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Chaturvedi A, Parakh S, Das S, Bhatt V, Luthra G, Luthra S. Multimodal Imaging in a Case of Chronic Sympathetic Ophthalmia. Cureus 2023; 15:e42645. [PMID: 37644926 PMCID: PMC10462382 DOI: 10.7759/cureus.42645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
We report a case of chronic sympathetic ophthalmia (SO) in a one-eyed patient who was successfully managed with systemic immunosuppression therapy. A 77-year-old one-eyed female presented with progressive diminution of vision in the left eye (OS) for one month. She had previously undergone a right eye (OD) pars plana vitrectomy elsewhere for exogenous post-operative endophthalmitis (after manual small incision cataract surgery five months ago), following which she developed phthisis. Granulomatous panuveitis and advanced cataract were noted in the OS. Findings on multimodal imaging, including spectral domain optical coherence tomography (SD-OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and B-scan ultrasonography, were consistent with those of chronic SO. Promptly, oral steroids and systemic immunosuppressants were initiated under the supervision of a rheumatologist. At the three-week follow-up, complete resolution of clinical signs was observed on multimodal imaging. Chronic SO may present with ambiguous clinical signs, leading to a diagnostic dilemma. This may cause a delay in initiating treatment, which can prove to be highly detrimental, especially in one-eyed patients. Multimodal imaging is critical in excluding differential diagnoses and proves to be indispensable in the timely management of this sight-threatening condition.
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2
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Agrawal R, Weng RC, Fonollosa A, Giralt L, Artaraz J, Yang P, Huang F, Tan B, Schmetterer L, Sen A, Gupta V, Xin W. Outcome Measures for Disease Monitoring in Intraocular Inflammatory and Infectious Diseases (OCTOMERIA): Understanding the Choroid in Uveitis with Optical Coherence Tomography (OCT). Ocul Immunol Inflamm 2023; 31:374-392. [PMID: 35201909 DOI: 10.1080/09273948.2022.2026414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare imaging modalities for the choroid of the eye, and evaluate various choroidal changes in uveitides entities. METHODS A comprehensive systematic literature review was conducted looking at current imaging modalities available to assess choroid architecture and commonly used parameters available to qualify and quantify choroidal changes, before looking at specific uveitides entities with choroidal involvement which have been broadly separated into non-infectious and infectious in etiology. RESULTS We describe the various modalities currently available to evaluate the choroid of the eye such as Ultrasound B Scan, ICGA, and OCT. Choroidal changes in various ocular and systemic diseases such as Behcet's Disease, Sarcoidosis, Syphillis, Tuberculosis, and many more have been reported and published. CONCLUSION Multiple choroidal tomographic and angiotomographic findings have been demonstrated for evaluation in uveitis. These findings can manifest in multiple ocular and systemic diseases, and can be illustrated using the various imaging modalities at present. Future advancements in choroidal imaging would help to adapt these findings into parameters for clinical practice to properly evaluate these ocular and systemic diseases.
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Affiliation(s)
- 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.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke NUS Medical School, Singapore, Singapore
| | - Rei Chern Weng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain.,Retina Department, Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - Lena Giralt
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Fanfan Huang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ocular Imaging Department, Singapore Eye Research Institute, Institute of Molecular and Clinical Ophthalmology Basel Switzerland
| | - Alok Sen
- Department of Vitreo-Retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, India.,The Bodhya Eye Consortium, India
| | - Vishali Gupta
- Department of Vitreoretina, Post Graduate Institute of Medical Education and Research, Chitrakoot, India
| | - Wei Xin
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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Parchand S, Agrawal D, Ayyadurai N, Agarwal A, Gangwe A, Behera S, Bhatia P, Mulkutkar S, Barwar G, Singh R, Sen A, Agarwal M. Sympathetic ophthalmia: A comprehensive update. Indian J Ophthalmol 2022; 70:1931-1944. [PMID: 35647958 PMCID: PMC9359263 DOI: 10.4103/ijo.ijo_2363_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within the first year of trauma occurrence but can be delayed by several years. It manifests as acute/chronic granulomatous uveitis with yellowish-white choroidal lesions or Dalen-Fuchs nodules. Initially, patients respond rapidly to corticosteroid therapy, but a majority require long-term use of corticosteroid-sparing agents to prevent recurrences. The purpose of this review is to elaborate on the current understanding of the pathophysiology, the importance of multimodal imaging in early diagnosis, and the role of newer immunomodulatory and biological agents in recalcitrant cases.
