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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [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: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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2
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Parikh R, Spence O, Giannelos N, Kaan I. Herpes Zoster Recurrence: A Narrative Review of the Literature. Dermatol Ther (Heidelb) 2024; 14:569-592. [PMID: 38416279 PMCID: PMC10965844 DOI: 10.1007/s13555-024-01101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/15/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Herpes zoster (HZ; shingles) is a painful, cutaneous disease caused by reactivation of the varicella zoster virus, which causes varicella (chickenpox) typically during childhood. The considerable healthcare burden of HZ is relatively well documented, with approximately one in three individuals experiencing at least one episode during their lifetime, debilitating symptoms including neuropathic pain, and complications such as post-herpetic neuralgia, vision loss, and rarely, stroke, and increased severity in immunocompromised individuals. However, we are not aware of a comprehensive review of literature specifically examining the burden of HZ recurrence. METHODS We conducted a PubMed search (1 January 2003-2 February 2023) to assess available literature on the incidence, risk factors, and clinical features of HZ recurrence. RESULTS The incidence of HZ recurrence reported by the studies identified was wide ranging. Studies in general populations of immunocompetent or immunocompetent/immunosuppressed (mixed) populations with an initial HZ episode estimate that approximately 1.2-9.6% of individuals may experience HZ recurrence, with an incidence rate of 1.7-16.6 cases per 1000 person-years. HZ recurrence was reported in 0.0-18.2% of immunocompromised individuals with HZ, with an incidence rate of 17.0-55 cases per 1000 person-years. Incidence rates varied according to study design, follow-up, and study populations. Recognized risk factors for HZ recurrence include immunocompromised status, female sex, family history, and comorbidities such as diabetes. Other factors that may predispose individuals to recurrence include long-lasting pain after the initial HZ episode and the presence of herpes zoster ophthalmicus. DISCUSSION Our review underlines that following an initial HZ episode, individuals remain at risk of HZ recurrence, adding to the disease burden in a population. As HZ is preventable by vaccination, national HZ vaccination recommendations should include the need for and timing of vaccination in both immunocompetent and immunocompromised individuals who have a history of HZ.
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Affiliation(s)
- Raunak Parikh
- Global Medical Affairs, Shingrix, GSK Wavre, Av. Fleming 20, Wavre, Belgium.
| | - O'Mareen Spence
- Vaccine Epidemiology - Viral Non-Respiratory, GSK, Rockville, MD, USA
| | | | - Iain Kaan
- Value Evidence and Outcomes, GSK, Singapore, Singapore
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3
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Ahmad F, Deshmukh N, Webel A, Johnson S, Suleiman A, Mohan RR, Fraunfelder F, Singh PK. Viral infections and pathogenesis of glaucoma: a comprehensive review. Clin Microbiol Rev 2023; 36:e0005723. [PMID: 37966199 PMCID: PMC10870729 DOI: 10.1128/cmr.00057-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, caused by the gradual degeneration of retinal ganglion cells and their axons. While glaucoma is primarily considered a genetic and age-related disease, some inflammatory conditions, such as uveitis and viral-induced anterior segment inflammation, cause secondary or uveitic glaucoma. Viruses are predominant ocular pathogens and can impose both acute and chronic pathological insults to the human eye. Many viruses, including herpes simplex virus, varicella-zoster virus, cytomegalovirus, rubella virus, dengue virus, chikungunya virus, Ebola virus, and, more recently, Zika virus (ZIKV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have been associated with sequela of either primary or secondary glaucoma. Epidemiological and clinical studies suggest the association between these viruses and subsequent glaucoma development. Despite this, the ocular manifestation and sequela of viral infections are not well understood. In fact, the association of viruses with glaucoma is considered relatively uncommon in part due to underreporting and/or lack of long-term follow-up studies. In recent years, literature on the pathological spectrum of emerging viral infections, such as ZIKV and SARS-CoV-2, has strengthened this proposition and renewed research activity in this area. Clinical studies from endemic regions as well as laboratory and preclinical investigations demonstrate a strong link between an infectious trigger and development of glaucomatous pathology. In this article, we review the current understanding of the field with a particular focus on viruses and their association with the pathogenesis of glaucoma.
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Affiliation(s)
- Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nikhil Deshmukh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aaron Webel
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandra Johnson
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ayman Suleiman
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Rajiv R. Mohan
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Frederick Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
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4
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Zhang J, Kamoi K, Zong Y, Yang M, Ohno-Matsui K. Cytomegalovirus Anterior Uveitis: Clinical Manifestations, Diagnosis, Treatment, and Immunological Mechanisms. Viruses 2023; 15:185. [PMID: 36680225 PMCID: PMC9867175 DOI: 10.3390/v15010185] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
Little is known regarding anterior uveitis (AU), the most common ocular disease associated with cytomegalovirus (CMV) infection in immunocompetent populations. CMV AU is highly prevalent in Asia, with a higher incidence in men. Clinically, it manifests mainly as anterior chamber inflammation and elevated intraocular pressure (IOP). Acute CMV AU may resemble Posner-Schlossman syndrome with its recurrent hypertensive iritis, while chronic CMV AU may resemble Fuchs uveitis because of its elevated IOP. Without prompt treatment, it may progress to glaucoma; therefore, early diagnosis is critical to prognosis. Knowledge regarding clinical features and aqueous humor analyses can facilitate accurate diagnoses; so, we compared and summarized these aspects. Early antiviral treatment reduces the risk of a glaucoma surgery requirement, and therapeutic effects vary based on drug delivery. Both oral valganciclovir and topical ganciclovir can produce positive clinical outcomes, and higher concentration and frequency are beneficial in chronic CMV retinitis. An extended antiviral course could prevent relapses, but should be limited to 6 months to prevent drug resistance and side effects. In this review, we have systematically summarized the pathogenesis, clinical features, diagnostic and therapeutic aspects, and immunological mechanisms of CMV AU with the goal of providing a theoretical foundation for early clinical diagnosis and treatment.
