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Zhou Y, Zhou A, Philip AM, Margolis M, Babiker F, Chang PY, Anesi SD, Foster CS. Vision Outcomes of Long-Term Immunomodulatory and Steroid Therapy in Sympathetic Ophthalmia. Am J Ophthalmol 2023; 253:152-159. [PMID: 37150338 DOI: 10.1016/j.ajo.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To compare vision acuity outcomes of long-term steroid therapy compared with immunomodulatory therapy for treatment of sympathetic ophthalmia. DESIGN Single-center, retrospective, comparative clinical study. METHODS Patients with sympathetic ophthalmia treated from March 2005 to October 2022 with at least 1 year of follow-up were included. Visual acuity outcomes were compared by steroid and immunomodulatory treatment modality. RESULTS Thirty-five patients with sympathetic ophthalmia were included in the study, with follow-up ranging from 1 to 17 years. Higher rates of vision loss correlated with longer periods of active uveitis and steroid treatment. Lower rates of vision loss correlated with longer periods of uveitis remission on immunomodulatory therapy alone and drug-free remission. Treatment with alkylating agents or combination therapy with an antimetabolite, a biologic-response modifier, and cyclosporine are more likely to result in sympathetic ophthalmia remission. CONCLUSION Immunomodulatory therapy leads to superior vision outcomes in cases of steroid-resistant or recurrent sympathetic ophthalmia. Steroid therapy may be useful for acute or recalcitrant sympathetic uveitis but is insufficient for long-term inflammatory control. PRéCIS: This manuscript describes a retrospective analysis of vision outcomes in patients with sympathetic ophthalmia. Results indicate that long-term immunomodulatory therapy is associated with better vision outcomes than long-term steroid therapy for sympathetic ophthalmia treatment.
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Affiliation(s)
- Yujia Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Avery Zhou
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Andrew M Philip
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Michael Margolis
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Fatima Babiker
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Peter Y Chang
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - Stephen D Anesi
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F)
| | - C Stephen Foster
- From Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA (Y.Z, A.Z, A.M.P, M.M, F.B, P.Y.C, S.D.A, C.S.F); Department of Ophthalmology, Harvard Medical School, Boston, MA, USA (C.S.F).
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Munro M, Sabbagh MA, Mieler WF. EIGHTY-TWO-YEAR-OLD MONOCULAR FEMALE WITH ACUTE DECREASED CENTRAL VISION. Retin Cases Brief Rep 2023; 17:S31-S35. [PMID: 36730825 DOI: 10.1097/icb.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To present a case of suspected sympathetic ophthalmia in an 82-year-old monocular woman. METHODS Case report. RESULTS Here, we present an 82-year-old woman, status postcataract extraction with lens subluxation followed by a complicated course ultimately requiring enucleation because of a blind and painful eye in 2020, who developed contralateral choroidal lesions 6 months postenucleation along with vitritis and anterior uveitis. The lesions were suspicious for an infectious versus autoimmune etiology. Thorough systemic work-up and multimodal imaging suggest an autoimmune case. The findings in this patient suggest early identified sympathetic ophthalmia with multifocal choroiditis. This patient responded well to treatment of the acute episode with systemic corticosteroids and ultimately required steroid-sparing immunosuppression. CONCLUSION Sympathetic ophthalmia is a rare entity classically observed after intraocular surgery and trauma. It may mimic many infectious and noninfectious uveitis entities. In this patient, sympathetic is a primary concern given her history and age of presentation with consideration for other uveitic entities.
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Affiliation(s)
- Monique Munro
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
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Zhao T, Cao Q, Zhou C, Wang Y, Du L, Yang P. Association Between HLA Polymorphisms and Sympathetic Ophthalmia in Han Chinese. Ocul Immunol Inflamm 2023:1-8. [PMID: 37145421 DOI: 10.1080/09273948.2023.2205930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Sympathetic ophthalmia (SO) is considered as an autoimmune disease with unclear mechanisms. This study investigated the relationship between HLA polymorphisms and SO. METHODS HLA typing was performed using the LABType reverse SSO DNA typing method. The allele and haplotype frequencies were assessed using the PyPop software. Statistical significance of genotype distributions between 116 patients and 84 healthy individuals (control) was determined using Fisher's exact test or Pearson's chi-squared test. RESULTS The SO group had a higher frequency of HLA-DRB1 * 04:05, HLA-DQB1 * 04:01, DRB1 * 04:05-DQB1 * 04:01 haplotype as compared to the control group (Pc < 0.001 for all). CONCLUSION This study revealed that DRB1 * 04:05 and DQB1 * 04:01 alleles, as well as DRB1 * 04:05-DQB1 * 04:01 haplotye could be potential risk factors for SO.
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Affiliation(s)
- Tingting Zhao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Qingfeng Cao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Liping Du
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Henan International Joint Research Laboratory for Ocular Immunology and Retinal Injury Repair, Zhengzhou, People's Republic of China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
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Toiv A, Durrani AF, Zhou Y, Zhao PY, Musch DC, Huvard MJ, Zacks DN. Risk Factors for Enucleation Following Open Globe Injury: A 17-Year Experience. Clin Ophthalmol 2022; 16:3339-3350. [PMID: 36237492 PMCID: PMC9553313 DOI: 10.2147/opth.s377137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose At the time of open globe injury (OGI), it may be difficult for clinicians to predict which eyes are at highest risk for requiring enucleation. We performed a 17-year retrospective cohort study to report outcomes and risk factors for enucleation following open globe injuryto better aid clinicians counseling patients at OGI diagnosis. Methods A retrospective cohort study of all patients who presented to the University of Michigan with open globe injury (OGI) and were surgically managed between January 2000 and July 2017 was conducted. At least 30 days of follow-up was required. All eyes that ultimately underwent enucleation following OGI were identified and their clinical course analyzed. The main outcome measured was the rate of enucleation after OGI. Results There were 587 eyes meeting inclusion criteria. The mean patient age was 40.75 ± 25.1 (range 1–91). 441/585 (75.4%) patients were male. Average follow-up time was 1029.9 ± 1285.9 days. 116/587 eyes (19.8%) required enucleation after OGI, with 81.9% undergoing enucleation less than 30 days from injury. In enucleated eyes, the mean presenting logMAR vision was 2.91 ± 0.47 (Snellen equivalent between hand motion and light perception). The most common mechanism of injury requiring enucleation was globe rupture, 89/116 (76.7%), with 14/116 (12.1%) penetrating injuries and 13/116 (11.2%) perforating injuries. The mean age of patients that underwent enucleation was 45.6 ± 22.5 (range 3–91). Conclusion Open globe injuries are often visually devastating and a significant number of cases ultimately require enucleation. Despite emergent closure within 24 hours, 19.8% of eyes managed for OGI at our institution required eventual enucleation. 81.2% of these eyes required enucleation within 30 days of injury. Wound length greater than 10 mm, uveal prolapse, higher zone of injury, IOFB, and RAPD were identified as risk factors that predict future need for enucleation.
