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Gentile P, Aldigeri R, Mastrofilippo V, Bolletta E, De Simone L, Gozzi F, Ragusa E, Ponti L, Adani C, Zanelli M, Belloni L, Bonacini M, Croci S, Zerbini A, De Maria M, Neri A, Vecchi M, Cappella M, Fastiggi M, De Fanti A, Citriniti G, Crescentini F, Galli E, Muratore F, Montepietra S, Contardi G, Massari M, Paci M, Facciolongo NC, Beltrami M, Cavallini GM, Salvarani C, Cimino L. Reggio Emilia (Northern Italy) Interdisciplinary Uveitis Clinic: What We Have Learned in the Last 20 Years. Ocul Immunol Inflamm 2024:1-11. [PMID: 38814046 DOI: 10.1080/09273948.2023.2296617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center. METHODS Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center. RESULTS Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs. CONCLUSIONS The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.
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Affiliation(s)
- P Gentile
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - R Aldigeri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - V Mastrofilippo
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Ragusa
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Ponti
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Adani
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L Belloni
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Bonacini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Zerbini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M De Maria
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Neri
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Vecchi
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Cappella
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Fastiggi
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A De Fanti
- Pediatrics Unit, Santa Maria Nuova Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G Citriniti
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Crescentini
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Galli
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - F Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Montepietra
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G Contardi
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Massari
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Paci
- Thoracic Surgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - N C Facciolongo
- Pulmonology Unit, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, Italy
| | - M Beltrami
- Medicine and Gastroenterology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G M Cavallini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - C Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - L Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Cytomegalovirus Anterior Uveitis in an Immunocompetent Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Okazawa R, Iwai S, Nagura K, Sora D, Sato T, Takayama K, Harimoto K, Kanda T, Takeuchi M. Epidemiology and characteristics of common forms of anterior uveitis at initial presentation in a tertiary facility in Japan. Jpn J Ophthalmol 2023; 67:22-31. [PMID: 36346554 DOI: 10.1007/s10384-022-00961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To elucidate detailed epidemiological profile of common types of anterior uveitis (AU) in real-world clinical setting of a tertiary facility in Japan, and to evaluate the characteristic clinical findings at initial presentation. STUDY DESIGN Retrospective cohort study. METHODS Clinical charts of 275 patients (335 eyes) aged 52.5 ± 19.1 years were reviewed retrospectively. Herpetic AU was diagnosed by multiplex polymerase chain reaction tests using aqueous humor. Time of uveitis onset, gender, laterality, disease course since the initial onset of AU, visual acuity (VA) and intraocular pressure (IOP) at first visit, and definitive diagnosis were collected from clinical charts. RESULTS Acute AU (AAU) was the most common (21.8%) form of AU; followed by herpetic AU (20.7%) comprising Herpes Simplex Virus (HSV) (8.0%), Varicella Zoster Virus (VZV) (9.1%) and cytomegalo virus (CMV) (3.6%); scleritis (13.5%); diabetic iritis (7.6%), and Posner-Schlossman syndrome (5.5%). Unilateral AU constituted 78.2%, and VA less than 20/30 accounted for 31.2%. Of all the eyes, 16.1% had an IOP higher than 20 mmHg, out of which 37.0% had herpetic AU, followed by scleritis in 25.9%, and Posner-Schlossman syndrome (PSS) in 11.1%. AU patients over 60 years of age were 40.4%, in which 34.2% had herpetic AU, followed by scleritis in 14.4% and AAU in 13.5%. Herpetic AU patients were significantly older and had higher IOP compared with AAU patients. CONCLUSION The most frequent AU was AAU, followed by herpetic AU. Herpetic AU patients were older and had higher intraocular pressure than AAU patients, although VA was equally impaired in both groups.
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Affiliation(s)
- Rina Okazawa
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Seima Iwai
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Koichi Nagura
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Daisuke Sora
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Kei Takayama
- Sakura street Takayama Eye Clinic, 4-262-1 Sakuragaoka, Higashiyamato, Japan
| | - Kozo Harimoto
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan.