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Affiliation(s)
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
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5
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Sudhakar P, Menon M, CK M, Balasubramaniam A. Glaucoma in Viral Keratouveitis: A Retrospective Review at a Tertiary Eye Hospital. J Curr Glaucoma Pract 2022; 16:65-70. [PMID: 36060041 PMCID: PMC9385385 DOI: 10.5005/jp-journals-10078-1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Priyanka Sudhakar
- Department of Glaucoma, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Meena Menon
- Department of Glaucoma, Sankara Eye Hospital, Bengaluru, Karnataka, India
- Meena Menon, Department of Glaucoma, Sankara Eye Hospital, Bengaluru, Karnataka, India, Phone: +91 9886283310, e-mail:
| | - Minija CK
- Department of Uvea services, Sankara Eye Hospital, Bengaluru, Karnataka, India
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Wintergerst MWM, Liu X, Terheyden JH, Pohlmann D, Li JQ, Montesano G, Ometto G, Holz FG, Crabb DP, Pleyer U, Heinz C, Denniston AK, Finger RP. Structural Endpoints and Outcome Measures in Uveitis. Ophthalmologica 2021; 244:465-479. [PMID: 34062542 DOI: 10.1159/000517521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
Most uveitis entities are rare diseases but, taken together, are responsible for 5-10% of worldwide visual impairment which largely affects persons of working age. As with many rare diseases, there is a lack of high-level evidence regarding its clinical management, partly due to a dearth of reliable and objective quantitative endpoints for clinical trials. This review provides an overview of available structural outcome measures for uveitis disease activity and damage in an anatomical order from the anterior to the posterior segment of the eye. While there is a multitude of available structural outcome measures, not all might qualify as endpoints for clinical uveitis trials, and thorough testing of applicability is warranted. Furthermore, a consensus on endpoint definition, standardization, and "core outcomes" is required. As stipulated by regulatory agencies, endpoints should be precisely defined, clinically important, internally consistent, reliable, responsive to treatment, and relevant for the respective subtype of uveitis. Out of all modalities used for assessment of the reviewed structural outcome measures, optical coherence tomography, color fundus photography, fundus autofluorescence, and fluorescein/indocyanine green angiography represent current "core modalities" for reliable and objective quantification of uveitis outcome measures, based on their practical availability and the evidence provided so far.
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Affiliation(s)
| | - Xiaoxuan Liu
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Dominika Pohlmann
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jeany Q Li
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Giovanni Montesano
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Giovanni Ometto
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Uwe Pleyer
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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7
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Babu K, Konana VK, Ganesh SK, Patnaik G, Chan NSW, Chee SP, Sobolewska B, Zierhut M. Viral anterior uveitis. Indian J Ophthalmol 2021; 68:1764-1773. [PMID: 32823392 PMCID: PMC7690545 DOI: 10.4103/ijo.ijo_928_20] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Viral anterior uveitis (VAU) needs to be suspected in anterior uveitis (AU) associated with elevated intraocular pressure, corneal involvement, and iris atrophic changes. Common etiologies of VAU include herpes simplex, varicella-zoster, cytomegalovirus, and rubella virus. Clinical presentations can vary from granulomatous AU with corneal involvement, Posner-Schlossman syndrome, Fuchs uveitis syndrome, and endothelitis. Due to overlapping clinical manifestations between the different viruses, diagnostic tests like polymerase chain reaction and Goldmann-Witmer coefficient analysis on the aqueous humor may help in identifying etiology to plan and monitor treatment.
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Affiliation(s)
- Kalpana Babu
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Vinaya Kumar Konana
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Sudha K Ganesh
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Gazal Patnaik
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nicole S W Chan
- Department of Ophthalmology, National University Hospital, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre; Singapore Eye Research Institute; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Duke-NUS Graduate Medical School Singapore, Singapore
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8
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Rao A, Gawas L. Atypical associations of viral anterior uveitis with glaucoma-a series of challenging scenarios with review of literature. Semin Ophthalmol 2021; 36:605-613. [PMID: 33734824 DOI: 10.1080/08820538.2021.1890789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report unusual associations, atypical clinical presentations, and outcomes of tailored treatment of viral uveitis and glaucoma. METHODS Patients diagnosed with viral uveitis with associated glaucoma, seen at a tertiary eye care center between 2013 and 2020, were screened. Twenty-four patients with unclassified or atypical clinical presentations of viral uveitis, atypical clinical course, or with diagnostic challenges and associated glaucoma, were included. Patients with classical features of viral anterior or posterior uveitis, other forms of autoimmune/infectious/traumatic uveitis, were excluded. RESULTS Viral re-activation causing recurrent choroidals after glaucoma filtering surgery responsive to systemic antiviral therapy, massive pigment dusting/plume as a presenting feature, multiple progressive focal anterior synechiae similar to iridocorneoendothelial (ICE) syndrome, were seen in this cohort of unusual viral uveitis in glaucoma. A high index of suspicion helped diagnose a viral etiology in cases with high intraocular pressure (IOP) after uneventful Ahmed glaucoma valve surgery (AGV) or post-YAG capsulotomy laser, presumed Posner-Schlossman syndrome with multiple recurrences or presumed steroid glaucoma. All patients responded well with anti-viral and tailored concomitant steroids, anti-glaucoma therapy with loss of visual acuity seen in one eye developing optic atrophy. CONCLUSIONS Uncommon clinical presentations or associations of viral uveitis in glaucoma should be kept in mind. A high index of suspicion and tailored prompt treatment may ensure good outcomes preventing further visual morbidity in glaucoma.
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Affiliation(s)
- Aparna Rao
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Lisika Gawas
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
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9
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Altan C, Basarir B. Aetiology and clinical characteristics of uveitic glaucoma in Turkish patients. Int Ophthalmol 2021; 41:2225-2234. [PMID: 33730317 DOI: 10.1007/s10792-021-01783-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the types, frequency and clinical profiles of uveitic glaucoma seen at a tertiary care center and also to have an idea about the distribution of uveitic glaucoma types in Turkish population. METHODS Consecutive case notes of all patients attending a specialized uveitis clinic over a 3-month period were reviewed retrospectively. RESULTS One hundred and seven eyes of 96 patients were included. Sixty-five of the eyes had anterior, one intermediate, nine posterior uveitis while 32 of them had panuveitis. Twenty-three eyes had acute, 52 chronic and 32 recurrent uveitis. Herpes virus associated iridocyclitis was the leading cause of anterior uveitis-associated uveitic glaucoma followed by cytomegalovirus (CMV) associated anterior uveitis; while steroid-induced glaucoma accounted for the majority of chronic uveitis with glaucoma followed by Fuchs' uveitis syndrome (FUS). The most common causes of glaucoma among the cases were steroid-induced in 30 eyes (28%), Herpes virus anterior uveitis in 24 eyes (22%), CMV anterior uveitis in 20 eyes (18%), FUS in 15 eyes (14%), ocular toxoplasmosis in 5 eyes (4%). Behçet's uveitis was the most common (n = 11, 36%) cause of steroid-induced glaucoma. The need for surgical intervention was 23.32% (n = 25; 12 of them were FUS, 8 steroid-dependent, 1 HSV and 3 CMV anterior uveitis and 1 angle closure glaucoma with idiopathic uveitis) in our cases. CONCLUSION Uveitic glaucoma is a common complication in a tertiary clinic. The most common causes are steroid-induced, FUS, viral anterior uveitis. The most common disease causing steroid induced glaucoma was Behçet's disease. Glaucoma surgery is required in a significant number of cases.
