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Fouad YA, Khanna S, Santina A, Sarraf D. Autoimmune retinopathy associated with systemic autoimmune disease: a case series. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00102-9. [PMID: 38768650 DOI: 10.1016/j.jcjo.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To describe various presentations of autoimmune retinopathy (AIR) associated with systemic autoimmune diseases. DESIGN Case series. PATIENTS AND METHODS Four patients with systemic autoimmune disorders and AIR are described in this report. The clinical and multimodal imaging characteristics, systemic work-up, genetic testing results, management, and course of disease are detailed. RESULTS The multimodal retinal features of 4 cases of AIR including the findings of fundus autofluorescence, optical coherence tomography, and electrophysiology necessary to document progressive photoreceptor loss are described. Each case of AIR was associated with a complicated autoimmune disorder. Case 1 was associated with chronic inflammatory demyelinating polyneuropathy and showed marked improvement with systemic steroid and intravenous immunoglobulin therapy. Case 2 was associated with rheumatoid arthritis, and the AIR condition progressed despite systemic immune therapy. Case 3 was associated with Lambert-Eaton myasthenic syndrome, and AIR developed 6 years later and stabilized with systemic immune therapy. Case 4 was associated with necrobiotic xanthogranuloma followed by AIR and was managed by systemic immune therapy. CONCLUSIONS AIR in association with these systemic conditions is rarely reported. Our cases highlight the gaps in our current understanding of the definition, systemic associations, pathogenesis, and management of AIR and the importance of multimodal imaging and a multidisciplinary approach in managing patients with suspected AIR.
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Affiliation(s)
- Yousef A Fouad
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA; Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Sheena Khanna
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Ahmad Santina
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA.
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2
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Gökgöz Özışık G, Eker Buyuksireci D, Şahin T, Caglıyan Turk A. Evaluation of Choroidal Thickness and Choroidal Vascularity Index in Patients with Rheumatoid Arthritis. Ocul Immunol Inflamm 2024:1-8. [PMID: 38691844 DOI: 10.1080/09273948.2024.2345289] [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: 06/07/2023] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To evaluate the choroidal vascularity index and choroidal thickness in patients with rheumatoid arthritis. METHOD This study is a case control study. Our study consists of a total of two groups, with 32 individuals diagnosed with rheumatoid arthritis (RA) and 32 healthy volunteers. The thickness of the subfoveal choroid was measured from the 500 micron (µm), 1000 µm, 1500 µm nasal aspect of the fovea, and 500µm, 1000µm, 1500 µm temporal and subfoveal thickness of the fovea. ImageJ version 1.53i (National Institutes of Health, Bethesda, MD, USA) from open access was used for choroidal vascular index calculation. RESULTS The mean age (p = 0.064) and gender distribution (p = 0.522) were not statistically different between these two groups. There was no difference between the groups in terms of visual acuity (p = 0.060), intraocular pressures (p=0.056), refractive errors (p = 0.418), and axial lengths (p = 0.280). Temporal 500 µm CT (p = 0.038), temporal 1000 µm CT (p = 0.010), and temporal 1500 µm CT (p = 0.005) differed significantly between the groups. The luminal area was significantly different between the RA group (842.71 ± 192.77) and the control group (957.78 ± 230.83) (p = 0.034). The choroidal vascularity index showed a significant difference between the RA group (64.99 ± 4.71) and the control group (67.34 ± 3.40) (p = 0.026). A significant difference was observed between the seronegative RA and the control group with temporal 1500 µm CT (p = 0.030), temporal 1000 µm CT (p = 0.023), and luminal area (p = 0.034). CONCLUSION We demonstrated thinning in CT and decreased CVI for the first time in RA patients by comparing it with the control group.
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Affiliation(s)
- Gülce Gökgöz Özışık
- Department of Ophthalmology, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Dilek Eker Buyuksireci
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Tayfun Şahin
- Department of Ophthalmology, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Ayla Caglıyan Turk
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Hitit University, Corum, Turkey
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3
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Musa M, Chukwuyem E, Ojo OM, Topah EK, Spadea L, Salati C, Gagliano C, Zeppieri M. Unveiling Ocular Manifestations in Systemic Lupus Erythematosus. J Clin Med 2024; 13:1047. [PMID: 38398361 PMCID: PMC10889738 DOI: 10.3390/jcm13041047] [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: 12/04/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by immune dysregulation and multi-organ involvement. In this concise brief review, we highlight key insights into Ocular Systemic Lupus Erythematosus (SLE), an intricate autoimmune disorder with diverse organ involvement. Emphasizing the formation of autoantibodies and immune complex deposition, we delve into the inflammation and damage affecting ocular structures. Clinical presentations, ranging from mild dry eye syndrome to severe conditions like retinal vasculitis, necessitate a comprehensive diagnostic approach, including clinical exams, serological testing, and imaging studies. Differential diagnosis involves distinguishing SLE-related ocular manifestations from other autoimmune and non-inflammatory ocular conditions. The multidisciplinary management approach, involving rheumatologists, ophthalmologists, and immunologists, tailors treatment based on ocular involvement severity, encompassing corticosteroids, immunosuppressive agents, and biologics. Follow-up is crucial for monitoring disease progression and treatment response. Future perspectives revolve around advancing molecular understanding, refining diagnostic tools, and exploring targeted therapies. Novel research areas include genetic factors, microbiome composition, and biotechnology for tailored and effective SLE ocular treatments.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Nigeria;
- Centre for Sight Africa, Onitsha 434112, Nigeria
| | | | - Oluwasola Michael Ojo
- School of Optometry and Vision Sciences, College of Health Sciences, University of Ilorin, Ilorin 240003, Nigeria
| | - Efioshiomoshi Kings Topah
- Department of Optometry, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano 700006, Nigeria
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Caterina Gagliano
- Faculty of Medicine and Surgery, University of Enna “Kore”, Piazza Dell’Università, 94100 Enna, Italy
- Eye Clinic, Catania University San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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4
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Kiyat P, Karti O, Gercik Ö, Şak T. Choroidal, retinal, and optic nerve changes in rheumatoid arthritis and primary sjogren's syndrome patients: comparıson with each other and healthy subjects. Int Ophthalmol 2024; 44:24. [PMID: 38324105 DOI: 10.1007/s10792-024-02970-9] [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: 05/09/2023] [Accepted: 12/04/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE The present study aims to evaluate the optic nerve, macula, and choroidal changes in both rheumatoid arthritis (RA) and primary Sjögren's syndrome (SjS) patients, and to compare these findings with age-matched healthy volunteers. METHODS This study included 46 RA patients, 33 primary SjS patients, and 37 age-matched healthy volunteers. All of the patients underwent a thorough ophthalmological examination, during which measurements of the retinal nerve fiber layer (RNFL), ganglion cell layer(GCL), and subfoveal choroidal thickness (CT) were taken using OCT (optical coherence tomography). The measurements taken from the right eye of each patient were used to compare among the groups. RESULTS RNFL thickness in superior quadrant was found to be statistically significantly thinner in the eyes with RA when compared to the control group (p = 0.022). In the nasal quadrant, the RNFL thickness was significantly thinner in patients with primary SjS compared to healthy individuals (p = 0.036). Also, the temporal quadrant RNFL was significantly thinner in RA patients than in the primary SjS patients (p = 0.033). GCL thickness was observed to be thinner in all quadrants of both RA and primary SjS groups compared to the control group. However, the difference was not found to be statistically significant. Subfoveal CT was observed to be thicker in RA and SjS groups compared to the control group, but this difference was also not statistically significant. CONCLUSION Systemic autoimmune diseases like RA and primary SjS can lead to a decrease in RNLF and GCL thickness, which can impair visual acuity even in the absence of ocular symptoms. Therefore, monitoring changes in the optic nerve, retina, and choroid layer are crucial in these patients.