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Affiliation(s)
- Swapnil Parchand
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Deepshikha Agrawal
- Department of Cornea and Anterior segment Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Nikitha Ayyadurai
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Aniruddha Agarwal
- The Eye Institute, Cleveland Clinic, Abu Dhabi (CCAD), Abu Dhabi, United Arab Emirates (UAE)
| | - Anil Gangwe
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Shashwat Behera
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Priyavat Bhatia
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Samyak Mulkutkar
- Department of Ophthalmology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Gulshan Barwar
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Alok Sen
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Uvea Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
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4
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Zhuang H, Zhang R, Zhang T, Chang Q, Xu G. Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia. Orphanet J Rare Dis 2022; 17:103. [PMID: 35246199 PMCID: PMC8895912 DOI: 10.1186/s13023-022-02258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background To investigate the clinical manifestations, visual outcomes and optical coherence tomographic (OCT) features of patients with posterior sympathetic ophthalmia (PSO). Methods We performed a retrospective review of 48 patients diagnosed with PSO between January 2013 and December 2019. We compared the clinical and OCT features among different clinical types of PSO. Results PSO could be classified into two types according to whether the fundus exhibited serous retinal detachment (SRD) or multifocal choroiditis (MFC). There were 41 patients (85.4%) with SRD and 7 patients (14.6%) with MFC. The latent period of patients with MFC was significantly longer than that of patients with SRD (P = 0.002). The final visual acuity of patients with MFC was significantly worse than that of patients with SRD (P = 0.0001). In patients with acute SRD, OCT revealed that the mean height of retinal detachment in the fovea was 528.8 ± 437.5 μm. After treatment, the retina reattached in all patients and the band structures of the outer retina were restored in most patients (92.7%). In patients with acute MFC, the OCT images revealed inflammatory lesions on the retinal pigment epithelium layer. After treatment, the OCT images showed hyperreflective fibrosis of the lesions and loss of the outer retinal band structures in all patients. Conclusions We found that PSO could be classified according to the presence of SRD or MFC. The visual prognosis differed significantly between these types of PSO. OCT imaging is useful for clinical classification and monitoring of retinal changes after treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02258-0.
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Affiliation(s)
- Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Rui Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China.
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Assessing Choroidal Nevi, Melanomas and Indeterminate Melanocytic Lesions Using Multimodal Imaging—A Retrospective Chart Review. Curr Oncol 2022; 29:1018-1028. [PMID: 35200586 PMCID: PMC8870916 DOI: 10.3390/curroncol29020087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 12/13/2022] Open
Abstract
Using multimodal imaging, the literature proposed the following risk factors for choroidal nevus growth into melanoma: increased tumor thickness, subretinal fluid, decreased visual acuity, presence of orange pigment, ultrasound acoustic hollowness, and increased tumor diameter. This study investigated the presence of the mentioned risk factors in choroidal nevi, choroidal melanomas, and indeterminate choroidal melanocytic lesions. This retrospective, single-center chart review assessed choroidal melanocytic tumors with multimodal imaging. We defined our primary outcome as the cumulative presence of mentioned risk factors. Further, we evaluated various optical coherence tomography (OCT), ultrasound, and autofluorescence findings. We analyzed 51 tumors from 49 patients during the period from April 2008 to June 2021. The median (IQR) age was 64.0 (56.0 to 70.5) years, with 23 of 49 (46.9%) patients being female. The follow-up time for all tumors was median (IQR) 25.0 (12.0 to 39.0) months. The choroidal nevi had a median (range) risk score of 0.0 (0.0 to 3.0), and the choroidal melanoma of 5.0 (3.0 to 6.0), with statistically significant different ratings (p < 0.001). Multimodal imaging creates a score that may help to distinguish choroidal nevi from choroidal melanomas objectively.