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Affiliation(s)
- Avi Toiv
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Asad F Durrani
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Peter Y Zhao
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA,Correspondence: David N Zacks, Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Tel +1 734-232-8404, Fax +1 734-232-8030, Email
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Parchand S, Agrawal D, Ayyadurai N, Agarwal A, Gangwe A, Behera S, Bhatia P, Mulkutkar S, Barwar G, Singh R, Sen A, Agarwal M. Sympathetic ophthalmia: A comprehensive update. Indian J Ophthalmol 2022; 70:1931-1944. [PMID: 35647958 PMCID: PMC9359263 DOI: 10.4103/ijo.ijo_2363_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within the first year of trauma occurrence but can be delayed by several years. It manifests as acute/chronic granulomatous uveitis with yellowish-white choroidal lesions or Dalen-Fuchs nodules. Initially, patients respond rapidly to corticosteroid therapy, but a majority require long-term use of corticosteroid-sparing agents to prevent recurrences. The purpose of this review is to elaborate on the current understanding of the pathophysiology, the importance of multimodal imaging in early diagnosis, and the role of newer immunomodulatory and biological agents in recalcitrant cases.
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Affiliation(s)
- Swapnil Parchand
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Deepshikha Agrawal
- Department of Cornea and Anterior segment Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Nikitha Ayyadurai
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Aniruddha Agarwal
- The Eye Institute, Cleveland Clinic, Abu Dhabi (CCAD), Abu Dhabi, United Arab Emirates (UAE)
| | - Anil Gangwe
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Shashwat Behera
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Priyavat Bhatia
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Samyak Mulkutkar
- Department of Ophthalmology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Gulshan Barwar
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Alok Sen
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Uvea Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
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Agarwal M, Radosavljevic A, Tyagi M, Pichi F, Al Dhanhani AA, Agarwal A, Cunningham ET. Sympathetic Ophthalmia - An Overview. Ocul Immunol Inflamm 2022; 31:793-809. [PMID: 35579612 DOI: 10.1080/09273948.2022.2058554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sympathetic ophthalmia (SO) is rare, bilateral granulomatous panuveitis that typically occurs following penetrating or perforating ocular trauma or surgery. This review aims to provide an update on the etiopathogenesis, clinical presentations, diagnosis and treatment of SO. METHODS Reports cited in MEDLINE database, that analyzed SO in at least 5 patients, published prior to December 1st, 2021 were included. RESULTS Initially, SO was associated with penetrating ocular trauma, however, various studies reported an increased incidence of SO after surgical procedures including vitreoretinal surgeries. Multimodal imaging including fluorescein and indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography have added further insights into the understanding of SO. While pulse dose corticosteroids & immunosuppressive drugs are still the treatment of choice, TNF-α blockers & other biologic drugs represent new promising agents. CONCLUSION There is a growing pool of evidence in understanding the pathogenesis of SO. Novel treatment options have provided better prognosis for this potentially blinding condition.
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Affiliation(s)
- Mamta Agarwal
- Medical Research Foundation, Sankara Nethralaya, Uveitis & Cornea Services, Chennai, India
| | | | | | - Francesco Pichi
- Eye Institute, Cleveland Clinic, Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University Cleveland, Cleveland, Ohio, USA
| | | | - Aditi Agarwal
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,West Coast Retina Medical Group, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,Proctor Foundation, UCSF School of MedicineThe Francis I., San Francisco, California, USA
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Zhuang H, Zhang R, Zhang T, Chang Q, Xu G. Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia. Orphanet J Rare Dis 2022; 17:103. [PMID: 35246199 PMCID: PMC8895912 DOI: 10.1186/s13023-022-02258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background To investigate the clinical manifestations, visual outcomes and optical coherence tomographic (OCT) features of patients with posterior sympathetic ophthalmia (PSO). Methods We performed a retrospective review of 48 patients diagnosed with PSO between January 2013 and December 2019. We compared the clinical and OCT features among different clinical types of PSO. Results PSO could be classified into two types according to whether the fundus exhibited serous retinal detachment (SRD) or multifocal choroiditis (MFC). There were 41 patients (85.4%) with SRD and 7 patients (14.6%) with MFC. The latent period of patients with MFC was significantly longer than that of patients with SRD (P = 0.002). The final visual acuity of patients with MFC was significantly worse than that of patients with SRD (P = 0.0001). In patients with acute SRD, OCT revealed that the mean height of retinal detachment in the fovea was 528.8 ± 437.5 μm. After treatment, the retina reattached in all patients and the band structures of the outer retina were restored in most patients (92.7%). In patients with acute MFC, the OCT images revealed inflammatory lesions on the retinal pigment epithelium layer. After treatment, the OCT images showed hyperreflective fibrosis of the lesions and loss of the outer retinal band structures in all patients. Conclusions We found that PSO could be classified according to the presence of SRD or MFC. The visual prognosis differed significantly between these types of PSO. OCT imaging is useful for clinical classification and monitoring of retinal changes after treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02258-0.
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Affiliation(s)
- Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Rui Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China.
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Horie S, Takase H, Yoshida T, Ohno-Matsui K. Sympathetic ophthalmia in eye with pathologic myopia. Am J Ophthalmol Case Rep 2022; 25:101295. [PMID: 35146188 PMCID: PMC8801987 DOI: 10.1016/j.ajoc.2022.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 08/07/2021] [Accepted: 01/17/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE To present our findings in a case of SO that developed in an eye with pathologic myopia. OBSERVATIONS The patient was an 83-year-old woman who was examined one month after an ocular trauma to the right eye. She was found to have signs of uveitis with multiple serous retinal detachments in the non-injured contralateral left eye. In addition, she had hearing loss and mononuclear pleocytosis of the spinal fluids. Swept-source OCT images showed focal and choroidal thickening in areas with abrupt edges that was restricted to the regions with more normal appearing choroid. Bruch's membrane was damaged at the edge of the focal choroidal thickening. The ocular and systemic findings were rapidly resolved after systemic corticosteroid therapy. CONCLUSIONS AND IMPORTANCE The pathobiological and clinical course of SO is nearly identical to Vogt-Koyanagi Harada disease (VKH) although its pathogenesis of autoimmunity had not been definitively established. In eyes with pathologic myopia, the choroid is extremely thin and sometimes completely absent. The findings in this rare case indicate that in eyes with thin choroid, the OCT findings typical of SO might be different from those seen in non-highly myopic eyes. Thus, the pre-status of the choroid may affect the choroidal thickening in pathological conditions. This case gives us a valuable insight in understanding the pathology of SO and characteristic of pathologic myopia.
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Affiliation(s)
- Shintaro Horie
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Takase
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Yoshida
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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Anikina E, Wagner S, Liyanage S, Sullivan P, Pavesio C, Okhravi N. The Risk of Sympathetic Ophthalmia Following Vitreoretinal Surgery. Ophthalmol Retina 2022; 6:347-360. [PMID: 35093583 DOI: 10.1016/j.oret.2022.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the clinical course and the outcomes of sympathetic ophthalmia and correlate these with the nature of the inciting event and the number of vitreoretinal procedures undergone by patients. DESIGN A retrospective case review. SUBJECTS All patients diagnosed with sympathetic ophthalmia who have been treated or monitored at a single centre over a 15 year period. METHODS A search of the electronic patient record system at Moorfields Eye Hospital, Londo over a 15 year period (between January 2000 and December 2015) was carried out, using the search terms "sympathetic", "ophthalmia" and "ophthalmitis". 61 patients with available records were identified and data collected from their complete electronic and paper records. MAIN OUTCOME MEASURES The main outcome measures looked at were the best-corrected visual acuity (BCVA) at 1 year and at the end of follow up and the number of vitreoretinal surgical procedures preceding the diagnosis. Data was also collected to report on patient age, gender, disease duration, ocular and systemic manifestations, ocular complications, retinal angiography and treatment. RESULTS There was a wide age range at presentation (2-84) and the length of follow up ranged 1-75 years. The first ocular event was trauma in 40 patients and surgery in 21. Vitreoretinal (VR) surgery accounted for 13 of the 21 surgical first event triggers (62%). 23/61 patients (38%) underwent VR surgery (1-7 operations) at some point prior to diagnosis. Surgical details were available for 15 patients, who had a total of 25 VR procedures carried out. Based on the surgical activity of the unit, the risk of developing SO following a single VR procedure is estimated at 0.008%, rising to 6.67% with 7 procedures. A total of 23 patients (38%) experienced a decrease in acuity at the end of the follow up period, versus 9 patients (15%) experiencing an improvement and 18 (30%) remaining unchanged. CONCLUSIONS We feel that the most significant finding in this study is the calculated risk of SO development following a single VR procedure, which is significantly lower in our cohort than previously reported in the literature. This is seen to rise exponentially with additional procedures.