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Affiliation(s)
- Pelin Kiyat
- Department of Ophthalmology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, Kozağaç Mah., Özmen Sok., No:147, Buca, İzmir, Turkey.
| | - Omer Karti
- Department of Ophthalmology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, Kozağaç Mah., Özmen Sok., No:147, Buca, İzmir, Turkey
| | - Önay Gercik
- Department of Rheumatology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Turkey
| | - Tuncer Şak
- Department of Rheumatology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Turkey
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5
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Shan H, Liu W, Li Y, Pang K. The Autoimmune Rheumatic Disease Related Dry Eye and Its Association with Retinopathy. Biomolecules 2023; 13:724. [PMID: 37238594 PMCID: PMC10216215 DOI: 10.3390/biom13050724] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Dry eye disease is a chronic disease of the ocular surface characterized by abnormal tear film composition, tear film instability, and ocular surface inflammation, affecting 5% to 50% of the population worldwide. Autoimmune rheumatic diseases (ARDs) are systemic disorders with multi-organ involvement, including the eye, and play a significant role in dry eye. To date, most studies have focused on Sjögren's syndrome (one of the ARDs) since it manifests as two of the most common symptoms-dry eyes and a dry mouth-and attracts physicians to explore the relationship between dry eye and ARDs. Many patients complained of dry eye related symptoms before they were diagnosed with ARDs, and ocular surface malaise is a sensitive indicator of the severity of ARDs. In addition, ARD related dry eye is also associated with some retinal diseases directly or indirectly, which are described in this review. This review also summarizes the incidence, epidemiological characteristics, pathogenesis, and accompanying ocular lesions of ARD's related dry eye, emphasizing the potential role of dry eye in recognition and monitoring among ARDs patients.
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Affiliation(s)
| | | | | | - Kunpeng Pang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan 250012, China
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6
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Rivera PA, Gupta A, Kombo N. Treatment of non-infectious retinal vasculitis. Ther Adv Ophthalmol 2023; 15:25158414231152761. [PMID: 37077655 PMCID: PMC10107051 DOI: 10.1177/25158414231152761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
Retinal vasculitis (RV) refers to an entity in which the retinal vasculature is inflamed, frequently with indications of inflammation elsewhere in the eye. Non-infectious RV can be idiopathic or associated with systemic disease, ocular conditions, and malignancy. It can also be classified based on the vessel affected: artery, vein, or both. Due to the lack of strong evidence-based treatment trials and algorithms for RV, physicians must often rely on their experience, which creates great variability in treating this entity. This article provides an overview of various treatment modalities used in the management of non-infectious RV, with a focus on immunomodulatory therapies. We outline a potential stepwise approach of starting with steroids to control the acute inflammation and subsequently changing to immunomodulatory therapy (IMT) for long-term treatment.
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Affiliation(s)
- Paola A. Rivera
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Akash Gupta
- Department of Medicine, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
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7
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Kurisu N, Hiyama T, Harada Y, Fukushima N, Katsuya N, Ureshino H, Ichinohe T, Kiuchi Y. Vitreoretinal Lymphoma in a Patient with Rheumatoid Arthritis with a History of Methotrexate-associated Lymphoproliferative Disorders. Ocul Immunol Inflamm 2022:1-6. [PMID: 36395469 DOI: 10.1080/09273948.2022.2144384] [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: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Methotrexate (MTX) may induce immunosuppression and facilitate the onset of lymphoproliferative disorders (LPD). Most cases of MTX-LPD occur in patients with rheumatoid arthritis; the incidence is high in Japan. Vitreoretinal lymphoma (VRL) is a rare non-Hodgkin's lymphoma that can masquerade as steroid-resistant chronic uveitis, leading to fatal diagnostic delay. A 68-year-old woman exhibited optic disc swelling and retinal vasculitis causing floaters in the right eye. She was undergoing long-term MTX treatment for rheumatoid arthritis; she previously had been diagnosed with MTX-LPD, which regressed upon discontinuation of MTX. Steroid therapy was ineffective for optic disc swelling and retinal vasculitis; her best-corrected visual acuity decreased to 20/400. Vitreous biopsy revealed VRL, which was successfully treated with high-dose MTX-based systemic chemotherapy and intravitreal injections of MTX. To our knowledge, this is the first case report of VRL in a patient with an autoimmune disease who have a history of MTX-LPD.
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Affiliation(s)
- Naho Kurisu
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- Department of Ophthalmology, Miyoshi Central Hospital, Hiroshima, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Noriyasu Fukushima
- Department of Haematology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Narutaka Katsuya
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Ureshino
- Department of Haematology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Haematology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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8
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Leone P, Prete M, Malerba E, Bray A, Susca N, Ingravallo G, Racanelli V. Lupus Vasculitis: An Overview. Biomedicines 2021; 9:biomedicines9111626. [PMID: 34829857 PMCID: PMC8615745 DOI: 10.3390/biomedicines9111626] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 12/21/2022] Open
Abstract
Lupus vasculitis (LV) is one of the secondary vasculitides occurring in the setting of systemic lupus erythematosus (SLE) in approximately 50% of patients. It is most commonly associated with small vessels, but medium-sized vessels can also be affected, whereas large vessel involvement is very rare. LV may involve different organ systems and present in a wide variety of clinical manifestations according to the size and site of the vessels involved. LV usually portends a poor prognosis, and a prompt diagnosis is fundamental for a good outcome. The spectrum of involvement ranges from a relatively mild disease affecting small vessels or a single organ to a multiorgan system disease with life-threatening manifestations, such as mesenteric vasculitis, pulmonary hemorrhage, or mononeuritis multiplex. Treatment depends upon the organs involved and the severity of the vasculitis process. In this review, we provide an overview of the different forms of LV, describing their clinical impact and focusing on the available treatment strategies.
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Affiliation(s)
- Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Eleonora Malerba
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Antonella Bray
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Nicola Susca
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy;
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124 Bari, Italy; (P.L.); (M.P.); (E.M.); (A.B.); (N.S.)
- Correspondence:
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9
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Ajayi I, Omotoye O, Ajite K, Abah E. Presentation, etiology and treatment outcome of neovascular glaucoma in Ekiti state, South Western Nigeria. Afr Health Sci 2021; 21:1266-1272. [PMID: 35222591 PMCID: PMC8843267 DOI: 10.4314/ahs.v21i3.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Neovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical locations. Objective The objective of this study was to determine the presentation, aetiology, and outcome of treatment of patients with NVG in a Nigerian tertiary hospital. Method A retrospective review of records of all cases of NVG seen over a 5year period was carried out. Demographic characteristics, presenting visual acuity and coexisting ocular and systemic conditions were noted. Data were analysed with Statistical Package for Social Sciences (SPSS) version 25. Results 29 eyes of patients with NVG were analysed. Most of the patients (89.70%) presented with visual acuity less than 3/60 in the affected eye. All patients except one were treated with anti-glaucoma medications while only 9(31%) consented to and received anti-vascular endothelial growth factor. No patient had improvement in visual acuity despite resolution of other symptoms at 12week follow up. Conclusion NVG though not as common as other forms of glaucoma accounted for a large proportion of monocular blindness in the affected eyes at presentation. There is need for health promotion and education among our people on the need for early preventive eye check practices.