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6
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Rogaczewska M, Iwanik K, Stopa M. Early presentation of sympathetic ophthalmia in optical coherence tomography studies: A case report. Indian J Ophthalmol 2020; 68:2019-2022. [PMID: 32823465 PMCID: PMC7690536 DOI: 10.4103/ijo.ijo_2184_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sympathetic ophthalmia (SO) is often diagnosed when an inflammatory process appears to be advanced. Herein, the authors present the prospective optical coherence tomography (OCT) study of the onset of SO in the sympathizing eye. Prior to any signs of uveitis, we noted the mild disintegration of the retinal pigment epithelium (RPE) layer, the interdigitation zone (IZ), and the ellipsoid zone (EZ). The complete disruption of IZ and EZ was seen 12 weeks later. After 14 weeks, the uveal inflammation was present, and OCT imaging disclosed the formation of nodule-like lesions between the Bruch's membrane and the RPE layer. The histopathological evaluation of the enucleated exciting eye confirmed the diagnosis of SO.
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Affiliation(s)
- Małgorzata Rogaczewska
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Iwanik
- Department of Clinical Pathomorphology, Poznan University of Medical Sciences, ul. Poznan, Poland
| | - Marcin Stopa
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
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7
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Dutta Majumder P. Commentary: Optical coherence tomography in sympathetic ophthalmia. Indian J Ophthalmol 2020; 68:2023-2024. [PMID: 32823466 PMCID: PMC7690494 DOI: 10.4103/ijo.ijo_886_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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8
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Agrawal R, Jain M, Khan R, Jaisankar D, Xin W, Ding J, Testi I, Raman R, Biswas J. Choroidal Structural Changes in Sympathetic Ophthalmia on Swept-Source Optical Coherence Tomography. Ocul Immunol Inflamm 2019; 29:537-542. [PMID: 31743045 DOI: 10.1080/09273948.2019.1685110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: To analyze choroidal angioarchitecture in sympathetic ophthalmia (SO) using swept-source optical coherence tomography (SS-OCT) images.Methods: Case-control study of six patients with SO. Qualitative changes and quantitative parameters, including choroidal thickness (CT) and choroidal vascularity index (CVI), were analyzed.Results: Qualitative findings in the acute phase of SO on SS-OCT included retinal serous detachment with hyperreflective septa, choroidal folds, alterations in angioarchitecture with loss of vascular lacunae, and Dalen-Fuchs nodules. There was significantly higher CT in SO (284.05 ± 24.12 µm) compared to healthy controls (229.57 ± 46.67 µm, p = 0.04) and also increased CVI in SO (62.06 ± 2.07% vs 56.79 ± 3.15%, p = 0.006).Conclusions: CVI was significantly increased in SO, representing a novel noninvasive biomarker of disease activity. SS-OCT provides a useful qualitative and quantitative parameter, which can be potentially explored in the diagnosis and monitoring of patients with SO.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Medical Retina and Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Mukesh Jain
- Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Rehana Khan
- Medical Research Foundation, Sankara Netralaya, Chennai, India
| | | | - Wei Xin
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jianbin Ding
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ilaria Testi
- Department of Medical Retina and Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rajiv Raman
- Medical Research Foundation, Sankara Netralaya, Chennai, India
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Brar M, Sharma M, Grewal S, Grewal DS. Treatment Response in Sympathetic Ophthalmia as Assessed by Widefield OCT Angiography. Ophthalmic Surg Lasers Imaging Retina 2018; 49:726-730. [DOI: 10.3928/23258160-20180831-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/03/2018] [Indexed: 01/09/2023]
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10
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Dogra M, Samanta R, Singh P, Singh SR, Bajgai P, Sharma A, Bansal R, Gupta V, Dogra MR, Singh R. Surgical Intervention in Inciting Eyes of Patients with Sympathetic Ophthalmia: A Case Series and Review of Literature. Ocul Immunol Inflamm 2018; 27:1154-1159. [PMID: 30081702 DOI: 10.1080/09273948.2018.1497663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To analyze the outcomes of surgical procedures on inciting eye of patients with Sympathetic ophthalmia (SO). Methods: Retrospective study of patients with SO who underwent surgical procedures on inciting eyes between January 2000 and December 2015. Outcome measures included flare up of inflammation in either eye and change in visual acuity in the inciting eye. Results: Four SO patients underwent surgeries in their inciting eyes after adequate control of inflammation. Surgical procedures included penetrating keratoplasty, glaucoma drainage device implantation, pars plana vitrectomy, and silicon oil removal. Keratoplasty, glaucoma surgery, and silicon oil removal were well tolerated, with no flare up of disease. The patient who underwent pars plana vitrectomy, however, had a poor outcome. Conclusions: Surgical intervention in inciting eyes of patients with SO, after being adequately treated with oral steroids and immunosuppression, is a viable option for improving anatomic and functional outcomes in these eyes.
