis higher than other previous studies.3,8,11-14,32,33,44,51 In the present study, at least one complication in 93% of the eyes was reported at the final visit, and complication rates for cataract (including cataract surgery) and glaucoma were 84 and 59%, respectively, at the final visit. These high rates may be explained by the duration of follow-up, the bias of selection in a tertiary referral center and the inclusion period (the early 2000 s), before the early use of anti-TNF treatments. Several studies observed a high complication rate in patients with posterior synechiae at the baseline visit.11,51-53 We did not find a significant difference concerning the presence of posterior synechiae at the end of follow-up, most probably due to treatment intensification.
Pediatric Uveitis in a Well-Defined Population: Improved Outcomes with Immunosuppressive Therapy
Published in Ocular Immunology and Inflammation, 2018
David S. Curragh, Marie O’Neill, Clara E. McAvoy, Madeleine Rooney, Eibhlin McLoone
Complications were known to be present at initial presentation in 37% of patients; the most common presenting complication was posterior synechiae in 22% of patients. By final visit, complications had occurred in 65% of patients. Figure 2 illustrates the variety and frequency of complications occurring at presentation and at any time point during the disease course. Overall, 46 complications were present at initial presentation and 112 complications occurred subsequently. Ocular hypertension and cataract were the most common complications to develop during the course of the disease and/or as a result of treatment. Cataract surgery was carried out in 11% of patients (48% of those with cataract). Seven percent of patients had glaucoma surgery; two patients had trabeculectomy, two had valve insertion, and two trabeculectomy with subsequent valve insertion. One patient had an iridotomy for iris bombe. Posterior segment surgery was required in 4% of patients.
Clinical Characteristics of Herpes Simplex Virus Associated Anterior Uveitis
Published in Ocular Immunology and Inflammation, 2018
Barbara Wensing, Manabu Mochizuki, Joke H. De Boer
Demographics showed that HSV was observed in patients of middle age with slightly higher occurrence in females. It had a predominant unilateral presentation with an acute onset of the disease in more than half of the patients (Table 1). Although sectorial atrophy of the iris is considered as pathognomonic for the diagnosis of HAU, it is often not present at disease onset but will develop during the course of the disease. Raised intraocular pressure (IOP) (>30 mmHg) is seen in 46–90% of the patients and is considered to be caused by trabeculitis (Table 2). Patients may present with high pressure (>50 mmHg), which generally rapidly drops after treatment with steroids and anti-glaucoma medication. Keratitis is observed in more than one third of the patients (Table 2). Corneal edema can be due to interstitial keratitis but may also be due to attacks of elevated intra-ocular pressure.4 Secondary glaucoma developed in 18–30% during the course of the disease.3–5 Posterior synechiae are seen in half of the patients. Cataract might be seen at onset, may be related to the age of the patient, and the incidence increases during the course of the disease.3 HAU shows medium to large KPs. Small KP’s may be more typical of CMV or Rubella uveitis.3