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Affiliation(s)
- Iyiade Ajayi
- Ekiti State University College of Medicine, Ophthalmology
| | | | - Kayode Ajite
- Ekiti State University College of Medicine, Ophthalmology
| | - Emmanuel Abah
- Ekiti State University College of Medicine, Ophthalmology
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10
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Temporally independent association of multiple evanescent white dot syndrome and optic neuritis. Graefes Arch Clin Exp Ophthalmol 2021; 259:2807-2811. [PMID: 34050810 DOI: 10.1007/s00417-021-05249-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To describe three patients that developed temporally distinct episodes of optic neuritis and multiple evanescent white dot syndrome (MEWDS). METHODS We retrospectively reviewed the medical records and imaging studies of three women evaluated at a tertiary referral center for both optic neuritis and MEWDS. RESULTS Three otherwise healthy women, aged 17, 36, and 41, developed temporally separated episodes of optic neuritis and MEWDS. The time periods between the two events were 3, 48, and 60 months, and in two of the three cases, the optic neuritis event preceded the episode of MEWDS. No patient endorsed prodromal flu-like symptoms prior to developing vision loss. The mean presenting visual acuities were better with the optic neuritis episode (LogMAR 0.360, Snellen 20/46) than with retinal event (LogMAR 0.684, Snellen 20/97). All three patients had improvement in vision, with mean visual acuity of 20/29 (LogMAR 0.165) at last follow-up. One patient later developed idiopathic noninfectious posterior uveitis and another developed multiple sclerosis requiring treatment. CONCLUSION While a rare association, patients can develop both optic neuritis and MEWDS within the same eye at different time points. It is unknown whether such patients are at even higher risk of developing systemic autoimmune disease than are patients with either MEWDS or optic neuritis alone.
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11
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Anesi SD, Chang PY, Maleki A, Stephenson A, Montieth A, Filipowicz A, Syeda S, Asgari S, Walsh M, Metzinger JL, Foster CS. Treatment of Noninfectious Retinal Vasculitis Using Subcutaneous Repository Corticotropin Injection. J Ophthalmic Vis Res 2021; 16:219-233. [PMID: 34055260 PMCID: PMC8126741 DOI: 10.18502/jovr.v16i2.9086] [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: 03/15/2019] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To show whether subcutaneous repository corticotropin injection (RCI, Acthar® Gel, a repository corticotropin injection, can be an effective potential therapeutic agent for noninfectious retinal vasculitis. Methods Patients with active retinal vasculitis were followed with serial ultra-wide-field fluorescein angiograms and treated with 80 units of subcutaneous repository corticotropin injection twice weekly. Results Primary outcome of ≥50% improvement in response level (RL) for retinal vasculitis and percent improvement in retinal vasculitis severity scoring (RVSS) by more than one quartile (≥25%) at week 12 was met in 15 and 16 of the 30 total eyes, respectively, including 1 eye with severe retinal vasculitis in each group. Complete resolution of retinal vasculitis was seen in seven eyes with a mean time of 17.1 weeks. Intraocular pressure elevation requiring therapy and cataract progression were noted in two and three eyes, respectively. One patient stopped medication due to side effects (injection site reaction). Conclusion Repository corticotropin injection was well-tolerated overall. Repository corticotropin injection may be an effective therapeutic agent in the treatment of noninfectious retinal vasculitis.
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Affiliation(s)
- Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Andrew Stephenson
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Alyssa Montieth
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Artur Filipowicz
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Sarah Syeda
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Marisa Walsh
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Jamie Lynne Metzinger
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States.,Harvard Medical School, Department of Ophthalmology, Boston, MA, United States
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12
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Hysa E, Cutolo CA, Gotelli E, Paolino S, Cimmino MA, Pacini G, Pizzorni C, Sulli A, Smith V, Cutolo M. Ocular microvascular damage in autoimmune rheumatic diseases: The pathophysiological role of the immune system. Autoimmun Rev 2021; 20:102796. [PMID: 33722750 DOI: 10.1016/j.autrev.2021.102796] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
Pathological eye involvement represents a quite common finding in a broad spectrum of autoimmune rheumatic diseases (ARDs). Ocular signs, often occur as early manifestations in ARDs, ranging from symptoms related to the mild dry eye disease to sight-threatening pathologies, linked to the immune response against retinal and choroidal vessels. Retinovascular damage driven by markedly inflammatory reactivity need a prompt diagnosis and treatment. Immune-complexes formation, complement activation and antibody-mediated endothelial damage seem to play a key role, particularly, in microvascular damage and ocular symptoms, occurring in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS). Conversely, early alterations of retinal and choroidal vessels in the asymptomatic patient, often detectable coincidentally, might be indicators of widespread vascular injury in other connective tissue diseases. Particularly, endothelin-induced hypoperfusion and pathological peri-choroidal extracellular matrix deposition, might be responsible for the micro-architectural alterations and loss of capillaries detected in systemic sclerosis (SSc). Instead, interferon alpha-mediated microvascular rarefaction, combined with endothelial lesions caused by specific autoantibodies and immune-complexes, appear to play a significant role in retinal vasculopathy associated to inflammatory idiopathic myopathies (IIM). The immuno-pathophysiological mechanisms of ocular microcirculatory damage associated with the major ARDs will be discussed under the light of the most recent achievements.
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Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Carlo Alberto Cutolo
- Ophtalmology Clinic DiNOGMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy.
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Marco Amedeo Cimmino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Greta Pacini
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
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Chen TY, Uppuluri A, Zarbin MA, Bhagat N. Risk factors for central retinal vein occlusion in young adults. Eur J Ophthalmol 2020; 31:2546-2555. [DOI: 10.1177/1120672120960333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: Several risk factors have been identified for central retinal vein occlusion (CRVO) in older population. CRVO in young is uncommon, and the risk factors for this group are unclear. This large retrospective, cross-sectional study used the National Inpatient Sample (NIS) database to evaluate the risk factors for CRVO in patients 18 to 40 years of age. Methods: The 2002 to 2014 NIS database was used. All patients 18 to 40 years of age with a primary diagnosis of CRVO were identified. Age- and gender-matched non-CRVO controls were randomly selected. The primary outcome was identification of risk factors for CRVO. Chi-square analysis and Firth logistic regression were performed with IBM SPSS 23 and R packages versions 3.4.3, respectively. p < 0.05 was considered significant. Results: A total of 95 weighted young CRVO patients were identified. The average age was 31.44 ± 6.41 years with no gender predilection. Systemic and ocular conditions found to have statistically significant associations with CRVO included primary open-angle glaucoma (POAG) (OR 836.72, p < 0.001), retinal vasculitis (OR 705.82, p < 0.001), pseudotumor cerebri (OR 35.94, p < 0.001), hypercoagulable state (OR 25.25, p < 0.001), history of deep vein thrombosis/pulmonary embolism (DVT/PE) (OR 21.88, p < 0.001), and hyperlipidemia (OR 3.60, p = 0.003). Conclusion: The most significant risk factors for CRVO in young adults were POAG, retinal vasculitis, and pseudotumor cerebri. Hypercoagulable states and DVT/PE were also associated with CRVO in this population. Systemic inflammatory conditions were not associated with CRVO. Traditional risk factors such as hypertension and diabetes did not pose significant risks, whereas hyperlipidemia was deemed a significant risk factor.