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Affiliation(s)
- Evgenia Anikina
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Siegfried Wagner
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Sidath Liyanage
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Paul Sullivan
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Narciss Okhravi
- Uveitis Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom.
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Ahmed K, Siddiqui MAR, Sarwar H. Imaging of Classic Dalén Fuchs Nodules in Sympathetic Ophthalmia With Spectral Domain OCT. Cureus 2022; 14:e20876. [PMID: 35145783 PMCID: PMC8803370 DOI: 10.7759/cureus.20876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia (SO) is a rare, severe condition that typically presents as bilateral diffuse granulomatous uveitis secondary to trauma in one eye. The variability of symptoms requires that diagnosis depends heavily on the correlation of these symptoms with relevant imaging. Visualisation of characteristic nodules seen between the Bruchs membrane and the retinal pigment epithelium, and the presence of Dalén Fuchs nodules, can be diagnostic when coupled with the clinical findings. This report discusses the use of spectral domain optical coherence tomography (OCT) to indicate the presence of Dalén Fuchs nodules, which have previously not been identified on OCT in a confirmed case of SO.
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Fromal OV, Swaminathan V, Soares RR, Ho AC. Recent advances in diagnosis and management of sympathetic ophthalmia. Curr Opin Ophthalmol 2021; 32:555-560. [PMID: 34494974 DOI: 10.1097/icu.0000000000000803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Sympathetic ophthalmia is a bilateral granulomatous uveitis that occurs following unilateral trauma or surgery and is sight-threatening in the contralateral eye. Despite significant potential morbidity, disease remains poorly understood. Variable presentations and clinical courses, as well as a lack of definitive diagnostic laboratory tests can complicate the diagnosis and result in delayed treatment, which can beget permanent vision loss. This review focuses on recent advances in areas of pathophysiology, classification, diagnosis and treatment. RECENT FINDINGS Sympathetic ophthalmia is thought to involve a cell-mediated immune response to retinal and uveal antigens exposed through trauma or surgery. Multiple mechanisms have been implicated, including activation of the interleukin-23/IL-17 pathway. Ongoing emphasis is placed on early disease recognition and prompt treatment with multimodal imaging. Multiple authors advocate for the routine use of optical coherence tomography (OCT) for screening and disease monitoring. Systemic steroids and steroids sparing-immunosuppressive agents remain the mainstay of treatment. SUMMARY Understanding pathophysiology may provide useful targets for drug development, as well as allow for identification of patients at risk. OCT is a useful tool in early diagnosis and management of sympathetic ophthalmia, as OCT changes may precede clinical symptoms and signs, allowing for early disease detection and better visual outcomes.
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Affiliation(s)
- Ollya V Fromal
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Paulbuddhe V, Addya S, Gurnani B, Singh D, Tripathy K, Chawla R. Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies? Clin Ophthalmol 2021; 15:4201-4218. [PMID: 34707340 PMCID: PMC8542579 DOI: 10.2147/opth.s289688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 01/05/2023] Open
Abstract
Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen-Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.
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Affiliation(s)
- Vivek Paulbuddhe
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Sujit Addya
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Bharat Gurnani
- Department of Cornea, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, Puducherry, India
| | - Dheerendra Singh
- Department of Retina, ASG Eye Hospital, Bhopal, 462016, Madhya Pradesh, India
| | - Koushik Tripathy
- Department of Vitreoretina, ASG Eye Hospital, Kolkata, 700058, West Bengal, India
| | - Rohan Chawla
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Abstract
PURPOSE Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible. METHODS A comprehensive literature review of SO and globe rupture was performed. RESULTS SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. CONCLUSION Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.
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Shen J, Zhang Z, Ye D, Wen Z, Shu X, Chen Z. Sympathetic ophthalmia after vitreoretinal surgery: a report of two cases. J Int Med Res 2021; 49:3000605211032782. [PMID: 34382463 PMCID: PMC8366150 DOI: 10.1177/03000605211032782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia (SO) is a panuveitis that usually occurs after trauma to one eye. We describe two cases of SO occurring after 23-gauge vitrectomy. Case 1 involved a 66-year-old woman who underwent pars plana vitrectomy (PPV) for a rhegmatogenous retinal detachment. Two months later, she presented with decreased visual acuity (VA) and bilateral uveitis. Case 2 involved a 43-year-old woman who underwent a second PPV for recurrent retinal detachment. Two months later, she presented with bilateral panuveitis. Both patients were diagnosed with SO and were treated with methylprednisolone and cyclosporine. The first patient was further treated with a dexamethasone intravitreal implant (Ozurdex®) owing to the side effects of methylprednisolone. The VA and symptoms improved significantly after treatment in both patients. Bilateral granulomatous panuveitis following PPV should alert surgeons to consider SO. Appropriate interventions for SO can produce positive outcomes.
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Affiliation(s)
- Junhui Shen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zheng Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Dian Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zuohui Wen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xupeng Shu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
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15
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Niederkorn JY. "Corneal Nerves, CD11c + Dendritic Cells and Their Impact on Ocular Immune Privilege". Front Immunol 2021; 12:701935. [PMID: 34220866 PMCID: PMC8253307 DOI: 10.3389/fimmu.2021.701935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
The eye and the brain have limited capacities for regeneration and as such, immune-mediated inflammation can produce devastating consequences in the form of neurodegenerative diseases of the central nervous system or blindness as a result of ocular inflammatory diseases such as uveitis. Accordingly, both the eye and the brain are designed to limit immune responses and inflammation – a condition known as “immune privilege”. Immune privilege is sustained by physiological, anatomical, and regulatory processes that conspire to restrict both adaptive and innate immune responses.