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Affiliation(s)
- Cigdem Altan
- University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number: 2, Beyoglu, Istanbul, Turkey.
| | - Berna Basarir
- University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number: 2, Beyoglu, Istanbul, Turkey
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de Carlo T, Sarran R, Vajaranant TS. An African American Man With Progressive Loss of Iris Pigmentation in Both Eyes. JAMA Ophthalmol 2021; 138:1089-1090. [PMID: 32816008 DOI: 10.1001/jamaophthalmol.2020.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Talisa de Carlo
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago
| | - Rebecca Sarran
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago
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Radosavljevic A, Agarwal M, Chee SP, Zierhut M. Epidemiology of Viral Induced Anterior Uveitis. Ocul Immunol Inflamm 2021; 30:297-309. [PMID: 33617392 DOI: 10.1080/09273948.2020.1853177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Viral agents are the most common cause of infectious anterior uveitis worldwide. The purpose of this review is to analyze the frequency, gender and racial differences of viral anterior uveitis (VAU) in various populations.Methods: Systematized literature review of epidemiological reports of VAU cited in PubMed, EMBASE and the Cochrane Library database published until June 30th, 2020.Results: A total of 12 clinical studies on epidemiology of definite VAU and 36 clinical studies of presumed VAU were identified. Members of Herpesviridae family represent the most common causes of VAU. Other less frequently reported causes, such as rubella and endemic viruses (HTLV-1, Chikungunya, Dengue, Ebola, Zika virus) were also analyzed.Conclusion: HSV, VZV are prevalent worldwide. CMV is more frequent in Asia, and rubella in the West. However, due to globalization and air travel, HTLV-1, Chikungunya, Dengue and Ebola may become important causes of VAU across the world.
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Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Duke-NUS Medical School, Singapore
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tubingen, Tubingen, Germany
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12
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Pigment dispersion syndrome and its implications for glaucoma. Surv Ophthalmol 2021; 66:743-760. [PMID: 33444629 DOI: 10.1016/j.survophthal.2021.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
Pigment dispersion syndrome (PDS) represents a clinical spectrum of a relatively common and usually underdiagnosed phenomenon produced by spontaneous pigment dispersion from the iris into the anterior segment. PDS is often bilateral, has no gender predisposition, and presents at a young age, particularly in myopes. Although most patients experiencing an episode of pigment dispersion are asymptomatic, extreme photophobia, ocular pain, redness, and blurred vision may occur. Other characteristic signs are iridolenticular contact, concave iris configuration, 360° peripheral iris transillumination, and pigment deposition on the anterior chamber angle or the corneal endothelium (Krukenberg spindle). Early PDS diagnosis is crucial to detect patients with pigment-related ocular hypertension (POHT) that can eventually lead to pigmentary glaucoma (PG). The latter represents a sight-threatening condition in which mechanical, environmental, and genetic factors contribute to optic nerve damage. In this review, we update the pathogenic mechanisms involved in the clinical spectrum of the disease. We describe its clinical presentation, ophthalmologic manifestations, and complications, including the factors influencing the development of POHT and PG. Because PDS has variable clinical presentations that lead to misdiagnoses, we emphasize the differential diagnosis and the actual therapeutic strategies according to disease status.
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Persistence of Inflammation After Uncomplicated Cataract Surgery: A 6-Month Laser Flare Photometry Analysis. Adv Ther 2020; 37:3223-3233. [PMID: 32440977 DOI: 10.1007/s12325-020-01383-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate, by laser photometry, the persistency of anterior chamber flare after uneventful phacoemulsification in asymptomatic patients with no signs of inflammation on slit lamp examination. METHOD Seventy-five patients previously enrolled in a randomized clinical trial that evaluated inflammation after uneventful phacoemulsification in eyes treated with dexamethasone 0.1% ophthalmic suspension (group 1) or bromfenac 0.09% ophthalmic solution (group 2) for 2 weeks. Anterior chamber inflammation was investigated by laser flare photometry. At 30 days after surgery, laser flare showed persistently elevated values. For this reason, patients were further analyzed at 3 and 6 months. Additionally, optical coherence tomography was used to measure the central macular thickness (CMT) and to assess for postoperative pseudophakic macular edema. RESULTS When compared to preoperative values, laser flare photometry demonstrated persistent ocular inflammation at postoperative days 90 and 180 in group 1, but not in group 2. Laser flare values showed a significant reduction in group 2 compared to group 1 throughout all the follow-up (p < 0.001). The increase in mean CMT at days 90 and 180 with respect to baseline was statistically significant in group 1 but not in group 2, in which it decreased to levels similar to preoperative value. Group 1 showed a higher increase in mean CMT compared to group 2 throughout all the follow-up (p < 0.001). The proportion of patients that developed pseudophakic cystoid macular edema (CME) was 14% (n = 5) and 0% (n = 0) in group 1 and group 2, respectively (p = 0.02). The bivariate analysis demonstrated a positive correlation between laser flare and CMT values in group 1 but not in group 2. CONCLUSION Anterior chamber inflammation persists for more than 30 days in a significant proportion of patients after uncomplicated cataract surgery and may be responsible for late onset of cystoid macular edema cases. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03317847.