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Affiliation(s)
- Tony Y. Chen
- The Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Aditya Uppuluri
- The Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Marco A. Zarbin
- The Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- The Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Newark, NJ, USA
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14
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Agarwal A, Aggarwal K, Handa S, Markan A, Gupta V. Subretinal Hemorrhage Complicating Retinal Angiomatous Proliferation in Tubercular Retinal Vasculitis. Ocul Immunol Inflamm 2020; 30:397-401. [PMID: 32976040 DOI: 10.1080/09273948.2020.1803363] [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: 10/23/2022]
Abstract
PURPOSE To report a patient with submacular hemorrhage due to retinal angiomatous proliferation (RAP) in tubercular retinal vasculitis (TRV). METHODS Case report. RESULTS We report a 33-year-old Asian Indian patient of TRV presenting with capillary non-perfusion areas, submacular hemorrhage and venous loops. The patient presented with sudden onset decrease in vision in the right eye. Multimodal imaging revealed presence of retinal vascular anastomosis and stage 2 RAP. Systemic examination was within normal limits. Laboratory evaluation revealed positive Mantoux and interferon gamma release assay. He underwent right eye intravitreal injection of recombinant tissue plasminogen activator (12.5µg/0.1ml) with 100% sulphur hexafluoride (SF6) tamponade. The patient had successful displacement of the submacular hemorrhage with some improvement in visual acuity. CONCLUSION This case highlights that rare vascular alterations such as RAP can develop in subjects with ocular tuberculosis.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sabia Handa
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Markan
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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15
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Espinosa G, Herreras JM, Muñoz-Fernández S, García Ruiz de Morales JM, Cordero-Coma M. Recommendations statement on the immunosuppressive treatment of non-infectious, non-neoplastic, non-anterior uveitis. Med Clin (Barc) 2020; 155:220.e1-220.e12. [PMID: 32199631 DOI: 10.1016/j.medcli.2019.10.023] [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: 06/18/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To generate recommendations on the use of immunomodulators in patients with non-infectious, non-neoplastic intermediate uveitis (IU), posterior uveitis (PU) and panuveitis (PanU) based on best evidence and experience. METHODS A multidisciplinary panel of 5 experts was established, who defined the scope, users, and sections of the document. A systematic literature review (SLR) was performed to assess the efficacy and safety of immunomodulatory drugs in patients with non-infectious, non-neoplastic, non-anterior uveitis. The results of the SLR were presented and discussed during an expert meeting in which 34 recommendations were generated. The level of agreement with the recommendations was also tested in 25 additional experts following a Delphi process. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of the experts voted ≥7. The level of evidence and grade or recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS The SLR included 33 articles. The 34 recommendations were accepted after 2 Delphi rounds (3 of them were modified after the first round). They include specific recommendations on patients with non-infectious, non-neoplastic, PU and PanU, as well as different treatment guidelines. CONCLUSIONS In patients with non-infectious, non-neoplastic, non-anterior uveitis these recommendations might help treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.
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Affiliation(s)
- Gerard Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España
| | - José M Herreras
- IOBA (Instituto Universitario de Oftalmobiología), Universidad de Valladolid, Valladolid, España; Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Santiago Muñoz-Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Universidad Europea, San Sebastián de los Reyes, Madrid, España
| | - José M García Ruiz de Morales
- Unidad de Uveítis, Servicio de Inmunología, Complejo Asistencial Universitario de León, León, España; Instituto de Biomedicina, Universidad de León (IBIOMED), León, España
| | - Miguel Cordero-Coma
- Instituto de Biomedicina, Universidad de León (IBIOMED), León, España; Unidad de uveítis, Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España.
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17
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Yener AÜ, Şahin K. The association of choroidal thickness with rheumatoid factor and anti-cyclic citrullinated peptide in rheumatoid arthritis. Int Ophthalmol 2020; 40:935-941. [PMID: 31927678 DOI: 10.1007/s10792-019-01265-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To measure ocular vascular parameters in rheumatoid arthritis patients and compare with those of controls and to evaluate the association of rheumatoid factor and anti-cyclic citrullinated peptide antibody with the choroidal thickness. METHODS Superficial foveal vessel density, superficial and deep foveal avascular zone area, and subfoveal choroidal thickness were measured using the swept-source optical coherence tomography angiography. Multivariate linear regression was used to assess the correlation of subfoveal choroidal thickness with serological markers in patients with rheumatoid arthritis. RESULTS Choroidal thickness in patients was significantly thinner than that in healthy controls (278.87 ± 59.54 μm vs. 323.94 ± 98.02 μm, p = 0.03). Despite the weak positive correlations between rheumatoid factor/anti-cyclic citrullinated peptide and choroidal thickness, these relationships were not statistically significant (p > 0.05). CONCLUSIONS In patients with rheumatoid arthritis, subfoveal choroid was thinner than controls. There were similar correlations between choroidal thickness and rheumatoid factor and anti-cyclic citrullinated peptide antibody.
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Affiliation(s)
- Arif Ülkü Yener
- Department of Ophthalmology, Keçiören Training and Research Hospital, Ankara, Turkey.
| | - Kubilay Şahin
- Department of Rheumatology, Keçiören Training and Research Hospital, Ankara, Turkey
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18
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Rice CM, Scolding NJ. The diagnosis of primary central nervous system vasculitis. Pract Neurol 2019; 20:109-114. [DOI: 10.1136/practneurol-2018-002002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/25/2022]
Abstract
The diagnosis of primary central nervous system (CNS) vasculitis is often difficult. There are neither specific clinical features nor a classical clinical course, and no blood or imaging investigations that can confirm the diagnosis. Contrast catheter cerebral angiography is neither specific nor sensitive, yet still underpins the diagnosis in many published studies. Here we describe an approach to its diagnosis, emphasising the importance of obtaining tissue, and present for discussion a new, binary set of diagnostic criteria, dividing cases into only ‘definite’ primary CNS vasculitis, where tissue proof is available, and ‘possible,’ where it is not. We hope that these criteria will be modified and improved by discussion among experts, and that these (improved) criteria may then be adopted and used as the basis for future prospective studies of the clinical features and diagnosis of this difficult and dangerous disorder, particularly for coordinated multicentre therapeutic trials.
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Shanmugam VK, Phillpotts M, Brady T, Dalal M, Haji-Momenian S, Akin E, Nataranjan K, McNish S, Karcher DS. Retinal vasculitis with Chronic Recurrent Multifocal Osteomyelitis: a case report and review of the literature. BMC Rheumatol 2019; 3:29. [PMID: 31388650 PMCID: PMC6676622 DOI: 10.1186/s41927-019-0076-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background Concurrent presentation of retinal vasculitis with mixed sclerotic and lytic bone lesions is rare. Case presentation We present the case of a 37-year old woman with a several year history of episodic sternoclavicular pain who presented for rheumatologic evaluation due to a recent diagnosis of retinal vasculitis. We review the differential diagnosis of retinal vasculitis, along with the differential diagnosis of mixed sclerotic and lytic bone lesions. Ultimately, bone marrow biopsy confirmed diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). Concurrent presentation of CRMO with retinal vasculitis is extremely rare but important to recognize. The patient demonstrated clinical response to prednisone and tumor necrosis factor-alpha inhibition (TNF-i). Conclusion This case reports and unusual presentation of CRMO spectrum disease involving the sternum and sternoclavicular joint with concurrent retinal vasculitis.