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[Viral anterior uveitis : S1 guidelines of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Version: 23 August 2022]. DIE OPHTHALMOLOGIE 2023; 120:30-37. [PMID: 36538083 DOI: 10.1007/s00347-022-01776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
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Gozzi F, Belloni L, Aldigeri R, Gentile P, Mastrofilippo V, De Simone L, Bolletta E, Alessandrello F, Bonacini M, Croci S, Zerbini A, Cavallini GM, Salvarani C, Cimino L. Aqueous Humor Analysis in Overlapping Clinical Diagnosis of Cytomegalovirus and Rubella Virus Anterior Uveitis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081054. [PMID: 36013521 PMCID: PMC9413047 DOI: 10.3390/medicina58081054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: A cross-sectional single-center study was conducted to investigate the etiology in hypertensive anterior uveitis whose clinical features are not fully distinctive from cytomegalovirus or from rubella virus and to demonstrate the possible coexistence of both these viruses in causing anterior uveitis. Materials and Methods: The clinical charts of a cohort of patients with hypertensive viral anterior uveitis of uncertain origin consecutively seen in a single center from 2019 to 2022 were retrospectively reviewed; data on the clinical features, aqueous polymerase chain reaction, and antibody response to cytomegalovirus and rubella virus were collected. Results: Forty-three eyes of as many subjects with viral anterior uveitis of uncertain origin were included. Thirty-two patients had an aqueous polymerase chain reaction or antibody index positive to cytomegalovirus only, while 11 cases had an aqueous antibody response to both cytomegalovirus and rubella virus. This latter overlapping group had a statistically significant higher rate of hypochromia and anterior vitritis (p-value: 0.02 and < 0.001, respectively). Conclusions: The simultaneous presence of intraocular antibodies against cytomegalovirus and rubella virus could redefine the differential diagnosis of hypertensive viral anterior uveitis, demonstrating a possible “converged” immune pathway consisting in a variety of stimuli.
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Affiliation(s)
- Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Lucia Belloni
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Raffaella Aldigeri
- Department of Medicine and Surgery, University of Parma, 43100 Parma, Italy
| | - Pietro Gentile
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy
| | | | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Elena Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Federica Alessandrello
- Department of Biomedical Sciences, Ophthalmology Clinic, University Hospital of Messina, 98125 Messina, Italy
| | - Martina Bonacini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Alessandro Zerbini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
| | - Gian Maria Cavallini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Carlo Salvarani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Rheumatology Unit, Azienda USL-IRCCS of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, 42123 Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence:
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Escribano Lopez P, Gonzalez Guijarro JJ. Iridian anterior segment OCT in rubella uveitis syndrome and cytomegalovirus anterior uveitis: a comparative study. Graefes Arch Clin Exp Ophthalmol 2022; 260:3647-3655. [PMID: 35708847 DOI: 10.1007/s00417-022-05733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare iris affectation in cytomegalovirus anterior uveitis (CMVAU), rubella virus-associated uveitis (RVU), and healthy contralateral eyes, using swept-source anterior segment optical coherence tomography (SS-AS-OCT). MATERIALS AND METHODS A comparative, transversal, retrospective study examining 60 eyes from 30 patients-18 eyes (17 patients) with CMVAU, 14 eyes (13 patients) with RVU, and 28 healthy eyes-was performed. Six-millimeter cross-sectional SS-AS-OCT B-scans were obtained in each iris quadrant. Images were exported to ImageJ®. Qualitative and quantitative analyses were done: stromal thickness (ST), smooth index (SI), and optical density (OD) of pigment epithelium. Comparisons between measurements and clinical-demographic parameters were performed using SPSS®. RESULTS Qualitative analysis showed extensive damage in iris stroma but was unable to differentiate between both uveitis. RVU eyes had a lower mean ST (315.72 μm ± 42.4) compared to those with CMVAU (348.6 μm ± 46) (p = 0.047) and a lower ST in the upper (338.9 μm ± 38.52)/(386.25 μm ± 47.2) (p = 0.005) and temporal (281.5 μm ± 57.3)/(326.43 μm ± 62.3) (p = 0.016) quadrants. Mean (0.94 ± 0.02)/(0.9 ± 0.03) (p = 0.001), temporal (0.94 ± 0.02)/(0.89 ± 0.03) (p < 0.001), and nasal SI (0.094 ± 0.02)/(0.9 ± 0.04) (p = 0.005) were higher in RVU. OD was similar in both uveitis. In healthy eyes, mean ST (376.8 μm ± 39.7) was higher and mean SI was lower (0.87 ± 0.04) than in RVU (p < 0.001) and CMVAU eyes (p = 0.032). Mean OD was higher in healthy eyes (911 ± 130) than in CMVAU eyes (800 ± 200) (p = 0.037). CONCLUSIONS The quantitative analysis of the SS-AS-OCT iris images allows for the differentiation between healthy eyes and those with CMVAU and RVU, as well as between both uveitis.