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Accorinti M, Petitti L, Gaeta A, Giannini D, De Geronimo D. Viral Acute Anterior Uveitis: Clinical Signs Useful for Differential Diagnosis. Ocul Immunol Inflamm 2020; 29:1355-1362. [DOI: 10.1080/09273948.2020.1751213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Luigi Petitti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Aurelia Gaeta
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
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Shirahama S, Kaburaki T, Takada S, Nakahara H, Tanaka R, Komae K, Fujino Y, Kawashima H, Aihara M. Comparison of visual field defect progression in secondary Glaucoma due to anterior uveitis caused by three types of herpes viruses. Graefes Arch Clin Exp Ophthalmol 2019; 258:639-645. [PMID: 31832767 DOI: 10.1007/s00417-019-04559-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/24/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To clarify the prevalence of secondary glaucoma (SG) and its speed of progression in patients with herpes simplex virus (HSV)-anterior uveitis (AU), varicella zoster virus (VZV)-AU, and cytomegalovirus (CMV)-AU. METHODS In total, 170 patients with herpetic AU were enrolled in this retrospective observational case series. Patients with visual field (VF) defects and glaucomatous disc abnormalities were diagnosed with SG. Moreover, the speed of SG progression was defined as decreasing mean deviation (MD) values per year. SG prevalence and annual MD-value decrease were compared among the three types of herpetic AU. RESULTS SG prevalence was 16%, 9%, and 72% in patients with HSV-AU, VZV-AU, and CMV-AU, respectively. Patients with CMV-AU had the highest SG prevalence (odds ratio = 3.15; 95% confidence interval = 1.15-8.65; P < 0.05). Furthermore, the annual MD-value change was significantly higher in SG caused by CMV-AU than in that caused by HSV/VZV-AU (-2.6 ± 2.4 dB/year and -0.45 ± 0.54 dB/year, respectively; P < 0.05). CONCLUSIONS Our results demonstrated that patients with CMV-AU may have a higher risk and faster speed of progression of SG than patients with HSV/VZV-AU. Therefore, clinicians should monitor glaucoma onset and VF-defect progression in patients with CMV-AU.
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Affiliation(s)
- Shintaro Shirahama
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Sachiko Takada
- Department of Ophthalmology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Komae
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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16
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Qian Z, Fan H, Tao Y, Li W, Gu W. Herpetic Anterior Uveitis in a Chinese Referral Center: Clinical Manifestations and Laboratory Test Results. Ocul Immunol Inflamm 2019; 28:758-763. [PMID: 31573356 DOI: 10.1080/09273948.2019.1619780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Zhuyun Qian
- Department of Opthalmology, Shanghai Aier Eye Hospital, Shanghai, China
| | - Hua Fan
- Department of Opthalmology, Shanghai Aier Eye Hospital, Shanghai, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wensheng Li
- Department of Opthalmology, Shanghai Aier Eye Hospital, Shanghai, China
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Wei Gu
- Department of Opthalmology, Beijing Yingzhi Aier Eye Hospital, Beijing, China
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17
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Infectious uveitis in immunodeficient HIV-negative patients: A retrospective study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:410-416. [PMID: 31435074 DOI: 10.5507/bp.2019.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS Cases of infectious uveitis in immunodeficient patients may present with atypical clinical features because the clinical course of disease is usually affected by the compromised immune system. Therefore, it is sometimes difficult to determine the correct diagnosis. The aim of this study was to evaluate a prevalence of immunodeficient HIV-negative individuals among patients with infectious uveitis and to assess diagnostic and therapeutic approaches. METHODS A retrospective study. RESULTS In years 2003-2017, we diagnosed 594 patients with infectious uveitis. In 35 of them, infectious uveitis occurred on the basis of immunodeficiency (malignancy, immunosuppressive therapy etc.). The most common infectious uveitis was cytomegalovirus retinitis, followed by acute retinal necrosis, herpetic anterior uveitis, endogenous fungal endophthalmitis, toxoplasmic retinochoroiditis, progressive outer retinal necrosis and syphilis. In indicated cases, intraocular fluid examination was a valuable diagnostic tool. After initiation of treatment, improvement of BCVA was observed in 13 eyes, stabilization in 13 eyes and deterioration in 11 eyes. In some patients who experienced adverse effects of medication, the recommended doses were decreased. CONCLUSION Our experience shows that patients with diagnoses of acute retinal necrosis or progressive outer retinal necrosis have a poor visual prognosis. The occurrence of cytomegalovirus retinitis signifies a very unfavorable survival prognosis in patients who underwent hematopoietic stem cell transplantation; the patients in our study died within 1 year from cytomegalovirus retinitis diagnosis.
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18
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Majmudar H, Hao M, Sankaranarayanan NV, Zanotti B, Volin MV, Desai UR, Tiwari V. A synthetic glycosaminoglycan mimetic blocks HSV-1 infection in human iris stromal cells. Antiviral Res 2018; 161:154-162. [PMID: 30481525 DOI: 10.1016/j.antiviral.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 11/26/2022]
Abstract
Herpes simplex virus type-1 (HSV-1) is a significant pathogen that affects vision by targeting multiple regions in the human eye including iris. Using a focused library of synthetic non-saccharide glycosaminoglycan mimetics (NSGMs), we identified sulfated pentagalloylglucoside (SPGG) as a potent inhibitor of HSV-1 entry and cell-to-cell spread in the primary cultures of human iris stromal (HIS) cells isolated from eye donors. Using in vitro β-galactosidase reporter assay and plaque reduction assay, SPGG was found to inhibit HSV-1 entry in a dosage-dependent manner (IC50 ∼6.0 μM). Interestingly, a pronounced inhibition in HSV-1 entry and spread was observed in HIS cells, or a cell line expressing specific gD-receptor, when virions were pre-treated with mimetics suggesting a possible interaction between SPGG and the HSV-1 glycoprotein. To examine the significance of gD-SPGG interaction, HIS cells were pretreated with SPGG, which showed a significant reduction in gD binding. Taken together, our results provide strong evidence of SPGG being a novel viral entry inhibitor against ocular HSV infection.
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Affiliation(s)
- Hardik Majmudar
- Department of Microbiology & Immunology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Meng Hao
- Department of Microbiology & Immunology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Nehru Viji Sankaranarayanan
- Department of Medicinal Chemistry and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Brian Zanotti
- Department of Microbiology & Immunology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Michael V Volin
- Department of Microbiology & Immunology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Umesh R Desai
- Department of Medicinal Chemistry and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Vaibhav Tiwari
- Department of Microbiology & Immunology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA.