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Affiliation(s)
- Victoria K Shanmugam
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Marc Phillpotts
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Timothy Brady
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Monica Dalal
- 2Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Shawn Haji-Momenian
- 3Department of Radiology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Esma Akin
- 3Department of Radiology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Kavita Nataranjan
- 4Department of Hematology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Sean McNish
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Donald S Karcher
- 5Department of Pathology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
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20
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Abd El Latif E, Montasser AS, Seleet MM, Elzawahry WM, Abdulbadiea Rashed M, Elbarbary H, Sabry K, Abdelmonagy Ibrahim M, El Hennawi H, Zayed MA, Kandil HW, Said OM. Pattern of Retinal Vasculitis in an Egyptian Cohort. Ocul Immunol Inflamm 2019; 27:897-904. [DOI: 10.1080/09273948.2019.1588332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Eiman Abd El Latif
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Mouamen M. Seleet
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Hossameldeen Elbarbary
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Karim Sabry
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Hazem El Hennawi
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A. Zayed
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hazem W. Kandil
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar M. Said
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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21
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Can ME, Unal Ö, Kars ME, Erten S, Dereli Can G, Duru N, Cagil N. An assessment of ocular elasticity using real time ultrasound and ocular response analyzer in active or remission rheumatoid arthritis. Int Ophthalmol 2018; 39:2187-2194. [PMID: 30511206 DOI: 10.1007/s10792-018-1055-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 11/26/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE To investigate the elasticity of ocular structures in patients with rheumatoid arthritis (RA) without ocular involvement. METHODS The study included 56 RA patients (study group) and 24 healthy volunteers as the control group. The rheumatoid arthritis patients were divided into two subgroups as those in active phase (Group 1, n = 25) or in remission phase (Group 2, n = 31) according to the disease activity index (DAS 28) score. The elastography values of the ratio of orbital fat-sclera (ROF/S) were measured with real-time US elastography, and corneal mechanical values were measured with the Reichert Ocular Response Analyzer in each eye. RESULTS The mean ROF/S value was 5.2 ± 1.8 in Group 1, 0.7 ± 0.4 Group 2, and 0.6 ± 0.1 in the control group. There was a significant difference between the Group 1 and control group with regard to ROF/S (p < 0.001), but no significant difference was determined between Group 2 and control group (p > 0.05). The mean ROF/S value was a significant difference between the Group 1 and 2 (p < 0.001). ROF/S was significantly correlated with DAS-28 and C-reactive protein (CRP) (r = 0.816, p < 0.001 and r = 0.259, p = 0.006). CONCLUSIONS ROF/S was significantly increased in patients in the active phase of RA. Findings revealed that ocular tissue structural changes may occur in the active phase and these could be related to ocular complications as a prognostic factor.
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Affiliation(s)
- Mehmet Erol Can
- Department of Ophthalmology, Yuksek Ihtisas Training and Research Hospital, Mimarsinan Mahallesi Emniyet Caddesi Polis Okulu Karşısı, Bursa, Turkey.
| | - Özlem Unal
- Department of Radiology, Yildirim Beyazit University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Meltem Ece Kars
- Department of Ophthalmology, Yildirim Beyazit University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Sukran Erten
- Department of Rheumatology, Yildirim Beyazit University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Gamze Dereli Can
- Department of Ophthalmology, Yuksek Ihtisas Training and Research Hospital, Mimarsinan Mahallesi Emniyet Caddesi Polis Okulu Karşısı, Bursa, Turkey
| | - Necati Duru
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Nurullah Cagil
- Department of Ophthalmology, Yildirim Beyazit University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
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22
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Low R, Chen EJ, Bin Ismail MA, Mi H, Ling HS, Lim WK, Teoh SC, Agrawal R. Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) - Report 2: Pattern of Uveitis Investigations in Singapore. Ocul Immunol Inflamm 2018; 28:92-99. [PMID: 30335550 DOI: 10.1080/09273948.2018.1535080] [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: 10/28/2022]
Abstract
Purpose: To analyze the pattern of laboratory investigations of uveitis at a tertiary referral eye care center in Singapore.Methods: Retrospective analysis of 2040 uveitis cases from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database over a 12-year period (2004 - 2015).Results: Patients with retinal vasculitis (RV) had the most tests utilized per patient (6.79), followed by intermediate uveitis (IU) (5.25), panuveitis (Pan) (5.12), posterior uveitis (PU) (4.17), anterior uveitis (AU) (2.75), and keratouveitis (KU) (1.10). The most frequently utilized test for infective etiology were the VDRL (41.3%), Syphilis IgG (29.5%), and T-SPOT.TB (24.6%). For autoimmune tests, ANA was most utilized (18.2%), followed by anti-dsDNA (14.8%), and HLA-B27 (12.4%).Conclusion: There was high utilization of autoimmune tests such as ANA, anti-dsDNA, RF, and ANCA, despite its limited yield. Rationalization of investigations in patients with ocular inflammation via a stepladder approach may help optimize the use of limited resources.
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Affiliation(s)
- Rebecca Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elizabeth J Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Helen Mi
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ho Su Ling
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Kiak Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Eagle Eye Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Stephen C Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Eagle Eye Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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23
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Fabiani C, Sota J, Rigante D, Vitale A, Emmi G, Lopalco G, Vannozzi L, Guerriero S, Bitossi A, Orlando I, Franceschini R, Frediani B, Galeazzi M, Iannone F, Tosi GM, Cantarini L. Efficacy of adalimumab and infliximab in recalcitrant retinal vasculitis inadequately responsive to other immunomodulatory therapies. Clin Rheumatol 2018; 37:2805-2809. [PMID: 29766375 DOI: 10.1007/s10067-018-4133-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/01/2018] [Indexed: 12/26/2022]
Abstract
The primary aim of the study was to evaluate the efficacy of tumor necrosis factor (TNF)-α blockers adalimumab (ADA) and infliximab (IFX) in refractory sight-threatening retinal vasculitis (RV) during a 12-month follow-up period. Secondary aims were to evaluate (i) any impact of concomitant conventional disease-modifying anti-rheumatic drugs (cDMARDs) and different lines of biologic therapy; (ii) any difference in terms of efficacy between ADA and IFX; (iii) consequences of biotherapies on the best-corrected visual acuity (BCVA); (iv) corticosteroid-sparing effect; and (vi) ocular complications during anti-TNF-α treatment. Demographic, clinical, and therapeutic data were retrospectively collected from the medical records and statistically analyzed. Forty-eight patients (82 eyes) were recruited, 22 (45.8%) of which received IFX and 26 (54.2%) ADA. The percentages of patients achieving RV remission within 3 and 12 months were 54 and 86%, respectively. A significant decrease in RV detection was identified from baseline to 3-month (p < 0.0001) and 12-month (p < 0.0001) assessments and between 3-month and 12-month visits (p = 0.004). No differences were identified in terms of RV resolution between (i) patients undergoing monotherapy and those co-administered with cDMARDs at 3-month (p = 0.560) and 12-month (p = 0.611) follow-up; (ii) biologic-naïve patients and those already exposed to other biologics at 3-month (p = 0.497) and 12-month (p > 0.99) visits; and (iii) patients treated with ADA and those treated with IFX (p = 0.357). During the study period, a statistically significant corticosteroid-sparing effect was observed (p = 0.0002), while BCVA values did not significantly change (p = 0.950). Anti-TNF-α monoclonal antibodies have proved excellent results in patients with recalcitrant sight-threatening RV.