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Affiliation(s)
- Patricia Escribano Lopez
- Hospital Universitario de La Princesa, C/Diego de Leon, 62, 28006, Madrid, Spain. .,Hospital Universitario Puerta de Hierro, C/Joaquin Rodrigo, 1, 28222, Majadahonda, Madrid, Spain. .,Ospedale Villa Igea, Ospedali Privati Forli, Viale Antonio Gramsci, 42, 47122, Forli, FC, Italy.
| | - Juan Jacobo Gonzalez Guijarro
- Hospital Universitario de La Princesa, C/Diego de Leon, 62, 28006, Madrid, Spain.,Universidad Autonoma de Madrid, C. Arzobispo Morcillo, 4, 28029, Madrid, Spain
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Distinguishing Features of Anterior Uveitis Caused by Herpes Simplex Virus, Varicella-Zoster Virus, and Cytomegalovirus. Am J Ophthalmol 2021; 227:191-200. [PMID: 33773985 DOI: 10.1016/j.ajo.2021.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine distinguishing features of the clinical characteristics of anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV). DESIGN Retrospective, multicenter case series. METHODS Consecutive patients with herpetic AU examined at 11 tertiary centers in Japan between January 2012 and December 2017 and who were followed for ≥3 months were evaluated. Diagnosis was made by polymerase chain reaction (PCR) for HSV, VZV, or CMV in the aqueous humor, or classical signs of herpes zoster ophthalmicus. RESULTS This study enrolled 259 herpetic AU patients, including PCR-proven HSV-AU (30 patients), VZV-AU (50), and CMV-AU (147), and herpes zoster ophthalmicus (32). All HSV-AU and VZV-AU patients were unilateral, while 3% of CMV-AU patients were bilateral. Most HSV-AU and VZV-AU patients were sudden onset with an acute clinical course, while CMV-AU had a more insidious onset and chronic course. There were no significant differences for all surveyed symptoms, signs, and complications between HSV-AU and VZV-AU. However, significant differences were detected for many items between CMV-AU and the other two herpetic AU types. Ocular hyperemia and pain, blurring of vision, ciliary injection, medium-to-large keratic precipitates (KPs), cells and flare in the anterior chamber, and posterior synechia significantly more often occurred in HSV-AU and VZV-AU vs CMV-AU. In contrast, small KPs, coin-shaped KPs, diffuse iris atrophy, elevated intraocular pressure, and glaucoma surgery were significantly more frequent in CMV-AU vs HSV-AU and VZV-AU. CONCLUSION This multicenter, retrospective study identified distinguishing features of HSV-AU, VZV-AU, and CMV-AU.
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Papasavvas I, Herbort CP. Cytomegalovirus Anterior Uveitis from the Perspective of the Common Practitioner: Missed Diagnosis Can Be at the Origin of Severe Functional Loss - A Scenario to Be Avoided. Klin Monbl Augenheilkd 2021; 238:448-453. [PMID: 33930916 DOI: 10.1055/a-1425-4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | - Carl Peter Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
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Leleu I, Jhanji V, Touhami S, Westcott M, Angi M, Titah C, Rousseau A, Hamard P, Brasnu E, Manicom T, Blumen-Ohana E, Rozenberg F, Vauloup-Fellous C, Deback C, Labetoulle M, Sahel JA, Bodaghi B, Merabet L, Kobal A, Brignole-Baudouin F, Errera MH. Clinical Features and Diagnosis of Anterior Segment Inflammation Related to Cytomegalovirus in Immunocompetent African, Asian, and Caucasian Patients. Ocul Immunol Inflamm 2021; 29:160-168. [PMID: 31642720 DOI: 10.1080/09273948.2019.1662059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
Objective: To report the clinical features and treatment outcomes in immunocompetent patients with anterior segment inflammation (ASI) related to human cytomegalovirus (HCMV) depending on their ethnic origin.Material and Methods: Multicenter retrospective study of 38 patients with at least one test, either HCMV-positive PCR or GWc.Results: Features of Posner-Schlossman syndrome were observed in 50% of the eyes, Fuchs heterochromic iridocyclitis in 13% of the eyes, chronic nonspecific anterior uveitis in 21% of the eyes, and corneal endotheliitis in 18% of the eyes. PCR and GWc were positive for HCMV in 50% and 96.2% of the eyes, respectively. Glaucoma was diagnosed in 50% of eyes. Treatment was oral valganciclovir in about half of the patients. Other treatments were intravenous ganciclovir and/or ganciclovir topical ointment and/or intravitreal ganciclovir.Conclusions: No obvious association of specific clinical features with individual ethnicity could be identified. We found a high rate of glaucoma in all ethnic groups. There was a delay in diagnosis and specific treatment of HCMV in most patients.