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19
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Chan NS, Chee S. Demystifying viral anterior uveitis: A review. Clin Exp Ophthalmol 2018; 47:320-333. [DOI: 10.1111/ceo.13417] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Soon‐Phaik Chee
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
- Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
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20
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Neumann R, Barequet D, Rosenblatt A, Amer R, Ben-Arie-Weintrob Y, Hareuveni-Blum T, Vishnevskia-Dai V, Raskin E, Blumenfeld O, Shulman S, Sanchez JM, Flores V, Habot-Wilner Z. Herpetic Anterior Uveitis – Analysis of Presumed and PCR Proven Cases. Ocul Immunol Inflamm 2018; 27:211-218. [DOI: 10.1080/09273948.2018.1483521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ron Neumann
- Private Inflammatory Eye Disease Clinic, Tel-Aviv, Israel
| | - Dana Barequet
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Rosenblatt
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Yael Ben-Arie-Weintrob
- Department of Ophthalmology, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tamar Hareuveni-Blum
- Department of Ophthalmology, Faculty of Medicine in the Galilee, Galilee Medical Center, Bar Ilan University, Naharia, Israel
| | - Vicktoria Vishnevskia-Dai
- The Goldschleger Eye Institute, Department of Ophthalmology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Eyal Raskin
- Department of Ophthalmology, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Oren Blumenfeld
- Department of Ophthalmology, Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Shiri Shulman
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juan M. Sanchez
- Department of Ophthalmology, Hadassah Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Victor Flores
- Department of Ophthalmology, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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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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22
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Cunningham ET, Miserocchi E, Tugal-Tutkun I, Zierhut M. Varicell Zoster Virus-Associated Uveitis. Ocul Immunol Inflamm 2018; 26:167-170. [DOI: 10.1080/09273948.2018.1444120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Emmett T. Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, Connecticut, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Elisabetta Miserocchi
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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23
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Tugal-Tutkun I, Cimino L, Akova YA. Review for Disease of the Year: Varicella Zoster Virus-Induced Anterior Uveitis. Ocul Immunol Inflamm 2017; 26:171-177. [DOI: 10.1080/09273948.2017.1383447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Luca Cimino
- Ocular Immunology Department, Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Yonca Aydin Akova
- Department of Ophthalmology, Bayindir Kavaklidere Hospital, Ankara, Turkey
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24
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Hoeksema L, Jansonius NM, Los LI. Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis. Am J Ophthalmol 2017; 181:55-60. [PMID: 28666730 DOI: 10.1016/j.ajo.2017.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the incidence of elevated intraocular pressure (IOP) and secondary glaucoma in herpetic anterior uveitis (AU), owing to either herpes simplex or varicella zoster virus, by using the Standardization of Uveitis Nomenclature (SUN) criteria, and to identify risk factors for the development of glaucoma. DESIGN Retrospective observational cohort study. METHODS Patients with herpetic AU presenting themselves between 2001 and 2013 at the ophthalmology department of the University Medical Center Groningen were included. Main outcome measures were the incidence of elevated IOP and glaucoma and risk factors for the development of glaucoma. RESULTS Seventy-three herpetic AU patients were included. Ocular complications most commonly seen during follow-up for uveitis were elevated IOP (75%), keratitis (59%), dry eyes (34%), posterior synechiae (34%), cataract (32%), and glaucoma (15%). Glaucoma patients, in comparison to non-glaucoma patients, had a higher number of IOP peaks during their follow-up for uveitis (P < .001). The majority of patients with elevated IOP (91%) had this already at the start of the uveitis. Nineteen percent of the patients needed glaucoma surgery. CONCLUSIONS Using the SUN criteria, our study confirmed that elevated IOP and secondary glaucoma are major complications in herpetic AU. If an elevated IOP occurred, it was usually already present at the start of a uveitis episode. A risk factor for the development of glaucoma was the number of endured IOP peaks. Future studies are needed to evaluate whether early and prolonged use of antiviral and IOP-lowering medication may prevent glaucoma.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Viral/blood
- Child
- Child, Preschool
- Cohort Studies
- DNA, Viral/genetics
- Eye Infections, Viral/virology
- Female
- Glaucoma/epidemiology
- Glaucoma/etiology
- Herpes Zoster Ophthalmicus/virology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Herpesvirus 3, Human/isolation & purification
- Humans
- Incidence
- Intraocular Pressure
- Keratitis, Herpetic/virology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Retrospective Studies
- Risk Factors
- Simplexvirus/genetics
- Simplexvirus/immunology
- Simplexvirus/isolation & purification
- Tonometry, Ocular
- Uveitis, Anterior/virology
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Affiliation(s)
- Lisette Hoeksema
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands.
| | - Nomdo M Jansonius
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Leonoor I Los
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
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25
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Othman K, Evelyn-Tai LM, Raja-Azmi MN, Julieana M, Liza-Sharmini AT, Tharakan J, Besari AM, Zunaina E, Shatriah I. Concurrent hyphema and orbital apex syndrome following herpes zoster ophthalmicus in a middle aged lady. Int J Surg Case Rep 2017; 30:197-200. [PMID: 28061417 PMCID: PMC5219611 DOI: 10.1016/j.ijscr.2016.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 11/16/2022] Open
Abstract
Herpes zoster ophthalmicus is an uncommon clinical presentation. Concurrent hyphema and orbital apex syndrome are rare clinical sequelae. Hyphema is postulated due to auto immune vasculitis affecting iris vessel. Orbital apex syndrome results from occlusive vasculitis affecting vasculature of optic nerve and extraocular muscles. This incidence probably suggests that occlusive vasculitis occurs at more than one site in the affected dermatome.
Introduction Hyphema and orbital apex syndrome occurring concurrently in a patient with herpes zoster ophthalmicus have not been reported previously. We present a case with these unique findings and discuss the pathogenesis of these conditions and their management. Presentation of case A 59-year-old Malay lady with underlying diabetes mellitus presented with manifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema, and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combination of intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Total hyphema persisted, and she required surgical intervention. Discussion Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbital apex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular muscles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascular inflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of local causes at the orbital apex area. Conclusion Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concurrent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation. Early diagnosis and prompt treatment are essential to prevent potential blinding situation.
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Affiliation(s)
- Khairuddin Othman
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Li Min Evelyn-Tai
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Raja-Azmi
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Muhammed Julieana
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Tajudin Liza-Sharmini
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - John Tharakan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Alwi Muhd Besari
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Ismail Shatriah
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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26
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Kardeş E, Bozkurt K, Sezgin Akçay Bİ, Ünlü C, Aydoğan Gezginaslan T, Ergin A. Clinical Features and Prognosis of Herpetic Anterior Uveitis. Turk J Ophthalmol 2016; 46:109-113. [PMID: 27800272 PMCID: PMC5076292 DOI: 10.4274/tjo.92053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/06/2015] [Indexed: 12/04/2022] Open
Abstract
Objective: To evaluate clinical features, complications, visual outcomes and treatment modalities in patients clinically diagnosed with herpetic anterior uveitis (AU). Materials and Methods: We retrospectively reviewed the medical records of 67 patients seen at the Umraniye Training and Research Hospital, Ophthalmology Clinic, Uveitis and Cornea Department from January 2009 to June 2013. Results: Thirty-seven patients (55.2%) were female and 30 (44.7%) patients were male. The average follow-up period was 12.9 ± 10.6 months (range: 1-45 months). The most common ocular findings were granulomatous keratic precipitates (KPs) (82.2%), corneal involvement (62.6%), iris atrophy (41.7%) and transient elevated intraocular pressure (IOP) (40.2%). Recurrences were observed in 46.2% of the eyes and the median recurrence rate was 1.0 during the follow-up period. Topical steroids and oral antiviral (acyclovir) therapy were applied to all patients during active episodes. Long-term oral acyclovir was used in 29.8% of the patients. Recurrence rates were significantly lower in patients who used oral acyclovir for more than 6 months, whereas complications rates and final visual acuity did not show any difference between groups. Final visual acuity was better than 20/40 in 61.1% of eyes, and visual impairment was due to corneal scarring or cataract formation. Conclusion: Herpetic AU can present with or without corneal involvement. Granulomatous KPs, iris atrophy and elevated IOP are important clinical findings for the diagnosis of cases without corneal involvement. Long-term oral acyclovir treatment (more than 6 months) and is important to decrease recurrence rates and possible complications. Visual prognosis is favorable in cases without corneal scarring.