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Affiliation(s)
- Claudia Fabiani
- Department of Ophthalmology, Humanitas Clinical and Research Center, via Manzoni 56, 20089, Rozzano, MI, Italy.
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci 1, 53100, Siena, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci 1, 53100, Siena, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Lopalco
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Alice Bitossi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Ida Orlando
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci 1, 53100, Siena, Italy
| | - Rossella Franceschini
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci 1, 53100, Siena, Italy
| | - Mauro Galeazzi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci 1, 53100, Siena, Italy
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci 1, 53100, Siena, Italy.
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24
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Agarwal A, Pichi F, Invernizzi A, Gupta V. Disease of the Year: Differential Diagnosis of Uveitic Macular Edema. Ocul Immunol Inflamm 2018; 27:72-88. [DOI: 10.1080/09273948.2018.1523437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science ‘Luigi Sacco’, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Retinal vasculitis (RV) is an inflammation of retinal blood vessels that can be associated with uveitis or be isolated, and can induce vascular occlusion and retinal ischemia. Visual acuity can be severely affected in case of macular involvement or neovessel formation. The diagnosis relies on fundoscopy and fluorescein angiography. Systemic diseases may be associated with RV, the most frequently encountered are Behçet's disease, sarcoidosis or multiple sclerosis, all predominantly associated with venous involvement, whereas systemic lupus erythematosus and necrotizing vasculitis are less frequently observed and predominantly associated with arterial or mixed vasculitis. Treatments are usually aggressive in order to preserve a good visual acuity and to reduce retinal inflammation and chronic ischemia. Steroids, immunosuppressive drugs, retinal laser photocoagulation, intravitreal anti-VEGF injections are usual treatments and more recently, anti-TNFalpha monoclonal therapeutic antibodies have been shown to be very successful.
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MICROVASCULAR FLOW ABNORMALITIES ASSOCIATED WITH RETINAL VASCULITIS: A Potential of Mechanism of Retinal Injury. Retina 2018; 37:1034-1042. [PMID: 27759582 DOI: 10.1097/iae.0000000000001359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the structural optical coherence tomography and related microvascular flow characteristics in eyes with retinal vasculitis. METHODS Regions involved with perivascular infiltration in eyes with retinal vasculitis, but no evidence of large vessel occlusion were evaluated with optical coherence tomography (OCT), OCT angiography, and fluorescein angiography. RESULTS Ten eyes of 5 patients with a variety of etiologies of retinal vasculitis were evaluated. These patients did not have either cotton wool spots or deeper placoid areas of retinal ischemia. Around large vessels there was perivascular infiltration with leakage and staining seen during fluorescein angiography. Structural OCT showed slight thickening with loss of visualization of normal retinal laminations. OCT angiography showed a lack of flow signal in capillary sized vessels in the same areas. Treatment resulted in a rapid thinning of the affected areas, with the inner and middle layers of the retina becoming thinner than surrounding uninvolved areas. OCT angiography did not show a return of capillary perfusion in these regions. The thickness change in the structural OCT as shown by a heat map had a pattern mimicking the original perivascular infiltration around large retinal vessels. CONCLUSION Capillary level perfusion abnormalities can develop in regions adjacent to large vessel inflammatory infiltrate that result in retinal thinning without the development of usual stigmata of acute microvascular flow obstruction such as cotton wool spots. This suggests that retinal damage may occur in retinal vasculitis that would not be recognized without using OCT-based imaging modalities.
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Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Prog Retin Eye Res 2017; 64:1-55. [PMID: 29229445 PMCID: PMC6404988 DOI: 10.1016/j.preteyeres.2017.11.003] [Citation(s) in RCA: 958] [Impact Index Per Article: 136.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023]
Abstract
Optical coherence tomography (OCT) was one of the biggest advances in ophthalmic imaging. Building on that platform, OCT angiography (OCTA) provides depth resolved images of blood flow in the retina and choroid with levels of detail far exceeding that obtained with older forms of imaging. This new modality is challenging because of the need for new equipment and processing techniques, current limitations of imaging capability, and rapid advancements in both imaging and in our understanding of the imaging and applicable pathophysiology of the retina and choroid. These factors lead to a steep learning curve, even for those with a working understanding dye-based ocular angiography. All for a method of imaging that is a little more than 10 years old. This review begins with a historical account of the development of OCTA, and the methods used in OCTA, including signal processing, image generation, and display techniques. This forms the basis to understand what OCTA images show as well as how image artifacts arise. The anatomy and imaging of specific vascular layers of the eye are reviewed. The integration of OCTA in multimodal imaging in the evaluation of retinal vascular occlusive diseases, diabetic retinopathy, uveitis, inherited diseases, age-related macular degeneration, and disorders of the optic nerve is presented. OCTA is an exciting, disruptive technology. Its use is rapidly expanding in clinical practice as well as for research into the pathophysiology of diseases of the posterior pole.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, United States.
| | - James G Fujimoto
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA, United States
| | - Nadia K Waheed
- The Department of Ophthalmology, Tufts University School of Medicine, Boston MA, United States
| | - Srinivas R Sadda
- Doheny Eye Institute, University of California - Los Angeles, Los Angeles, CA, United States
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
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Dumitrascu OM, Okazaki EM, Cobb SH, Zarka MA, De Souza SA, Kumar G, O'Carroll CB. Amyloid-Beta-Related Angiitis with Distinctive Neuro-Ophthalmologic Features. Neuroophthalmology 2017; 42:237-241. [PMID: 30042795 DOI: 10.1080/01658107.2017.1374982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023] Open
Abstract
Amyloid beta-related angiitis (ABRA) is a subtype of cerebral amyloid angiopathy-related inflammation, with distinctive pathology and prognosis compared with cerebral amyloid angiopathy (CAA). On a spectrum of increasing severity, ABRA is considered to be in-between the less aggressive inflammatory-CAA and the more severe primary central nervous system (CNS) angiitis. Whereas retinal pathological changes were described in subjects with primary or secondary CNS angiitis, and non-inflammatory CAA, bilateral posterior pole superficial and peripapillary retinal hemorrhages have not been reported as initial signs in patients with pathology-confirmed ABRA, accompanying neurological spells and characteristic neuroimaging findings.
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Affiliation(s)
| | - Erin M Okazaki
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Steven H Cobb
- Department of Ophthalmology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Stephen A De Souza
- Department of Ophthalmology, College of Medicine, University of Arizona, Phoenix, Arizona, USA
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Coroidopatía lúpica: reporte de un caso. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kal A, Duman E, Sezenöz AS, Ulusoy MO, Kal Ö. Evaluation of retrobulbar blood flow and choroidal thickness in patients with rheumatoid arthritis. Int Ophthalmol 2017; 38:1825-1831. [PMID: 28730400 DOI: 10.1007/s10792-017-0656-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/15/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values. METHODS We evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed. RESULTS Peak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT. CONCLUSIONS Ocular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.
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Affiliation(s)
- Ali Kal
- Department of Ophthalmology, Baskent University, Konya, Turkey.