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Affiliation(s)
- Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramanuj Samanta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Pallavi Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Simar Rajan Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Priya Bajgai
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Aman Sharma
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Mangat R Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
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11
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Exudative retinal detachment. Surv Ophthalmol 2017; 62:723-769. [DOI: 10.1016/j.survophthal.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
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Abstract
In this study, we report a case of bilateral exudative retinal detachment due to sympathetic ophthalmia after successful limbal corneal laceration repair. Steroids remain mainstay management in controlling this disorder; however, there is no role of prophylactic steroid to prevent it. On the contrary, steroid use may alter the course of the disease. Background/Purpose: To report a case of atypical sympathetic ophthalmia after limbal corneal laceration. Methods and Results: An 11-year-old child had a successful left eye corneal laceration repair at the temporal limbus with excision of exposed nonnecrotic iris tissue, resulting in good visual acuity of 20/80 and 20/25 on postoperative Days 1 and 7, respectively. The patient was prescribed 1 mg/kg oral prednisolone in a tapering dose as prophylaxis. On postoperative Day 21, the patient presented with acute onset decreased vision in both eyes. Visual acuity was counting fingers 3 feet in both eyes. On examination, anterior segment examination was quiet without any inflammation, anterior vitreous face showed 1+ cells, and dilated funduscopy revealed bilateral symmetrical serous retinal detachments along the posterior pole. Optical coherence tomography demonstrated separation and elevation of inner neurosensory layers from the outer segment marking presence of hyperreflective material along with subretinal fluid between detached surfaces. There was stippled hyperfluorescence along the posterior pole as seen in fluorescein angiography. With a diagnosis of sympathetic ophthalmia confirmed, oral prednisolone (2 mg/kg body weight) was instituted after which, there was gradual decrease in macular elevation with corresponding improvement in visual acuity with no recurrence for the last 6 months. Conclusion: To our knowledge, this is the first reported instance of an atypical presentation of sympathetic ophthalmia, and antecedent corticosteroid therapy would have mitigated robust anterior segment findings usually associated with the condition.
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Raven ML, Ringeisen AL, Yonekawa Y, Stem MS, Faia LJ, Gottlieb JL. Multi-modal imaging and anatomic classification of the white dot syndromes. Int J Retina Vitreous 2017; 3:12. [PMID: 28331634 PMCID: PMC5357819 DOI: 10.1186/s40942-017-0069-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 02/27/2017] [Indexed: 12/18/2022] Open
Abstract
The white dot syndromes (WDS) are a diverse group of posterior uveitidies that share similar clinical findings but are unique from one another. Multimodal imaging has allowed us to better understand the morphology, the activity and age of lesions, and whether there is CNV associated with these different ocular pathologies. The “white dot syndromes” and their uveitic masqueraders can now be anatomically categorized based on lesion localization. The categories include local uveitic syndromes with choroidal pathology, systemic uveitic syndromes with choroidal pathology, and multifocal choroiditis with outer retinal/choriocapillaris pathology with uveitis and without uveitis. Neoplastic and infectious etiologies are also discussed given their ability to masquerade as WDS.