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Affiliation(s)
- Jerry Y Niederkorn
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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16
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Clinical Review of Ocular Traumas Resulting in Enucleation or Evisceration in a Tertiary Eye Care Center in Hungary. J Ophthalmol 2021; 2021:5588977. [PMID: 34136279 PMCID: PMC8177989 DOI: 10.1155/2021/5588977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To analyse the demographic and clinical characteristics of ocular traumas resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 15 years. Patients and Methods. A retrospective review of enucleated/eviscerated eyes that underwent surgery between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, due to ocular trauma as the primary indication for enucleation/evisceration. For each subject, clinical history, B-scan ultrasound report, and histopathology results were reviewed. Results There were 124 enucleated/eviscerated eyes from 124 patients (91 males (73.4%)). The mean age at the time of trauma was 37.3 ± 26.0 years while the mean age at the time of enucleation/evisceration was 46.9 ± 20.3 years. The main clinical diagnoses after ocular trauma were open globe injury (n = 96; 77.4%), ocular burns (n = 6; 4.8%), traumatic optic neuropathy (n = 4; 3.2%), bulbar avulsion (n = 3; 2.4%), traumatic cataract (n = 2; 1.6%), retinal ablation (n = 1; 0.8%), and traumatic carotid-cavernous fistula (n = 1; 0.8%). Among the 124 patients, 98 (79.0%) underwent enucleation and 26 (21.0%) evisceration. Patients who underwent primary enucleation/evisceration (n = 24 19.4%) were significantly older at the time of the injury (57.7 ± 22.7 years) than people who underwent secondary eye removal (32.4 ± 24.4 years) (p < 0.0001). The mean time interval between trauma and enucleation/evisceration was 114.9 ± 163.5 months. The main clinical indications for anophthalmic surgery were atrophia/phthisis bulbi (n = 56, 45.2%), acute trauma (n = 25, 20.2%), painful blind eye due to glaucoma (n = 17, 13.7%), endophthalmitis (n = 10, 8.1%), and cosmetic reasons (n = 7, 5.6%). One patient (0.8%) had sympathetic ophthalmia. Conclusions Primary enucleation/evisceration was performed in one-fifth of all ocular trauma-related anophthalmic surgeries in our tertiary eye care center with enucleation being the most common procedure. Atrophia/phthisis bulbi was the most frequent immediate clinical indication for enucleation/evisceration.
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An Atypical Presentation of Sympathetic Ophthalmia in an Intact Globe Following Mechanical Fall: A Case Report and Literature Review. Vision (Basel) 2021; 5:vision5010011. [PMID: 33669961 PMCID: PMC7930941 DOI: 10.3390/vision5010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To describe an atypical case of sympathetic ophthalmia presenting after blunt trauma causing disinsertion of the iris in an intact globe. METHODS Case report. RESULTS A 71-year-old lady presented to the Emergency Department following a mechanical fall. On examination, she was noted to have periocular haematoma, subconjunctival haemorrhage, hyphaema, and vitreous haemorrhage in the left eye, but there was no evidence of globe rupture. The presenting visual acuity was 6/18. As the hyphaema and vitreous haemorrhage settled, a complete loss of the iris was noted with normal fundus. She was re-admitted a month later under the medical team with urinary tract infection and reduced vision in both eyes. On examination, there was mild conjunctival injection, keratic precipitates, anterior chamber flare, 180-degree posterior synechiae, and vitritis with no fundal view of the right eye. She was diagnosed with sympathetic ophthalmia and was treated with topical and systemic corticosteroid. Her vision improved gradually with treatment and was stable at 6/6 on the right (sympathising) eye and 6/9 on the left (excited) eye at final follow-up. CONCLUSION Sympathetic ophthalmia may result from non-penetrating ocular trauma. Comprehensive history of mechanism of injury and ophthalmic examination is essential so that prompt treatment can be given to improve the visual prognosis of affected patients.
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18
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Rua D, Pohlmann D, Pleyer U. Sympathetic Ophthalmia - a Contribution to Immunology, Clinic and Current Imaging. Klin Monbl Augenheilkd 2020; 237:1060-1069. [PMID: 32967030 DOI: 10.1055/a-1245-4373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sympathetic ophthalmia (SO) is a rare inflammation of an operated or injured eye that spreads to the fellow eye. It is typically a bilateral granulomatous panuveitis. The traumatized eye is referred to as inciting eye and the fellow eye as sympathizing eye. The pathophysiology of the disease is not entirely understood, but there is strong evidence of an autoimmune genesis. PATIENTS/MATERIAL AND METHODS A selective literature search on epidemiology, immunology, clinical features and risk factors of SO was carried out. In addition, our own experience using multimodal imaging for this clinical entity was introduced. RESULTS In the literature, the incidence after traumatic eye injuries is 0.1 - 3% and approximately 0.01% after intraocular surgery. Among the iatrogenic causes, vitreoretinal surgery has the highest rate of SO, presumably due to disruption of the blood-retinal barrier and involvement of retinal and choroidal tissue, which are susceptible to anterior traction, phthisis and chronic inflammation. In 90% of patients, the disease develops within a year following the eliciting event and is associated with a potentially bilateral risk of blindness. Typical symptoms include bilateral visual impairment with photophobia, dull pain and photopsia. The spectrum of clinical manifestations ranges from granulomatous anterior uveitis and vitritis, to choroiditis, serous retinal detachment and Dalen-Fuchs nodules in the context of posterior involvement. The diagnosis of SO is generally based on clinical presentation and is supported by imaging methods. These primarily comprise fluorescein and indocyanine green angiography, which are increasingly being supplemented by non-invasive methods such as optical coherence tomography. They can provide important information for assessment of severity, differential diagnosis as well as for disease monitoring. The differential diagnosis includes i. a. Vogt-Koyanagi-Harada syndrome, ocular sarcoidosis and the rare phacoanaphylactic endophthalmitis. Immediate systemic high-dose steroid therapy is used as initial treatment. The course of the disease is often relapsing to chronic progressive. Immunomodulators such as ciclosporine A, azathioprine, cyclophosphamide, mycophenolate mofetil, and biologics are increasingly being used and contribute to the significantly better prognosis of the disease. Generally, SO can be triggered by any kind of intraocular intervention. CONCLUSION SO remains a threatening clinical diagnosis that poses diagnostic and therapeutic challenges. It can be triggered post-traumatic, but also any intraocular surgery. This should be taken into account when assessing the indication for intraocular eye surgery, especially in eyes with reduced visual outcome.
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Affiliation(s)
- David Rua
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
| | | | - Uwe Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
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19
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Neelam S, Niederkorn JY. Corneal Nerve Ablation Abolishes Ocular Immune Privilege by Downregulating CD103 on T Regulatory Cells. Invest Ophthalmol Vis Sci 2020; 61:25. [PMID: 32305043 PMCID: PMC7401639 DOI: 10.1167/iovs.61.4.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Severing corneal nerves during orthotopic corneal transplantation elicits the elaboration of the neuropeptide substance P (SP), which induces the generation of CD11c+ contrasuppressor (CS) cells. CS cells disable T regulatory cells (Tregs) that are induced when antigens enter the anterior chamber (AC), either by direct injection or by orthotopic corneal transplantation. This study examined the crucial cell surface molecules on Tregs that are adversely affected by CS cells that are generated by severing corneal nerves. Methods CS cells were induced by producing shallow 2.0-mm circular incisions in the corneal epithelium in BALB/c mice. CD8+ Tregs were generated by injecting ovalbumin into the AC. The effects of CS cells and SP on the expression and function of two cell surface molecules (CD103 and the receptor of interferon-γ) that are crucial for the induction and function of CD8+ Tregs were analyzed. Results SP converted CD11c+, but not CD11c−, dendritic cells (DCs) to CS cells. Severing corneal nerves resulted in a 66% reduction in the expression of CD103 on CD8+ AC-associated immune deviation (ACAID) Tregs, and a 50% reduction in the interferon-γ receptor (IFN-γR). These effects could be mimicked in vitro by coculturing CS cells with CD8+ ACAID Tregs. Conclusions The elaboration of SP in response to corneal nerve ablation converts CD11c+ DCs to CS cells. CS cells disable CD8+ ACAID Tregs by downregulating two crucial cell surface molecules, CD103 and IFN-γR, by an SP-dependent pathway. Blocking this pathway may provide a means of restoring ocular immune privilege in corneas subjected to corneal nerve injury.