- Göz Hastaliklari ABD, Baskent Üniversitesi Tıp Fakültesi, Hoca Cihan Mh. Saray Cd.No:1, 42080, Konya, Turkey.
| | - Enes Duman
- Department of Radiology, Baskent University, Konya, Turkey
| | | | | | - Öznur Kal
- Department of Nephrology, Baskent University, Konya, Turkey
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Agarwal A, Afridi R, Agrawal R, Do DV, Gupta V, Nguyen QD. Multimodal Imaging in Retinal Vasculitis. Ocul Immunol Inflamm 2017; 25:424-433. [DOI: 10.1080/09273948.2017.1319494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rupesh Agrawal
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore
| | - Diana V. Do
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Quan Dong Nguyen
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, Gupta V, Gupta A, Do DV, Nguyen QD. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary-referral institutions. Clin Exp Ophthalmol 2017; 46:62-74. [DOI: 10.1111/ceo.12997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Aniruddha Agarwal
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Samendra Karkhur
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital; University of Milan; Milan Italy
| | - Ramandeep Singh
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Mangat R Dogra
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Amod Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Diana V Do
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
| | - Quan D Nguyen
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
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Gao N, Li MT, Li YH, Zhang SH, Dai RP, Zhang SZ, Zhao LD, Wang L, Zhang FC, Zhao Y, Zeng XF. Retinal vasculopathy in patients with systemic lupus erythematosus. Lupus 2017; 26:1182-1189. [PMID: 28355986 DOI: 10.1177/0961203317698050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective case control study was conducted in the Peking Union Medical College Hospital. Medical records were reviewed for demographic data, clinical features, laboratory results, systemic lupus erythematosus (SLE) disease activity evaluations, and ophthalmic examinations to investigate the clinical characteristics and significance of retinal vasculopathy (RV) in Chinese patients with systemic lupus erythematosus. The prevalence of RV was approximately 0.66% (35/5298) in SLE patients. A total of 60 eyes were involved. The ocular presentations included decrease of visual acuity (48/60, 80%), visual field loss (7/60, 11.7%), and diplopia (3/60, 5%). Ophthalmic fundoscopic examination revealed cotton-wool spots (30/60, 50%), retinal vascular attenuation (31/60, 51.6%), and hemorrhages (41/60, 68.3%). Retinal angiogram showed that 72.7% (16/22) eyes had vaso-occlusion. The ophthalmic episodes could occur at any stage of SLE duration, with a median of 12 months (0-168 months) following SLE onset. Twenty-one (35%) eyes did not recover, or even worsened, during hospital stay. RV was found to be significantly associated with neuropsychiatric lesions (51.4% vs. 21.3%, p = .005) and hematological disturbance (62.9% vs. 34.3%, p = .005). SLE patients with RV had significantly higher SLE disease activity index scores than controls (19.9 ± 0.9 vs. 10.2 ± 0.7, p < .001). An inverse association of anti-SSA antibody with RV was detected (34.3% vs. 67.1%, p = .001). Nervous system disturbance (odds ratio (OR) = 4.340, 95% confidence interval (CI) 1.438, 13.094, p = .009) and leukocytopenia (OR = 6.385, 95% CI 1.916, 21.278, p = .003) were independent risk factors, while anti-SSA antibody positivity (OR = 0.249, 95% CI 0.087, 0.710, p = .009) was a protective factor for RV in SLE patients. In certain cases, RV is a threatening condition for SLE patients presenting with clinical ocular manifestations. Ophthalmo-fundoscopic detection is recommended as soon as SLE is diagnosed.
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Affiliation(s)
- N Gao
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - M T Li
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Y H Li
- 2 Department of Rheumatology, No.323 PLA Hospital, Xi'an, China
| | - S H Zhang
- 3 Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - R P Dai
- 3 Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - S Z Zhang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - L D Zhao
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - L Wang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - F C Zhang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Y Zhao
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - X F Zeng
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Ting DSJ, Anand S. Fibrovascular corneal mass: A rare initial sign of rheumatoid arthritis. Can J Ophthalmol 2017; 52:e18-e19. [PMID: 28237163 DOI: 10.1016/j.jcjo.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/27/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Darren Shu Jeng Ting
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, United Kingdom.
| | - Seema Anand
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, United Kingdom
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Uveitis in childhood-onset systemic lupus erythematosus patients: a multicenter survey. Clin Rheumatol 2017; 36:547-553. [PMID: 28070763 DOI: 10.1007/s10067-016-3534-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/27/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023]
Abstract
The aim of this study is to assess uveitis prevalence in a large cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. A retrospective multicenter cohort study including 852 cSLE patients was performed in ten pediatric rheumatology centers (Brazilian cSLE group). An investigator meeting was held and all participants received database training. Uveitis was diagnosed through clinical assessment by the uveitis expert ophthalmologist of each center. Patients with and without uveitis were assessed for lupus clinical/laboratory features and treatments. Uveitis was observed in 7/852 cSLE patients (0.8%). Two of them had ocular complications: cataract and irreversible blindness in one patient and retinal ischemia with subsequent neovascularization and unilateral blindness in another. Uveitis was identified within the first 6 months of cSLE diagnosis in 6/7 patients (86%). Comparison of a subgroup of cSLE patients with (n = 7) and without uveitis (n = 73) and similar length of disease duration showed that patients with uveitis had increased SLEDAI-2K score (19 vs. 6; p < 0.01). In addition, fever (71 vs. 12%; p < 0.01), lymphadenopathy (29 vs. 1.4%; p = 0.02), arthritis (43 vs. 7%; p = 0.02), and use of intravenous methylprednisolone (71 vs. 22%; p = 0.01) were higher in cSLE patients with uveitis, as compared to those without this manifestation, respectively. Presence of fever was significantly associated with uveitis, independently of SLEDAI scores or use of intravenous methylprednisolone pulses, as shown by adjusted regression analysis (adjusted prevalence ratio 35.7, 95% CI 2.4-519.6; p < 0.01). Uveitis was a rare and initial manifestation of active cSLE patients. Early recognition is essential due to the possibility of irreversible blindness.
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Lamba N, Lee S, Chaudhry H, Foster CS. A review of the ocular manifestations of rheumatoid arthritis. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1243771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Neerav Lamba
- Massachusetts Eye Research and Surgery Institution (MERSI), 1440 Main Street, Suite 201, Waltham, MA 02451, USA
- Ocular Immunology & Uveitis Foundation, 348 Glen Road, Weston, MA 02493, USA
| | - Stacey Lee
- Massachusetts Eye Research and Surgery Institution (MERSI), 1440 Main Street, Suite 201, Waltham, MA 02451, USA
- Ocular Immunology & Uveitis Foundation, 348 Glen Road, Weston, MA 02493, USA
| | - Hina Chaudhry
- Department of Rheumatology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - C. Stephen Foster
- Massachusetts Eye Research and Surgery Institution (MERSI), 1440 Main Street, Suite 201, Waltham, MA 02451, USA
- Ocular Immunology & Uveitis Foundation, 348 Glen Road, Weston, MA 02493, USA
- Department of Ophthalmology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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[Structural and morphological changes in the eyes of arterial hypertensive patients with and without anti-CCP-positive rheumatoid arthritis]. Ophthalmologe 2016; 114:348-357. [PMID: 27572952 DOI: 10.1007/s00347-016-0349-y] [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: 10/21/2022]
Abstract
INTRODUCTION To investigate the additive systemic inflammatory process of rheumatoid arthritis (RA) in arterial hypertension patients, structural and morphological changes of the retina and optic nerve head were assessed by modern topographic technologies. Similarities of underlying vascular mechanisms between RA and arterial hypertension are interesting and have not been researched in depth. The aim of this study is to evaluate changes of RA and arterial hypertension with the optic coherence topography (OCT) and Heidelberg retina tomography (HRT III), to validate RA changes in comparison to arterial hypertension only patients and, finally, if these methods are useful to detect the chronic inflammatory influence of the RA on the eye. METHODS In this prospective study design, data of 18 patients with RA and arterial hypertension (55.3 ± 4.31 years old), positive for antibodies against cyclic citrullinated peptides, 21 patients with arterial hypertension (54.2 ± 4.18 years old) and 19 healthy subjects (53.1 ± 3.25 years old) were included. Intensive ophthalmologic and internistic screening tests were carried out in all subjects. All participants were investigated for the retinal nerve fiber layer (RNFL) and macula thickness with the OCT (Carl Zeiss AG Germany) and for stereometric parameters of the optic nerve head with the Heidelberg Retina Tomograph III (Heidelberg Engineering Germany). The pachymetry was conducted by the Orbscan II system (Bausch & Lomb). Statistical data were assessed by SPSS, v20.0. RESULTS No significant differences were found in visual function, diastolic and systolic blood pressure. RNFL, and macular thickness (Stratus-OCT) were almost consistent between the groups and even the main stereometric parameters measured with HRT III showed no significant differences. CONCLUSION Contrary to our study hypothesis no structural and morphological changes could be detected in patients with arterial hypertension without RA compared to healthy subjects. Furthermore, no RA-specific effects could be shown in comparison with the hypertension group. Thus, the used examination techniques are not suitable to prove the systemic inflammatory influence of RA on the eye.