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Affiliation(s)
- Meisha L Raven
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA.,McPherson Eye Research Institute, Madison, WI USA
| | - Alexander L Ringeisen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA
| | - Yoshihiro Yonekawa
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Maxwell S Stem
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Lisa J Faia
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Justin L Gottlieb
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA.,Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2870 University Ave, Room 206, Madison, WI 53705 USA
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14
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Mahajan S, Invernizzi A, Agrawal R, Biswas J, Rao NA, Gupta V. Multimodal Imaging in Sympathetic Ophthalmia. Ocul Immunol Inflamm 2016; 25:152-159. [PMID: 27960610 DOI: 10.1080/09273948.2016.1255339] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To show the current status of multimodal imaging and its role in supporting an early diagnosis of sympathetic ophthalmia. METHODS The diagnosis is mainly clinical supported with ancillary investigations; mainly fluorescein angiography and others, including indocyanine angiography optical coherence tomography (OCT), OCT enhanced depth imaging, autofluorescence imaging, and ultrasonography. RESULTS Various imaging modalities such as OCT, autofluorescence imaging and angiography are critical in the diagnosis and management of sympathetic ophthalmia. The clinician must make adequate use of such ancillary investigations in the management of the patients. CONCLUSIONS Sympathetic ophthalmia is a rare, bilateral inflammation of the uveal tract following penetrating trauma or surgery in one eye. The intraocular inflammation requires a prompt diagnosis so that the treatment can be initiated as early as possible.
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Affiliation(s)
- Sarakshi Mahajan
- a Advanced Eye Centre , Post Graduate Institute of Medical Education & Research , Chandigarh , India
| | - Alessandro Invernizzi
- b Uveitis and Ocular Infectious Diseases Service - Eye Clinic, Department of Biomedical and Clinical Science , "Luigi Sacco" Liuigi Sacco Hospital, University of Milan , Milan , Italy.,c Department of Clinical Sciences and Community Health , University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico , Milan , Italy
| | - Rupesh Agrawal
- d National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
| | - Jyotirmay Biswas
- e Uveitis and Ocular Pathology Department , Sankara Nethralya , Chennai , India
| | - Narsing A Rao
- f USC Roski Eye Institute, Keck School of Medicine, University of Southern California , Los Angeles , California , USA
| | - Vishali Gupta
- a Advanced Eye Centre , Post Graduate Institute of Medical Education & Research , Chandigarh , India
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15
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de Andrade FA, Fiorot SHS, Benchimol EI, Provenzano J, Martins VJ, Levy RA. The autoimmune diseases of the eyes. Autoimmun Rev 2016; 15:258-71. [DOI: 10.1016/j.autrev.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/27/2015] [Indexed: 02/06/2023]
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16
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Enhanced depth imaging OCT (EDI-OCT) findings in acute phase of sympathetic ophthalmia. Int Ophthalmol 2015; 35:433-9. [PMID: 25772275 DOI: 10.1007/s10792-015-0058-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to describe the EDI-OCT findings in an acute phase of sympathetic ophthalmia (SO). A 24-year-old gentleman was referred to clinic complaining of progressive blurry vision of his right eye within last 3 days. He had a history of repaired corneoscleral laceration in his left eye followed by lensectomy and anterior vitrectomy approximately 1 month before his recent right eye discomfort. Physical examination revealed a granulomatous uveitis with an exudative RD of the right eye consistent with SO. EDI-OCT was done at initial exam and repeated 1 and 15 months after therapy. EDI-OCT 1 month following therapy showed significant improvement in choroidal thickening and outer retinal cell layers. The choroidal thickness in the right sympathizing eye decreased from 617 to 568 μm and in the left exciting eye from 539 to 521 μm. After 15 month follow-up, choroidal thickness that is reported in EDI-OCT is 436 μm in the right and 382 μm in the left eye. SO should be added to the list of choroidopathies that cause an increase in choroidal thickness in acute phase of disorder with subsequent decrease after therapy, so help us in assessing and estimation of response to treatment.