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20
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Rogaczewska M, Iwanik K, Stopa M. Early presentation of sympathetic ophthalmia in optical coherence tomography studies: A case report. Indian J Ophthalmol 2020; 68:2019-2022. [PMID: 32823465 PMCID: PMC7690536 DOI: 10.4103/ijo.ijo_2184_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sympathetic ophthalmia (SO) is often diagnosed when an inflammatory process appears to be advanced. Herein, the authors present the prospective optical coherence tomography (OCT) study of the onset of SO in the sympathizing eye. Prior to any signs of uveitis, we noted the mild disintegration of the retinal pigment epithelium (RPE) layer, the interdigitation zone (IZ), and the ellipsoid zone (EZ). The complete disruption of IZ and EZ was seen 12 weeks later. After 14 weeks, the uveal inflammation was present, and OCT imaging disclosed the formation of nodule-like lesions between the Bruch's membrane and the RPE layer. The histopathological evaluation of the enucleated exciting eye confirmed the diagnosis of SO.
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Affiliation(s)
- Małgorzata Rogaczewska
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Iwanik
- Department of Clinical Pathomorphology, Poznan University of Medical Sciences, ul. Poznan, Poland
| | - Marcin Stopa
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
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21
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Suppression of the Reactive Oxygen Response Alleviates Experimental Autoimmune Uveitis in Mice. Int J Mol Sci 2020; 21:ijms21093261. [PMID: 32380695 PMCID: PMC7247341 DOI: 10.3390/ijms21093261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
Reactive oxygen species (ROS) are produced by host phagocytes and play an important role in antimicrobial actions against various pathogens. Autoimmune uveitis causes blindness and severe visual impairment in humans at all ages worldwide. However, the role of ROS in autoimmune uveitis remains unclear. We used ROS-deficient (Ncf1−/−) mice to investigate the role of ROS in experimental autoimmune uveitis (EAU). Besides, we also used the antioxidant N-acetylcysteine (NAC) treatment to evaluate the effect of suppression of ROS on EAU in mice. The EAU disease scores of Ncf1−/− mice were significantly lower than those of wild-type mice. EAU induction increased the levels of cytokines (interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-12, IL-17, and tumor necrosis factor (TNF)-α) and chemokines (monocyte chemoattractant protein (MCP)-1) in the retinas of wild-type mice but not in those of Ncf1−/− mice. EAU induction enhanced the level of NF-κB activity in wild-type mice. However, the level of NF-κB activity in Ncf1−/− mice with EAU induction was low. Treatment with the antioxidant NAC also decreased the severity of EAU in mice with reduced levels of oxidative stress, inflammatory mediators, and NF-κB activation in the retina. We successfully revealed a novel role of ROS in the pathogenesis of EAU and suggest a potential antioxidant role for the treatment of autoimmune uveitis in the future.
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Niederkorn JY. The Eye Sees Eye to Eye With the Immune System: The 2019 Proctor Lecture. Invest Ophthalmol Vis Sci 2019; 60:4489-4495. [PMID: 31661549 PMCID: PMC6819053 DOI: 10.1167/iovs.19-28632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Jerry Y. Niederkorn
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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23
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Massa H, Pipis SY, Adewoyin T, Vergados A, Patra S, Panos GD. Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges. Clin Ophthalmol 2019; 13:1761-1777. [PMID: 31571815 PMCID: PMC6750710 DOI: 10.2147/opth.s180580] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
Macular edema (ME) is the most common sight-threatening complication in uveitis. The diagnostic and therapeutic management of the uveitic macular edema (UME) might be challenging due to the complex diagnostic workup and the difficulties physicians face to find the underlying cause, and due to its usually recurrent nature and the fact that it can be refractory to conventional treatment. Some of the mild cases can be treated with topical steroids, which can be combined with non-steroid anti-inflammatory drugs. However, immunomodulators such as methotrexate, tacrolimus, azathioprine, cyclosporine and mycophenolate mofetil together with anti-tumor necrosis factor-α (anti-TNF alpha) monoclonal antibodies such as adalimumab and infliximab, may be required to control the inflammation and the associated ME in refractory cases, or when an underlying disease is present. This review of the literature will focus mostly on the non-infectious UME.
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Affiliation(s)
- Horace Massa
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Spyros Y Pipis
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Temilade Adewoyin
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Athanasios Vergados
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Sudeshna Patra
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Georgios D Panos
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Tyagi M, Agarwal K, Reddy Pappuru RR, Dedhia C, Agarwal H, Nayak S, Panchal B, Kaza H, Basu S, Pathengay A, Murthy S, Sangwan VS. Sympathetic Ophthalmia after Vitreoretinal Surgeries: Incidence, Clinical Presentations and Outcomes of a Rare Disease. Semin Ophthalmol 2019; 34:157-162. [PMID: 31055985 DOI: 10.1080/08820538.2019.1610464] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries Methods: Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes. Results: 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye Conclusions: Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia.
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Affiliation(s)
- Mudit Tyagi
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Komal Agarwal
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Rajeev R Reddy Pappuru
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Chintan Dedhia
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Hitesh Agarwal
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Sameera Nayak
- b Uveitis and Retina services, KVC Campus , L.V. Prasad Eye Institute , Vijayawada , India
| | - Bhavik Panchal
- c Uveitis and Retina Services, GMRV Campus , L.V .Prasad Eye Institute , Visakhapatnam , India
| | - Hrishikesh Kaza
- d Uveitis and Retina Services, MTC Campus , L. V. Prasad Eye Institute , Bhubaneshwar , India
| | - Soumyava Basu
- d Uveitis and Retina Services, MTC Campus , L. V. Prasad Eye Institute , Bhubaneshwar , India
| | - Avinash Pathengay
- c Uveitis and Retina Services, GMRV Campus , L.V .Prasad Eye Institute , Visakhapatnam , India
| | - Somasheila Murthy
- e Uveitis and Ocular Immunology Services , Tej Kohli Cornea Institute, L. V. Prasad Eye Institute , Hyderabad , India
| | - Virender S Sangwan
- e Uveitis and Ocular Immunology Services , Tej Kohli Cornea Institute, L. V. Prasad Eye Institute , Hyderabad , India
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Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation, UCSF School of Medicine , San Francisco , California , USA
| | - Dara Kilmartin
- d Research Foundation, Royal Victoria Eye & Ear Hospital , Dublin , Ireland
| | - Mamta Agarwal
- e Uveitis Services, Medical Research Foundation, Sankara Nethralaya , Chennai , India
| | - Manfred Zierhut
- f Centre for Ophthalmology, University Tuebingen, Elfriede-Aulhorn-Str , Tuebingen , Germany
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Heydon P, Hooper C, Lawlor M, Lee A. Sympathetic ophthalmia following cyclodialysis cleft repair. Clin Exp Ophthalmol 2019; 47:811-813. [PMID: 30801884 DOI: 10.1111/ceo.13488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Heydon
- Ophthalmology Department Liverpool Hospital, Sydney, Australia
| | - Claire Hooper
- Ophthalmology Department Liverpool Hospital, Sydney, Australia
| | - Mitchell Lawlor
- Ophthalmology Department Liverpool Hospital, Sydney, Australia
| | - Anne Lee
- Ophthalmology Department Liverpool Hospital, Sydney, Australia
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27
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Allon G, Shapira Y, Beiran I, Blumenthal EZ. Hydration of small leaking corneal perforations with cefuroxime. Int Ophthalmol 2019; 39:2401-2406. [PMID: 30710252 DOI: 10.1007/s10792-019-01079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 01/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe a new technique for sealing small corneal perforations after penetrating trauma. METHODS Corneal perforations in six eyes were sealed using a stromal cefuroxime hydration technique. This technique is identical to the current method used to seal leaking incisions upon completion of cataract surgery except for the use of cefuroxime instead of balanced salt solution. Additionally, cefuroxime was intentionally injected into the anterior chamber. A therapeutic contact lens was used after the hydration. Comparison was made in eight eyes with small traumatic corneal perforation that was sealed using therapeutic contact lenses without hydration. RESULTS This novel technique was applied in six cases, with leakage stopping immediately following hydration in each of these eyes. In cases presenting with a shallow or flat anterior chamber, this maneuver produced immediate reformation of the chamber. Of note, the corneal scars after hydration were minimal with little effect on visual acuity. When compared to eyes with small corneal perforations which were sealed with therapeutic contact lenses without hydration, all cases that were hydrated with cefuroxime were sealed immediately, as opposed to cases treated without hydration. Furthermore, the eyes that underwent hydration with cefuroxime had a worse average visual acuity on admission, a better average visual acuity 1 month post-trauma, and a shorter average length of hospitalization. CONCLUSIONS This new technique offers five major advantages: (1) Immediate sealing of the corneal perforation is achieved. (2) Definitive treatment can be achieved at the slit lamp. (3) Since neither stitches nor glue is applied, healing is achieved with minimal scarring and discomfort. (4) Little equipment is required. (5) Injection of cefuroxime into the anterior chamber provides prophylaxis against infection.