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Abstract
Eye involvement represents a common finding in patients with systemic autoimmune diseases, particularly rheumatoid arthritis, Sjogren syndrome, seronegative spondyloarthropathy, and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The eye is a privileged immune site but commensal bacteria are found on the ocular surface. The eye injury may be inflammatory, vascular or infectious, as well as iatrogenic, as in the case of hydroxychloroquine, chloroquine, corticosteroids, and bisphosphonates. Manifestations may affect different components of the eye, with episcleritis involving the episclera, a thin layer of tissue covering the sclera; scleritis being an inflammation of the sclera potentially leading to blindness; keratitis, referring to corneal inflammation frequently associated with scleritis; and uveitis as the inflammation of the uvea, including the iris, ciliary body, and choroid, subdivided into anterior, posterior, or panuveitis. As blindness may result from the eye involvement, clinicians should be aware of the possible manifestations and their management also independent of the ophthalmologist opinion as the therapeutic approach generally points to the underlying diseases. In some cases, the eye involvement may have a diagnostic implication, as for episcleritis in rheumatoid arthritis, or acute anterior uveitis in seronegative spondyloarthritis. Nonetheless, some conditions lack specificity, as in the case of dry eye which affects nearly 30 % of the general population. The aim of this review is to elucidate to non-ophthalmologists the major ocular complications of rheumatic diseases and their specific management and treatment options.
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Affiliation(s)
- Elena Generali
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy.
- BIOMETRA Department, University of Milan, Milan, Italy.
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Rue KS, Rodger DC, Rao NA. Retinopathy in lupus transitioned to Kikuchi-Fujimoto disease. Am J Ophthalmol Case Rep 2016; 3:43-46. [PMID: 29503907 PMCID: PMC5757397 DOI: 10.1016/j.ajoc.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose We present a patient with systemic lupus erythematosus with significant vaso-occlusive retinal findings mimicking antiphospholipid antibody syndrome, who developed Kikuchi-Fujimoto disease. Observations Our patient was initially diagnosed with systemic lupus erythematosus with antiphospholipid antibody syndrome given consistent serologic markers and profound retinal vascular ischemia. However, on subsequent follow up, she presented with fever and lymphadenopathy and underwent lymph node biopsy, which declared histologic findings of Kikuchi-Fujimoto disease. Repeat markers for antiphospholipid antibody syndrome were negative and she was taken off lifelong anticoagulation. Conclusions and importance Systemic lupus erythematosus and Kikuchi-Fujimoto disease may have many similar features and even biomarkers, and given the potential overlap of presentation, clinicians must carefully distinguish between these diseases to prevent unnecessary treatment.
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Affiliation(s)
- Kelly S Rue
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Damien C Rodger
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Narsing A Rao
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Fisher DE, Ward MM, Hoffman HJ, Li CM, Cotch MF. Impact of Sensory Impairments on Functional Disability in Adults With Arthritis. Am J Prev Med 2016; 50:454-462. [PMID: 26410186 PMCID: PMC4801663 DOI: 10.1016/j.amepre.2015.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Mobility is reduced in people with sensory impairments and those with arthritis. The combined impact of these conditions may be underappreciated. This study examines the associations between impairments in vision, hearing, and balance and functional ability in adults with versus without arthritis. METHODS Using National Health and Nutrition Examination Survey data from 1999-2004, arthritis status, functional ability, and sensory impairments (vision, hearing, and balance) were assessed from self-reported responses by 6,654 individuals aged ≥50 years (mean age, 63.4 years; 46.3% male). Multivariable regression analyses, conducted in 2014, assessed the associations between sensory impairment and arthritis on functional ability and mobility. RESULTS Among study participants, 41.8% reported having arthritis; of these, 27.1%, 44.9%, and 35.1% reported impaired vision, hearing, or balance, respectively. Having multiple sensory impairments was significantly associated with reduced functional ability in people with arthritis; individuals with three sensory impairments reported the highest levels of disability for all functional domains (compared with no impairment; lower extremity mobility, 80.2% vs 39.1%; general physical activities, 94.7% vs 75.9%; activities of daily living, 69.7% vs 27.2%; instrumental activities of daily living, 77.2% vs 37.4%; leisure and social activities, 66.3% vs 30.6%; impaired gait speed, 48.1% vs 16.3%; all p<0.001). Importantly, visual deficits, in combination with arthritis, had the greatest impact on mobility, with odds of impaired mobility at least twice as high as for individuals without arthritis. CONCLUSIONS Addressing sensory deficits, especially difficulties with vision, may improve functional ability, which may be particularly helpful for adults with arthritis.
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Affiliation(s)
- Diana E Fisher
- Division of Epidemiology and Clinical Applications, Intramural Research Program, National Eye Institute, NIH, Bethesda, Maryland.
| | - Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland
| | - Chuan-Ming Li
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, Intramural Research Program, National Eye Institute, NIH, Bethesda, Maryland
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Duru N, Altinkaynak H, Erten Ş, Can ME, Duru Z, Uğurlu FG, Çağıl N. Thinning of Choroidal Thickness in Patients with Rheumatoid Arthritis Unrelated to Disease Activity. Ocul Immunol Inflamm 2015; 24:246-53. [DOI: 10.3109/09273948.2015.1024329] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
Sarcoidosis is a systemic disease characterized by the development of epithelioid granulomas in various organs. Although the lungs are involved in most patients with sarcoidosis, virtually any organ can be affected. Recognition of extrapulmonary sarcoidosis requires awareness of the organs most commonly affected, such as the skin and the eyes, and vigilance for the most dangerous manifestations, such as cardiac and neurologic involvement. In this article, the common extrapulmonary manifestations of sarcoidosis are reviewed and organ-specific therapeutic considerations are discussed.
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Affiliation(s)
- Deepak A. Rao
- Division of Rheumatology, Brigham and Women’s Hospital, 45 Francis Street, PBB-3, Boston, MA 02115, USA
| | - Paul F. Dellaripa
- Division of Rheumatology, Brigham and Women’s Hospital, 45 Francis Street, PBB-3, Boston, MA 02115, USA
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