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Shaggy photoreceptors with subfoveal fluid associated with a distant choroidal melanoma. Case Rep Ophthalmol Med 2015; 2015:187542. [PMID: 25713741 PMCID: PMC4332978 DOI: 10.1155/2015/187542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/22/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To describe the enhanced depth imaging optical coherence tomography (EDI-OCT) findings in a patient with an extra macula choroidal melanoma before and after treatment. Methods. Observational case report. Results. A 45 year-old Caucasian male patient was referred to retina clinic for management of choroidal melanoma. Examination revealed a nasal choroidal melanoma while EDI-OCT illustrated subfoveal fluid pocket with elongated shaggy photoreceptors distant and separate from the tumor. The patient was treated with plaque brachytherapy and intravitreal bevacizumab. One week after plaque removal, there was a dramatic reduction in the shaggy photoreceptors.
Conclusion. Choroidal melanomas have effects that are not localized to the area of the tumor. This loculated pocket of subretinal fluid and coinciding changes to photoreceptor morphology may be related to global changes in choroidal function or release of tumor related cytokines.
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Saxena S, Srivastav K, Cheung CM, Ng JY, Lai TY. Photoreceptor inner segment ellipsoid band integrity on spectral domain optical coherence tomography. Clin Ophthalmol 2014; 8:2507-22. [PMID: 25525329 PMCID: PMC4266419 DOI: 10.2147/opth.s72132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Spectral domain optical coherence tomography cross-sectional imaging of the macula has conventionally been resolved into four bands. However, some doubts were raised regarding authentication of the existence of these bands. Recently, a number of studies have suggested that the second band appeared to originate from the inner segment ellipsoids of the foveal cone photoreceptors, and therefore the previously called inner segment-outer segment junction is now referred to as inner segment ellipsoidband. Photoreceptor dysfunction may be a significant predictor of visual acuity in a spectrum of surgical and medical retinal diseases. This review aims to provide an overview and summarizes the role of the photoreceptor inner segment ellipsoid band in the management and prognostication of various vitreoretinal diseases.
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Affiliation(s)
- Sandeep Saxena
- Retina Service, Department of Ophthalmology, King George's Medical University Lucknow, India
| | - Khushboo Srivastav
- Retina Service, Department of Ophthalmology, King George's Medical University Lucknow, India
| | | | - Joanne Yw Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
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Mahendradas P, Madhu S, Kawali A, Govindaraj I, Gowda PB, Vinekar A, Shetty N, Shetty R, Shetty BK. Combined depth imaging of choroid in uveitis. J Ophthalmic Inflamm Infect 2014; 4:18. [PMID: 26530343 PMCID: PMC4883994 DOI: 10.1186/s12348-014-0018-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/16/2014] [Indexed: 12/03/2022] Open
Abstract
Background Understanding the changes that occur in the choroid is of paramount importance in various uveitis entities. B-scan ultrasonography and indocyanine green angiography can be used to study choroid. Currently, spectral-domain optical coherence tomography is used as the standard noninvasive technique to study the choroid by enhanced depth imaging. Our aim was to study the structural visibility of the choroid using spectral-domain optical coherence tomography in the same area of interest in patients with uveitis with posterior segment manifestations using conventional, enhanced depth imaging (EDI), and combined depth imaging (CDI) techniques. Results Fifty-eight (58) eyes of 48 patients between age group 9 and 82 years were confirmed cases of uveitis. Out of the 48 patients, 21 (43.75%) were males while 27 (56.25%) were females. Sixteen eyes (27.59%) had intermediate uveitis, 33 (56.9%) had posterior uveitis, and 9 eyes (15.51%) had panuveitis. For posterior vitreous, there was substantial agreement for all the three groups (kappa value of 0.77, 0.73, and 0.72 in groups 1, 2, and 3, respectively). For vitreo retinal interface and inner choroid, there was perfect interobserver agreement, and for outer choroid, there was substantial to almost perfect interobserver agreement (kappa value of 0.71, 0.81, and 0.86 in groups 1, 2, and 3, respectively). Chi-squared test was done to compare the three groups. The method of scanning had a significant effect on the visualization of posterior vitreous and the outer choroid (p < 0.01) and did not have an effect on the visualization of vitreoretinal interface, inner retina, outer retina, and inner choroidal layers (p > 0.05). Conclusion The CDI technique alone might provide a good structural visibility compared to normal and EDI scanning done separately in patients with uveitis with posterior segment pathology. CDI OCT technique is thus able to visualize all posterior structures in a single image in patients with uveitis with posterior segment manifestations. Electronic supplementary material The online version of this article (doi:10.1186/s12348-014-0018-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Sumukh Madhu
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Indu Govindaraj
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Poornachandra B Gowda
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Anand Vinekar
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Naren Shetty
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Rohit Shetty
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
| | - Bhujang K Shetty
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, Bangalore, 560010, India.