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Affiliation(s)
- Gilad Allon
- Department of Ophthalmology, Rambam Healthcare Campus, P.O.B 9602, 31096, Haifa, Israel.
| | - Yinon Shapira
- Department of Ophthalmology, Rambam Healthcare Campus, P.O.B 9602, 31096, Haifa, Israel
| | - Itzchak Beiran
- Department of Ophthalmology, Rambam Healthcare Campus, P.O.B 9602, 31096, Haifa, Israel
| | - Eytan Z Blumenthal
- Department of Ophthalmology, Rambam Healthcare Campus, P.O.B 9602, 31096, Haifa, Israel
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Sympathetic ophthalmia associated with untreated choroidal melanoma. Can J Ophthalmol 2018; 53:e173-e176. [PMID: 30340733 DOI: 10.1016/j.jcjo.2017.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/23/2022]
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29
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Tan XL, Seen S, Dutta Majumder P, Ganesh SK, Agarwal M, Soni A, Biswas J, Aggarwal K, Mahendradas P, Gupta V, Ling HS, Teoh S, Pavesio C, Agrawal R. Analysis of 130 Cases of Sympathetic Ophthalmia - A Retrospective Multicenter Case Series. Ocul Immunol Inflamm 2018; 27:1259-1266. [PMID: 30207811 DOI: 10.1080/09273948.2018.1517894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To analyze the demographic profile, treatment, and visual outcome of the patients with sympathetic ophthalmia (SO) in a multicenter collaborative retrospective cohort study.Methods: Medical records of the patients with SO from UK, Singapore, India were reviewed for history of ocular trauma or surgery and subsequent development of uveitis consistent with SO, presenting symptoms, treatment, and visual outcomes.Results: A total of 130 patients were diagnosed with SO during the study period. Eighty-one (62.3%) patients were men. The mean age was 48.4 ± 15.5 years. The most common presenting symptom was blurring of vision (89.2%), followed by pain (29.2%) and floaters (23.8%). Ninety-two (70.7%) required additional immunosuppressive therapy. Thirty-six (27.9%) patients underwent enucleation of the inciting eye.Conclusions: SO is a potentially sight-threatening disease with high rates of visual loss. It warrants prompt evaluation and treatment. With the advances and availability in immunotherapy, the visual prognosis is relatively good.
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Affiliation(s)
- Xiu Ling Tan
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Sophia Seen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Sudha K Ganesh
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Mamta Agarwal
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Aniruddh Soni
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Kanika Aggarwal
- Uveitis Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Vishali Gupta
- Uveitis Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ho Su Ling
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Stephen Teoh
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Dogra M, Samanta R, Singh P, Singh SR, Bajgai P, Sharma A, Bansal R, Gupta V, Dogra MR, Singh R. Surgical Intervention in Inciting Eyes of Patients with Sympathetic Ophthalmia: A Case Series and Review of Literature. Ocul Immunol Inflamm 2018; 27:1154-1159. [PMID: 30081702 DOI: 10.1080/09273948.2018.1497663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To analyze the outcomes of surgical procedures on inciting eye of patients with Sympathetic ophthalmia (SO). Methods: Retrospective study of patients with SO who underwent surgical procedures on inciting eyes between January 2000 and December 2015. Outcome measures included flare up of inflammation in either eye and change in visual acuity in the inciting eye. Results: Four SO patients underwent surgeries in their inciting eyes after adequate control of inflammation. Surgical procedures included penetrating keratoplasty, glaucoma drainage device implantation, pars plana vitrectomy, and silicon oil removal. Keratoplasty, glaucoma surgery, and silicon oil removal were well tolerated, with no flare up of disease. The patient who underwent pars plana vitrectomy, however, had a poor outcome. Conclusions: Surgical intervention in inciting eyes of patients with SO, after being adequately treated with oral steroids and immunosuppression, is a viable option for improving anatomic and functional outcomes in these eyes.
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Affiliation(s)
- Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramanuj Samanta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Pallavi Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Simar Rajan Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Priya Bajgai
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Aman Sharma
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Mangat R Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
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Abstract
In this study, we report a case of bilateral exudative retinal detachment due to sympathetic ophthalmia after successful limbal corneal laceration repair. Steroids remain mainstay management in controlling this disorder; however, there is no role of prophylactic steroid to prevent it. On the contrary, steroid use may alter the course of the disease. Background/Purpose: To report a case of atypical sympathetic ophthalmia after limbal corneal laceration. Methods and Results: An 11-year-old child had a successful left eye corneal laceration repair at the temporal limbus with excision of exposed nonnecrotic iris tissue, resulting in good visual acuity of 20/80 and 20/25 on postoperative Days 1 and 7, respectively. The patient was prescribed 1 mg/kg oral prednisolone in a tapering dose as prophylaxis. On postoperative Day 21, the patient presented with acute onset decreased vision in both eyes. Visual acuity was counting fingers 3 feet in both eyes. On examination, anterior segment examination was quiet without any inflammation, anterior vitreous face showed 1+ cells, and dilated funduscopy revealed bilateral symmetrical serous retinal detachments along the posterior pole. Optical coherence tomography demonstrated separation and elevation of inner neurosensory layers from the outer segment marking presence of hyperreflective material along with subretinal fluid between detached surfaces. There was stippled hyperfluorescence along the posterior pole as seen in fluorescein angiography. With a diagnosis of sympathetic ophthalmia confirmed, oral prednisolone (2 mg/kg body weight) was instituted after which, there was gradual decrease in macular elevation with corresponding improvement in visual acuity with no recurrence for the last 6 months. Conclusion: To our knowledge, this is the first reported instance of an atypical presentation of sympathetic ophthalmia, and antecedent corticosteroid therapy would have mitigated robust anterior segment findings usually associated with the condition.