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Affiliation(s)
- Esra Kardeş
- Ümraniye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Kansu Bozkurt
- Ümraniye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | | | - Cihan Ünlü
- Ümraniye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | | | - Ahmet Ergin
- Ümraniye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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27
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Goh RL, Kong YXG, Chauhan D, Brooks AM. Herpes simplex uveitis as a cause of persistent high intraocular pressure after cataract surgery. Clin Exp Ophthalmol 2016; 44:726-727. [PMID: 27011104 DOI: 10.1111/ceo.12750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Rachel Lz Goh
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Yu Xiang George Kong
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Devinder Chauhan
- Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Anne Mv Brooks
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Centre for Eye Research Australia, East Melbourne, Victoria, Australia
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28
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de-la-Torre A, Valdes-Camacho J, Foster CS. Bilateral Herpes Simplex Uveitis: Review of the Literature and Own Reports. Ocul Immunol Inflamm 2016; 25:497-502. [DOI: 10.3109/09273948.2016.1142572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alejandra de-la-Torre
- Immunology Department, School of Medicine and Health Sciences, Group of Public Health Research, Rosario University, Bogota Colombia
| | - Juanita Valdes-Camacho
- Biomedical Research Center, Faculty of Health Sciences, Quindio University, Group of Molecular Parasitology (GEPAMOL), Armenia, Quindio, Colombia
| | - C. Stephen Foster
- MERSI, Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts, USA
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29
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Gondchawar A, Biswas J, Murali S, Eawaran LMP. A case of herpes simplex keratouveitis diagnosed by real time polymerase chain reaction. Indian J Ophthalmol 2015; 63:854-5. [PMID: 26669338 PMCID: PMC4730698 DOI: 10.4103/0301-4738.171968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ankush Gondchawar
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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30
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Shoughy SS, Alkatan HM, Al-Abdullah AA, El-Khani A, de Groot-Mijnes JD, Tabbara KF. Polymerase chain reaction in unilateral cases of presumed viral anterior uveitis. Clin Ophthalmol 2015; 9:2325-8. [PMID: 26715836 PMCID: PMC4686330 DOI: 10.2147/opth.s93655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and objectives Anterior uveitis is the most common form of intraocular inflammation. The main aim of this study was to determine the viral etiology in patients with unilateral cases of anterior uveitis. Patients and methods A total of 12 consecutive patients with the diagnosis of idiopathic unilateral anterior uveitis were included prospectively. Aqueous specimens were obtained from each patient by anterior chamber paracentesis and subjected to the detection of viral DNA/RNA genome by polymerase chain reaction assay for herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein–Barr virus, and rubella virus. Results There were six male and six female patients. The mean age was 43 years, with an age range of 11–82 years. All 12 cases presented with unilateral anterior uveitis. In four (33%) patients, polymerase chain reaction was positive for viral genome. Two patients were positive for herpes simplex virus type 1, one patient was positive for cytomegalovirus and one for Epstein–Barr virus. Conclusion Recent molecular diagnostic assays would help in the identification of the causative agent in patients with unilateral anterior uveitis.
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Affiliation(s)
- Samir S Shoughy
- Department of Ophthalmology, The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Pathology & Laboratory Medicine and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia ; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulelah A Al-Abdullah
- Department of Pathology & Laboratory Medicine and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Albarah El-Khani
- Department of Pathology & Laboratory Medicine and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Khalid F Tabbara
- Department of Ophthalmology, The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia ; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; The Wilmer Ophthalmological Institute of The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hoeksema L, Los LI. Visual Prognosis and Ocular Complications in Herpetic versus HLA-B27- or Ankylosing Spondylitis-associated Anterior Uveitis. Ocul Immunol Inflamm 2015; 24:302-12. [PMID: 26133756 DOI: 10.3109/09273948.2015.1005237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the visual prognosis and ocular complications in patients with herpetic versus HLA-B27 associated anterior uveitis (AU). METHODS This was a retrospective, observational study conducted at the ophthalmology department of the University Medical Center of Groningen. Sixty-two herpetic and 113 HLA-B27-associated AU patients were included. The main outcome measures were visual acuity and ocular complications. RESULTS Visual acuity over time was significantly lower in herpetic as compared to HLA-B27 AU, mainly due to corneal scarring. The incidence rate of any ocular complication was higher in herpetic AU compared to HLA-B27-associated AU (0.140/EY versus 0.076/EY, p = <0.001), which was mainly due to glaucoma (0.033/EY versus 0.004/EY, p < 0.001) and cataract (0.059/EY versus 0.023/EY, p < 0.001). CONCLUSIONS The most prominent finding was a worse visual prognosis in herpetic AU, which is probably related to higher prevalence of corneal scarring and glaucoma. In addition, herpetic AU patients have more ocular complications overall.
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Affiliation(s)
- Lisette Hoeksema
- a Department of Ophthalmology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands and.,b W. J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen , The Netherlands
| | - Leonoor I Los
- a Department of Ophthalmology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands and.,b W. J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen , The Netherlands
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Pleyer U, Chee SP. Current aspects on the management of viral uveitis in immunocompetent individuals. Clin Ophthalmol 2015; 9:1017-28. [PMID: 26089633 PMCID: PMC4467646 DOI: 10.2147/opth.s60394] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Viruses are a fundamental etiology of ocular inflammation, which may affect all structures of the organ. Advances in molecular diagnostics reveal an increasingly broader spectrum of virus-associated intraocular inflammation, including all members of the herpes family, rubella virus, and other more rare causes such as Epstein–Barr and chikungunya virus. In particular, viruses of the herpes family are important causes of anterior and posterior uveitis. Owing to their often fulminant clinical course and persistence in ocular tissues, a clear differential diagnosis between alpha- and beta-type herpes viruses is essential to guide acute and long-term treatment. Here, we review the epidemiology, clinical, and laboratory findings of virus-associated uveitis with emphasis on their therapy and management and include our own experience.