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Teke MY, Elgin U, Nalcacioglu-Yuksekkaya P, Sen E, Ozdal P, Ozturk F. Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy. Int J Ophthalmol 2014; 7:350-4. [PMID: 24790884 DOI: 10.3980/j.issn.2222-3959.2014.02.29] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 08/27/2013] [Indexed: 01/05/2023] Open
Abstract
AIM To discuss and compare the fundus autofluorescence (FAF) and optical coherence tomography (OCT) in acute or chronic central serous chorioretinopathy (CSCR). METHODS Medical records of 100 cases of CSCR were reviewed. Acute and chronic cases were evaluated according to the duration of decreased visual acuity, serous retinal detachment (RD) and focal leakage on fluorescein angiography (FA). Chi-square test was used for statistical analysis. RESULTS Forty cases had acute and 60 cases had chronic CSCR. FAF showed focal hypo-autofluorescence in 34 (85%) and iso-autofluorescence in 6 (15%) of acute cases and hypo-autofluorescence in 51 (85%), hyper-autofluorescence in 6 (10%) and iso-autofluorescence in 3 (5%) of chronic cases. OCT showed serous RD with distinct borders correlated with FAF findings (hypo-autofluorescence) in all acute CSCR cases. In chronic CSCR group, OCT showed serous RD with indistinct borders correlated with FAF findings. The differences between the OCT and FAF findings of the two groups were significant (P=0.000). CONCLUSION OCT and FAF findings can support the clinical observations in differential diagnosis of acute and chronic CSCR and help clinicians to evaluate retinal pigment epithelium, outer segments of photoreceptors and the components of serous RD.
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Affiliation(s)
| | - Ufuk Elgin
- Ulucanlar Eye Research Hospital, Ankara 06240, Turkey
| | | | - Emine Sen
- Ulucanlar Eye Research Hospital, Ankara 06240, Turkey
| | - Pinar Ozdal
- Ulucanlar Eye Research Hospital, Ankara 06240, Turkey
| | - Faruk Ozturk
- Ulucanlar Eye Research Hospital, Ankara 06240, Turkey
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Gupta V, Al-Dhibi HA, Arevalo JF. Retinal imaging in uveitis. Saudi J Ophthalmol 2014; 28:95-103. [PMID: 24843301 DOI: 10.1016/j.sjopt.2014.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/24/2014] [Indexed: 11/25/2022] Open
Abstract
Ancillary investigations are the backbone of uveitis workup for posterior segment inflammations. They help in establishing the differential diagnosis and making certain diagnosis by ruling out certain pathologies and are a useful aid in monitoring response to therapy during follow-up. These investigations include fundus photography including ultra wide field angiography, fundus autofluorescence imaging, fluorescein angiography, optical coherence tomography and multimodal imaging. This review aims to be an overview describing the role of these retinal investigations for posterior uveitis.
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Affiliation(s)
- Vishali Gupta
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hassan A Al-Dhibi
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - J Fernando Arevalo
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia ; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kumar K, Mathai A, Murthy SI, Jalali S, Sangwan V, Reddy Pappuru R, Pathangay A. Sympathetic ophthalmia in pediatric age group: clinical features and challenges in management in a tertiary center in southern India. Ocul Immunol Inflamm 2013; 22:367-72. [PMID: 24131076 DOI: 10.3109/09273948.2013.841958] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To study the clinical features and visual outcome of sympathetic ophthalmia in pediatric patients attending a tertiary care center. METHODS Retrospective review of patients ≤16 years with sympathetic ophthalmia seen during the period 2001-2011. RESULTS During this period, 2511 pediatric patients with open globe injuries and 14 patients with sympathetic ophthalmia were seen. Six patients developed sympathetic ophthalmia during follow-up here. The incidence rate of sympathetic ophthalmia is 0.24% (6/2511, 95% CI:0.05-0.43%). The commonest presenting signs were anterior uveitis and exudative detachment. All patients were treated with systemic steroids, while 7 patients received additional immunosuppressive therapy. Eight patients had a follow-up of more than 6 months. Mean presenting best-corrected visual acuity (1.25 ± 1.03 logMAR) in the sympathizing eye improved significant following treatment (0.42 ± 0.80 logMAR, p = 0.003). CONCLUSIONS The incidence of sympathetic ophthalmia was 0.24%. Appropriate immunosuppression can lead to favorable visual outcomes in the sympathizing eye.