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Raven ML, Ringeisen AL, Yonekawa Y, Stem MS, Faia LJ, Gottlieb JL. Multi-modal imaging and anatomic classification of the white dot syndromes. Int J Retina Vitreous 2017; 3:12. [PMID: 28331634 PMCID: PMC5357819 DOI: 10.1186/s40942-017-0069-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 02/27/2017] [Indexed: 12/18/2022] Open
Abstract
The white dot syndromes (WDS) are a diverse group of posterior uveitidies that share similar clinical findings but are unique from one another. Multimodal imaging has allowed us to better understand the morphology, the activity and age of lesions, and whether there is CNV associated with these different ocular pathologies. The “white dot syndromes” and their uveitic masqueraders can now be anatomically categorized based on lesion localization. The categories include local uveitic syndromes with choroidal pathology, systemic uveitic syndromes with choroidal pathology, and multifocal choroiditis with outer retinal/choriocapillaris pathology with uveitis and without uveitis. Neoplastic and infectious etiologies are also discussed given their ability to masquerade as WDS.
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Affiliation(s)
- Meisha L Raven
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA.,McPherson Eye Research Institute, Madison, WI USA
| | - Alexander L Ringeisen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA
| | - Yoshihiro Yonekawa
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Maxwell S Stem
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Lisa J Faia
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Justin L Gottlieb
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA.,Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2870 University Ave, Room 206, Madison, WI 53705 USA
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33
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OLIGOARTRITE E ENTESITE ASSOCIADAS À OFTALMIA SIMPÁTICA: RELATO DE CASO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
BACKGROUND An ocular injury can lead to secondary glaucoma in the traumatized eye in 3% to 20% of cases. Literature on the risk of developing elevated intraocular pressure in the nontraumatized fellow eye is scant. Clinicians treating ocular traumas should also bear in mind sympathetic ophthalmia, a rare bilateral granulomatous panuveitis following accidental or surgical trauma to 1 eye. CASE REPORT We report a case of high-pressure glaucoma of the fellow eye without any signs of uveitis. The left eye of a 24-year-old man was injured in an inadvertent movement during a free-time table-tennis match. The eye was severely crushed, leading to blindness. His right eye developed medically uncontrolled high-pressure glaucoma only 1 month after the injury. CONCLUSION To the best of our knowledge, there are no previous reports of post-traumatic glaucoma in the nontraumatized eye after open-globe injury.
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Affiliation(s)
- Anu Vaajanen
- Tays Eye Centre, Tampere University Hospital
- Department of Ophthalmology, School of Medicine, University of Tampere, Tampere, Finland
- Correspondence: Anu Vaajanen, Tampere, Finland (e-mail: )
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35
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Allon G, Beiran I, Blumenthal EZ. Hydration with Cefuroxime-a method for sealing a small leaking corneal perforation. Int J Ophthalmol 2016; 9:792-3. [PMID: 27275441 DOI: 10.18240/ijo.2016.05.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/04/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gilad Allon
- Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Itzchak Beiran
- Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Eytan Z Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel
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36
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Wand K, Straub M, Lohmann CP, Mayer CS. [Sympathetic ophthalmia : Therapy with steroid-free immunosuppressant azathioprine]. Ophthalmologe 2016; 113:867-869. [PMID: 26879557 DOI: 10.1007/s00347-016-0227-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article describes the case of a 48-year-old male patient who presented with persistent inflammation and deterioration of vision to a best corrected visual acuity (BCVA) of 0.6 in the only functioning left eye. The right eye had suffered a severe penetrating ocular trauma 6 months prior to presentation. After diagnosis of a sympathetic ophthalmia a high dosage corticosteroid therapy was initiated. Due to intolerance with decompensating diabetes an immunosuppressive therapy with azathioprine was initiated. This therapy resulted in stable clinical findings with an increase in BCVA to 0.9.
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Affiliation(s)
- K Wand
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - M Straub
- Institut für Allgemeine Pathologie und Pathologische Anatomie der Technischen Universität München, Trogerstr. 18, 81675, München, Deutschland
| | - C P Lohmann
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - C S Mayer
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
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37
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Payal AR, Foster CS. Long-Term Drug-Free Remission and Visual Outcomes in Sympathetic Ophthalmia. Ocul Immunol Inflamm 2016; 25:190-195. [DOI: 10.3109/09273948.2015.1092557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Abhishek R. Payal
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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38
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Koh S, Koh H, Nakashima Y, Katayama T, Sakabe M, Okamura H, Yoshimura T, Nanno S, Nishimoto M, Hayashi Y, Nakane T, Nakamae H, Ohsawa M, Hino M. Plasma Kinetics of Th1, Th2 and Th17 Cytokines in Polymyositis Related to Chronic Graft-versus-Host Disease. Intern Med 2016; 55:2265-70. [PMID: 27523006 DOI: 10.2169/internalmedicine.55.6206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein describe a case of myelodysplastic syndrome with chronic graft-versus-host disease (cGVHD)-related polymyositis. On approximately day 1,570 post HLA-identical sibling bone marrow transplant, the patient presented with a fever, myalgia and liver dysfunction. A muscle biopsy revealed destruction of the muscle fibers and infiltration of CD20(+) B cells and CD4(+) and CD8(+) T cells, and a liver biopsy confirmed the findings of cGVHD. An analysis of plasma cytokine profiles indicated elevation of not only T-helper (Th)1 and Th2, but also Th17 cytokines. Increases in these cytokines in addition to the invasion of inflammatory cells might be associated with the pathophysiology of cGVHD involving the muscle and liver.
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Affiliation(s)
- Shiro Koh
- Hematology, Graduate School of Medicine, Osaka City University, Japan
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Clinebell K, Valpey R, Walker T, Gopalan P, Azzam P. Self-Enucleation and Severe Ocular Injury in the Psychiatric Setting. PSYCHOSOMATICS 2015; 57:25-30. [PMID: 26791513 DOI: 10.1016/j.psym.2015.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the first medically-reported case of auto-enucleation was described in the mid-19th century, ocular self-gouging has long been depicted in historical legend and mythology. Cases of enucleation have since been identified across various cultures. Though relatively uncommon, this major form of self-mutilation now afflicts approximately 500 individuals per year, and may present more commonly among certain clinical populations. METHODS We present 2 cases of self-enucleation in patients with psychotic illnesses and review existing literature on the history of enucleation, associated pathology, and management (both medically and psychiatrically) for this serious form of self-injury. RESULTS Literature review includes a brief historical perspective of auto-enucleation and its context in psychosomatic medicine, with cases to highlight key aspects in the prevention and management of ocular self-injury. Normal eye pathology is described briefly, with a focus on medical care after self-inflicted damage, as pertinent to consultation psychiatrists. Interventions for behavioral and pharmacologic management of agitation and impulsivity are reviewed, including consideration for electroconvulsive therapy, in this particular context. CONCLUSION Although severe ocular self-injury is uncommon, psychiatrists should be familiar with approaches to prevent and manage auto-enucleation in individuals at risk thereof. Consultation psychiatrists must work closely with ophthalmologists to address affective, behavioral, and cognitive triggers and complications of ocular self-injury.