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Affiliation(s)
- Uwe Pleyer
- Augenklinik, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Soon-Phaik Chee
- Augenklinik, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany ; Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore ; Singapore Eye Research Institute, National University of Singapore, Singapore ; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; Duke-NUS Graduate Medical School Singapore, Singapore
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Parkins GE, Ayettey-Adamafio M, Avogo D, Scheller EL, Pinsky HM. A suspected dental cellulitis leading to diagnosis of both herpes zoster ophthalmicus and HIV. ORAL AND MAXILLOFACIAL SURGERY CASES 2015. [DOI: 10.1016/j.omsc.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.
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Sen HN, Davis J, Ucar D, Fox A, Chan CC, Goldstein DA. Gender disparities in ocular inflammatory disorders. Curr Eye Res 2014; 40:146-61. [PMID: 24987987 DOI: 10.3109/02713683.2014.932388] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ocular inflammatory disorders disproportionately affect women, and the majority of affected women are of childbearing age. The role of sex or reproductive hormones has been proposed in many other inflammatory or autoimmune disorders, and findings from non-ocular autoimmune diseases suggest a complex interaction between sex hormones, genetic factors and the immune system. However, despite the age and sex bias, factors that influence this disparity are complicated and unclear. This review aims to evaluate the gender disparities in prevalence, incidence and severity of the most common infectious and non-infectious ocular inflammatory disorders.
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Affiliation(s)
- Hatice Nida Sen
- National Eye Institute, National Institutes of Health , Bethesda, MD , USA
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Sex and reproduction in the transmission of infectious uveitis. J Ophthalmol 2014; 2014:683246. [PMID: 25105020 PMCID: PMC4106153 DOI: 10.1155/2014/683246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/16/2014] [Indexed: 12/17/2022] Open
Abstract
Current data permit only speculations regarding sex differences in the prevalence of infectious uveitis between women and men because uveitis case surveys do not uniformly report gender data. Differences in prevalence that are reported in the literature could relate to simple differences in the number of women and men at risk for infection or to biological differences between men and women. Compared to other types of uveitis, infectious uveitis may be directly related to occupational exposures or sexual behaviors, which differ between women and men, and may mask actual biological differences in susceptibility to ocular manifestations of the infection and its prognosis. In infectious uveitis for which there is no element of sexual transmission and data is available, prevalence of ocular disease is roughly equal between women and men. Women also have a unique relationship with infectious uveitis in their role as mothers. Vertical transmission of infections such as herpes simplex, toxoplasmosis, and cytomegalovirus can produce severe chorioretinitis in neonates.
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Presumed Herpetic Anterior Uveitis: A Study with Retrospective Analysis of 79 Cases. Eur J Ophthalmol 2013; 24:14-20. [DOI: 10.5301/ejo.5000331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/20/2022]
Abstract
Purpose To describe the clinical features, visual outcome, medical treatment, and complications of presumed herpetic anterior uveitis. Methods We retrospectively analyzed the clinical data related to 79 eyes of 77 patients with presumed herpetic anterior uveitis seen at the Uveitis Unit of the Ulucanlar Eye Training and Research Hospital from 1996 to 2011. Age at onset of disease, sex, follow-up duration, existence of corneal involvement, posterior synechiae, distorted pupil, iris atrophy, characteristic of keratic precipitates, elevated intraocular pressure (IOP), medical treatment, recurrence rate, complications, visual acuities (VA), and surgery for complications were recorded. The complication rates in patients with and without corneal involvement were compared. Results There were 38 (49.4%) female and 39 (50.6%) male patients. The mean age at presentation was 48.5 ± 14.8 (20–82) years. The follow-up period was 26.5 (2–127) months. Two patients had bilateral involvement. Ocular findings were a corneal scar or active keratitis in 37 (46.8%) eyes, secondary glaucoma in 14 (17.7%), iris atrophy in 39 (49.4%), distorted pupil in 16 (20.3%), posterior synechiae in 23 (29.1%), and granulomatous anterior uveitis in 30 (40%) eyes. Eight (10.1%) eyes had a posterior subcapsular cataract. Glaucoma surgery was required for uncontrolled IOP with maximum medical treatment in 2 (2.4%) eyes. Long-term oral acyclovir was used in 9 (11.3%) patients. Final VA was ≤ 0.1 in 8 (10.1%) eyes; of these, 6 had either corneal scarring or cataract and 2 preexisting amblyopia. Conclusions Presumed herpetic anterior uveitis with or without keratitis has characteristic clinical findings that enable the diagnosis. Long-term prophylactic antiviral therapy should be considered especially in patients <50 years old.
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Abstract
The diagnosis of Behçet disease is clinical and based on the presence of characteristic ocular and systemic inflammatory manifestations. Patients may present with anterior, posterior, or panuveitis in one or both eyes. The differential diagnosis includes a variety of infectious and noninfectious causes of acute nongranulomatous anterior uveitis, intermediate uveitis, occlusive retinal vasculitis, focal or multifocal retinitis, and necrotizing retinitis. A course characterized by sudden onset with improvement followed by recurrence of inflammatory signs is most typical for Behçet uveitis.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
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40
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Abstract
Ocular herpes simplex virus 1 (HSV-1) infection can lead to multiple complications, including iritis, an inflammation of the iris. Here, we use human iris stroma cells as a novel in vitro model to demonstrate HSV-1 entry and the inflammatory mediators that can damage the iris. The upregulated cytokines observed in this study provide a new understanding of the intrinsic immune mechanisms that can contribute to the onset of iritis.