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Affiliation(s)
- Kshitiz Kumar
- Srimati. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute , Hyderabad , India
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Onal S, Tugal-Tutkun I, Neri P, P Herbort C. Optical coherence tomography imaging in uveitis. Int Ophthalmol 2013; 34:401-35. [DOI: 10.1007/s10792-013-9822-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/24/2013] [Indexed: 11/28/2022]
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Abstract
Ancillary investigations are the backbone of uveitis work-up both for anterior and posterior segment diseases. They help in making the diagnosis, ruling out certain differential diagnosis and monitoring inflammation during the follow-up. This review aims to be an overview describing the role of commonly used investigations for uveitis.
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Affiliation(s)
- Vishali Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
PURPOSE OF REVIEW The advancement of optical coherence tomography has improved the resolution of in-vivo images of the retina. This has led to a wealth of novel knowledge regarding the microstructures of the photoreceptor layer and its relationship with visual functions under different pathological diseases. RECENT FINDINGS Identification of the hyperreflective lines in the photoreceptor layer has been made possible by spectral domain optical coherence tomography. The inner segment/outer segment junction, external limiting membrane, cone outer segment tips, and the retinal pigment epithelium were thought to be the origins of the four hyperreflective lines seen in the photoreceptor layer. Integrity of these lines has been linked with visual functions in various retinopathies, and has been suggested to carry prognostic implications. Recovery of initially interrupted lines has been documented following successful treatment. SUMMARY Identification of these hyperreflective lines may have clinical implications as visual function was found to correlate closely with their integrity. Restoration of these lines may indicate treatment response and potential visual recovery.
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Mahendradas P, Avadhani K, Madhavarao B, Vinekar A, Sahana K, Shetty R, Shetty BK. High definition spectral domain optical coherence tomography of retinal pigment epithelial rip in a case of sympathetic ophthalmia. J Ophthalmic Inflamm Infect 2013; 3:19. [PMID: 23514588 PMCID: PMC3605124 DOI: 10.1186/1869-5760-3-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 12/02/2022] Open
Abstract
Background We are reporting a case of granulomatous panuveitis in the right eye following penetrating injury to the left eye. Findings A 34-year-old female was diagnosed to have sympathetic ophthalmia on treatment with systemic steroids. Vision did not improve in spite of aggressive systemic steroid therapy. On examination, patient had large retinal pigment epithelial rip nasal to the disc with exudative retinal detachment which was documented with FFA, ICG, and OCT. RPE rip is responsible for the persistent exudative retinal detachment in the right eye. Conclusions RPE rip can cause decreased vision due to persistence of retinal detachment in a case of sympathetic ophthalmia.
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Affiliation(s)
- Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya and Post Graduate Institute of Ophthalmology, 121/C, Chord Road, Rajaji Nagar 1st 'R' Block, 560010, Bangalore, India.
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Fleischman D, Say EAT, Wright JD, Landers MB. Multimodality diagnostic imaging in a case of sympathetic ophthalmia. Ocul Immunol Inflamm 2012; 20:300-2. [PMID: 22594960 DOI: 10.3109/09273948.2012.682637] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Castiblanco C, Adelman RA. Imaging for sympathetic ophthalmia: impact on the diagnosis and management. Int Ophthalmol Clin 2012; 52:173-181. [PMID: 22954939 DOI: 10.1097/iio.0b013e318265d5c7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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