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Affiliation(s)
- Kimberly Clinebell
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Robin Valpey
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA.
| | - Teresa Walker
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Priya Gopalan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Pierre Azzam
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
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40
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Yoon JM, Cho GE, Kang SW. A case of sympathetic ophthalmia after 23-gauge transconjunctival sutureless vitrectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:205-7. [PMID: 26028951 PMCID: PMC4446563 DOI: 10.3341/kjo.2015.29.3.205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Je Moon Yoon
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Eun Cho
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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41
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Abstract
Corneal transplantation stands alone as the most common and successful form of solid organ transplantation. Even though HLA matching and systemic antirejection drugs are not routinely used, 90% of the first time corneal allografts will succeed. By contrast, all other major categories of organ transplantation require HLA matching and the use of systemically administered immunosuppressive drugs. This remarkable success of corneal transplants under these conditions is an example of "immune privilege" and is the primary reason for the extraordinary success of corneal transplantation. A number of dogmas have emerged over the past century to explain immune privilege and the immunobiology of corneal transplantation. Many of these dogmas have been based largely on inferences from clinical observations on keratoplasty patients. The past 30 years have witnessed a wealth of rodent studies on corneal transplantation that have tested hypotheses and dogmas that originated from clinical observations on penetrating keratoplasty patients. Rodent models allow the application of highly sophisticated genetic and immunological tools for testing these hypotheses in a controlled environment and with experiments designed prospectively. These studies have validated some of the widely held assumptions based on clinical observations and in other cases, previous dogmas have been replaced with new insights that could only come from prospective studies performed under highly controlled conditions. This review highlights some of the key dogmas and these widely held assumptions that have been scrutinized through the use of rodent models of penetrating keratoplasty. This review also makes note of new immunological principles of corneal immunology that have emerged from rodent studies on corneal transplantation that most likely would not have been revealed in studies on corneal transplantation patients.
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Affiliation(s)
- Jerry Y Niederkorn
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390
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42
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Abstract
Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.
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43
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Al-Dhibi HA, Al-Mahmood AM, Arevalo JF. A systematic approach to emergencies in uveitis. Middle East Afr J Ophthalmol 2014; 21:251-8. [PMID: 25100911 PMCID: PMC4123279 DOI: 10.4103/0974-9233.134687] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Uveitis is a common cause of preventable blindness although it is consider a sight-threatening condition particularly in cases with posterior segment inflammation. To deal with emergency conditions in uveitis, we must aware of the essential signs and symptoms that reflect a true uveitic emergency. Failure to recognize these essential signs and symptoms of a true uveitic emergency may result in a devastating visual outcome. This review provides general ophthalmologists and residents, clinical guidelines for the main uveitic entities that require immediate recognition and urgent intervention in the emergency room to prevent severe permanent visual loss.
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Affiliation(s)
- Hassan A Al-Dhibi
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ammar M Al-Mahmood
- Division of Anterior Segment and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - J Fernando Arevalo
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia ; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sen HN, Davis J, Ucar D, Fox A, Chan CC, Goldstein DA. Gender disparities in ocular inflammatory disorders. Curr Eye Res 2014; 40:146-61. [PMID: 24987987 DOI: 10.3109/02713683.2014.932388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ocular inflammatory disorders disproportionately affect women, and the majority of affected women are of childbearing age. The role of sex or reproductive hormones has been proposed in many other inflammatory or autoimmune disorders, and findings from non-ocular autoimmune diseases suggest a complex interaction between sex hormones, genetic factors and the immune system. However, despite the age and sex bias, factors that influence this disparity are complicated and unclear. This review aims to evaluate the gender disparities in prevalence, incidence and severity of the most common infectious and non-infectious ocular inflammatory disorders.
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Affiliation(s)
- Hatice Nida Sen
- National Eye Institute, National Institutes of Health , Bethesda, MD , USA
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Gender differences in vogt-koyanagi-harada disease and sympathetic ophthalmia. J Ophthalmol 2014; 2014:157803. [PMID: 24734166 PMCID: PMC3964687 DOI: 10.1155/2014/157803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/13/2014] [Accepted: 01/31/2014] [Indexed: 12/21/2022] Open
Abstract
Vogt-Koyanagi-Harada disease (VKH) and sympathetic ophthalmia (SO) are types of T-cell mediated autoimmune granulomatous uveitis. Although the two diseases share common clinical features, they have certain differences in gender predilections. VKH classically has been reported as more prevalent in females than males, yet some studies in Japan and China have not found differences in gender prevalence. Male patients have a higher risk of chorioretinal degeneration, vitiligo, and worse prognosis. Conversely, the changing levels of estrogen/progesterone during pregnancy and the menstrual cycle as well as higher levels of TGF-β show a protective role in females. Potential causes of female predilection for VKH are associated with HLA-DR and HLA-DQ alleles. SO, a bilateral granulomatous uveitis, occurs in the context of one eye after a penetrating injury due to trauma or surgery. In contrast to the female dominance in VKH, males are more frequently affected by SO due to a higher incidence of ocular injury, especially during wartime. However, no gender predilection of SO has been reported in postsurgical cases. No clinically different manifestations are revealed between males and females in SO secondary to either ocular trauma or surgery. The potential causes of the gender difference may provide hints on future treatment and disease evaluation.
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Kang EM, Lee YH, Seo SJ, Kim CY, Seong GJ, Hong S. Glaucoma Surgery in Patients with Painful Blind Glaucomatous Eyes. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.10.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eun Min Kang
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ha Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Jin Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Samin Hong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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McAlinden C, Saldanha M, Laws D. Evisceration for the management of ocular trauma. BMJ Case Rep 2013; 2013:bcr-2013-201235. [PMID: 24172777 DOI: 10.1136/bcr-2013-201235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Despite the eye being surrounded by orbital bones and protective mechanisms such as the blink reflex, it is vulnerable to trauma. The two key issues to consider when presented with a case of ocular trauma are the visual potential of the eye and the risk of sympathetic ophthalmia. The Ocular Trauma Score can be used to assess the visual potential of the injured eye. Surgical management may be either repair or removal of the eye (evisceration or enucleation). Herein we describe a case of ocular trauma and the decision-making process in the management of the injury.
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Chu XK, Chan CC. Sympathetic ophthalmia: to the twenty-first century and beyond. J Ophthalmic Inflamm Infect 2013; 3:49. [PMID: 23724856 PMCID: PMC3679835 DOI: 10.1186/1869-5760-3-49] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/23/2013] [Indexed: 12/20/2022] Open
Abstract
Sympathetic ophthalmia is a rare bilateral granulomatous inflammation that follows accidental or surgical insult to the uvea of one eye. Onset of sympathetic ophthalmia can be insidious or acute, with recurrent periods of exacerbation. Clinical presentation shows mutton-fat keratic precipitates, choroidal infiltrations, and Dalen-Fuchs nodules. Histopathology reveals diffuse or nodular granulomatous inflammation of the uvea. Prevention and treatment strategies for sympathetic ophthalmia are currently limited to two modalities, enucleation of the injured eye and immunosuppressive therapy, aimed at controlling inflammation. The etiology and pathophysiology of the disease is still unclear but is largely thought to be autoimmune in nature. Recent insight on the molecular pathology of the disease as well as developments in imaging technology have furthered both the understanding on the autoimmune process in sympathetic ophthalmia and the targeting of prevention and treatment strategies for the future.
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Affiliation(s)
- Xi K Chu
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, 10 Center Drive, Room 10N103, Bethesda, MD 20892, USA.
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Morales J, Al Shahwan S, Al Odhayb S, Al Jadaan I, Edward DP. Current surgical options for the management of pediatric glaucoma. J Ophthalmol 2013; 2013:763735. [PMID: 23738051 PMCID: PMC3655566 DOI: 10.1155/2013/763735] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 12/29/2012] [Accepted: 01/29/2013] [Indexed: 12/11/2022] Open
Abstract
Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm's canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging.
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Affiliation(s)
- Jose Morales
- King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia
| | - Sami Al Shahwan
- King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia
| | - Sami Al Odhayb
- King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia
| | - Ibrahim Al Jadaan
- King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia
| | - Deepak P. Edward
- King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia
- The Wilmer Eye Institute, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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