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Han JB, Kim TG, Jin KH. Three Cases of Pupil Abnormality in Herpes Zoster Ophthalmicus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.9.1452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Bin Han
- Department of Ophthalmology, KyungHee University Medical Center, KyungHee University School of Medicine, Seoul, Korea
| | - Tae Gi Kim
- Department of Ophthalmology, KyungHee University Medical Center, KyungHee University School of Medicine, Seoul, Korea
| | - Kyung Hyun Jin
- Department of Ophthalmology, KyungHee University Medical Center, KyungHee University School of Medicine, Seoul, Korea
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42
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Jap A, Chee SP. Diagnostic issues in viral anterior uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2012. [DOI: 10.1586/eop.11.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW With improvements in molecular diagnostics tests, viruses are increasingly being found to be associated with what was previously described as idiopathic anterior uveitis. This review presents the clinical features of viral anterior uveitis. RECENT FINDINGS Herpes simplex virus/varicella zoster virus (HSV/VZV) are important causes of anterior uveitis, but other viruses including cytomegalovirus (CMV) and rubella are also found in a significant number of cases. The various viral anterior uveitides have similar features and should be suspected in eyes with diffuse, fine, stellate keratic precipitates, iris atrophy or ocular hypertension. Acyclovir remains the mainstay of therapy in HSV/VZV infections. CMV responds to ganciclovir, but the relapse rate is high and prolonged therapy may be required. Cataract and glaucoma are the main complications of viral anterior uveitis requiring appropriate management. SUMMARY There is considerable overlap between clinical manifestations of the different viral anterior uveitides as well noninfectious hypertensive anterior uveitis syndromes. Hence, corticosteroids should be used with caution in these eyes if virus diagnostic tests are not available.
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Chee SP, Jap A. Immune ring formation associated with cytomegalovirus endotheliitis. Am J Ophthalmol 2011; 152:449-453.e1. [PMID: 21676373 DOI: 10.1016/j.ajo.2011.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe immune ring (IR) formation as a manifestation of cytomegalovirus (CMV) endotheliitis. DESIGN Retrospective observational case series. METHODS Review of all consecutive CMV anterior uveitis and endotheliitis patients seen at the Singapore National Eye Centre for the occurrence of an IR. CMV infection was diagnosed by polymerase chain reaction analysis of the aqueous. RESULTS None of the 72 eyes with CMV anterior uveitis had an IR formation. Four episodes of IR formation were seen in 3 eyes (14.3%) of 21 cases of CMV-positive endotheliitis. All were unilateral and all 3 patients were human immunodeficiency virus negative middle-aged Chinese males. The IR developed 2 to 7 months after occurrence of the endotheliitis and the aqueous was positive for CMV during 2 of the episodes of IR formation. In 2 eyes, the IR occurred at the completion of a course of systemic ganciclovir when the aqueous was negative for CMV. The immune rings resolved with combination therapy of topical prednisolone acetate 0.12% and ganciclovir. Patient 1 had a recurrence of the IR 4 months after stopping treatment but again resolved following treatment with ganciclovir and topical corticosteroids. CONCLUSION Corneal immune rings can occur as a result of CMV infection. Hence CMV infection may have to be considered in such cases.
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MESH Headings
- Administration, Topical
- Adult
- Antiviral Agents/administration & dosage
- Antiviral Agents/therapeutic use
- Aqueous Humor/virology
- Cytomegalovirus/genetics
- Cytomegalovirus/isolation & purification
- Cytomegalovirus Infections/diagnosis
- Cytomegalovirus Infections/drug therapy
- Cytomegalovirus Infections/immunology
- DNA, Viral/analysis
- Drug Therapy, Combination
- Endothelium, Corneal/immunology
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/drug therapy
- Eye Infections, Viral/immunology
- Female
- Ganciclovir/administration & dosage
- Ganciclovir/therapeutic use
- Glucocorticoids/administration & dosage
- Glucocorticoids/therapeutic use
- HIV Seronegativity
- Humans
- Male
- Middle Aged
- Polymerase Chain Reaction
- Precipitins/immunology
- Prednisolone/administration & dosage
- Prednisolone/analogs & derivatives
- Prednisolone/therapeutic use
- Retrospective Studies
- Treatment Outcome
- Uveitis, Anterior/diagnosis
- Uveitis, Anterior/drug therapy
- Uveitis, Anterior/immunology
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Singapore; National University Health System, Singapore; Singapore Eye Research Institute, Singapore.
| | - Aliza Jap
- Singapore National Eye Centre, Singapore; Division of Ophthalmology, Changi General Hospital, Singapore
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Wensing B, Relvas LM, Caspers LE, Valentincic NV, Stunf S, de Groot-Mijnes JDF, Rothova A. Comparison of rubella virus- and herpes virus-associated anterior uveitis: clinical manifestations and visual prognosis. Ophthalmology 2011; 118:1905-10. [PMID: 21764137 DOI: 10.1016/j.ophtha.2011.03.033] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 03/23/2011] [Accepted: 03/24/2011] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To compare the clinical characteristics and visual prognosis of patients with anterior uveitis (AU) and intraocular fluid analysis positive for rubella virus (RV), herpes simplex virus (HSV), or varicella zoster virus (VZV). DESIGN Retrospective, observational study. PARTICIPANTS The study included 106 patients with AU and positive polymerase chain reaction (PCR) results, Goldmann-Witmer coefficients (GWCs), or both, for RV (n = 57), HSV (n = 39), or VZV (n = 10). METHODS Clinical records of the included patients were analyzed retrospectively; demographic constitution, ophthalmologic characteristics, and visual prognosis were compared. MAIN OUTCOME MEASURES Age, gender, and diverse clinical and laboratory characteristics, including course and laterality of AU; prevalence of positive results for PCR, GWC, or both; conjunctival redness; corneal edema; history of keratitis; presence of keratic precipitates; synechiae; heterochromia; and grade of inflammation. In addition, complications and visual acuity at 1 and 3 years of follow-up were recorded. RESULTS All 3 types of viral AU were characterized by unilateral involvement (80%-97%). Rubella virus AU was characterized by younger age at onset and chronic course and typically was associated with cataract at presentation. Heterochromia was present in 23% of RV AU patients. Anterior uveitis associated with HSV or VZV occurred characteristically in older patients and frequently followed an acute course. Clinical features associated with herpetic AU included conjunctival redness, corneal edema, history of keratitis, and development of posterior synechiae. Herpes simplex virus AU often had severe anterior chamber inflammation, whereas the presence of vitritis was more common in RV AU and VZV AU. The prevalence of documented intraocular pressure (IOP) of more than 30 mmHg (25%-50%; P = 0.06) and development of glaucoma (18%-30%; P = 0.686) were similar in all 3 groups. Focal chorioretinal scars were seen in 22% of RV AU eyes, in 0% of HSV AU eyes, and in 11% of VZV AU eyes (P = 0.003). Visual prognosis was favorable for all 3 groups. CONCLUSIONS These observations identify clinical differences between RV AU, HSV AU, and VZV AU and may be of particular value to ophthalmologists who are unable to carry out intraocular fluid analysis to discriminate between these types of viral AU. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Barbara Wensing
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
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