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Affiliation(s)
- Igor Leleu
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | | | - Sara Touhami
- Department of Ophthalmology, Hôpital de la Pitié-Salpêtrière, Paris, France
- Department of Ophthalmology, Hôpital de Lariboisière, Paris, France
| | - Mark Westcott
- Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
| | - Martina Angi
- Department of Ophthalmology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Cherif Titah
- Department of Ophthalmology, Fondation Ophthalmologique de Rothschild, Paris, France
| | - Antoine Rousseau
- Department of Ophthalmology, Hôpital Bicêtre, Université Paris Sud, APHP, Paris, France
| | - Pascale Hamard
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Emmanuelle Brasnu
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Thomas Manicom
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Esther Blumen-Ohana
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Flore Rozenberg
- Université Paris Descartes, Paris, France
- Virology Department, Hôpital Cochin, Université Paris V, Paris, France
| | | | - Claire Deback
- Virology Department, Université Paris Sud, APHP, Villejuif, France
| | - Marc Labetoulle
- Department of Ophthalmology, Hôpital Bicêtre, Université Paris Sud, APHP, Paris, France
| | - Jose-Alain Sahel
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
- Sorbonne Universités, UPMC Univ Paris VI, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Hôpital de la Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Univ Paris VI, Paris, France
| | - Lilia Merabet
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Alfred Kobal
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
| | - Françoise Brignole-Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
- Virology Department, Hôpital Cochin, Université Paris V, Paris, France
| | - Marie-Hélène Errera
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Ophthalmology Department and Laboratory and DHU Sight Restore, Paris, France
- Pittsburgh University Hospital, Pittsburgh, PA, USA
- Sorbonne Universités, UPMC Univ Paris VI, Paris, France
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Cappelli F, Caudano F, Marenco M, Testa V, Masala A, Sindaco D, Macrì A, Traverso CE, Iester M, Ricciarelli R. Evaluating the Correlation between Alzheimer's Amyloid-β Peptides and Glaucoma in Human Aqueous Humor. Transl Vis Sci Technol 2020; 9:21. [PMID: 32821493 PMCID: PMC7401938 DOI: 10.1167/tvst.9.5.21] [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: 01/10/2020] [Accepted: 02/23/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Recent studies suggest that glaucoma may share common pathogenic mechanisms with Alzheimer's disease. To test this hypothesis, we investigated the correlation between glaucoma and amyloid-β42 (Aβ42) concentration in human samples of aqueous humor (AH). Methods Eighty-one candidates for cataract or glaucoma surgery were consecutively enrolled, with a median age of 77 years; of these, 32 subjects were affected by glaucoma and 49 were controls. Before surgery, each patient received an ophthalmological examination including biometry, intraocular pressure (IOP) measurement, fundus photography, and determination of the mean thickness of the ganglion cell complex (GCC) and/or retinal nerve fiber layer. During the surgical procedure, an AH sample was collected and immediately processed for total protein (TP) and Aβ42 evaluation. Results Aβ42 levels were not statistically different between the glaucomatous and control samples, but a significant increase in TP concentration was found in the AH of glaucoma patients compared with controls (P = 0.02). In addition, positive correlations were observed between TP and Aβ42 (r = 0.51; P < 0.0001), between TP and IOP (r = 0.44; P < 0.0001), and between Aβ42 and IOP (r = 0.22; P = 0.033). Conclusions Our results indicate that an increased protein concentration in the AH could play a role in the pathogenesis of glaucomatous disease. Translational Relevance This study strongly supports the hypothesis that increased TP in the AH may have a pathogenic role in glaucoma. Further investigations are needed to clarify whether the protein enhancement represents a causative factor and whether it can be used as a marker of disease or as a novel therapeutic target.
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Affiliation(s)
- Francesca Cappelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Francesca Caudano
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Maria Marenco
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Valeria Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | | | - Daniele Sindaco
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Angelo Macrì
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo E Traverso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Iester
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberta Ricciarelli
- Department of Experimental Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir. Cornea 2020; 39:584-589. [PMID: 32068609 DOI: 10.1097/ico.0000000000002251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America. METHODS This is a retrospective case series review (2002-2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed. RESULTS Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: -0.21 LogMAR, 95% CI -0.33 to -0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02-0.41; P = 0.002), and IOP (difference: -4.21 mm Hg, 95% CI -7.98 to -0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping. CONCLUSIONS Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.
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