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Marchese A, Filipello F, Cicinelli MV, Sanvito F, Pedica F, Bandello F, Modorati G, Miserocchi E. Acute and Chronic Manifestations of Sympathetic Ophthalmia on Multimodal Imaging. Ocul Immunol Inflamm 2024; 32:1359-1367. [PMID: 37712945 DOI: 10.1080/09273948.2023.2245048] [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: 11/05/2022] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE To report the clinical and multimodal imaging features of sympathetic ophthalmia in the acute and chronic phases. METHODS Retrospective cohort study of consecutive patients with sympathetic ophthalmia seen at a tertiary referral center. Charts, imaging studies, and histopathological specimens were reviewed. The clinical features and multimodal imaging in the sympathizing eye were analyzed by sorting features into those seen in the acute and chronic phase. RESULTS Ten patients were included in the analysis and all of them had previous ocular trauma or complicated retinal detachment. In the acute phase, 70% had anterior uveitis, 70% had vitritis, and 100% had active posterior uveitis; posterior uveitis included multifocal choroiditis (80%), optic disc swelling (40%), multiple serous retinal detachments (20%), MEWDS-like findings (10%), and retinal vasculitis with chorioretinitis (10%). In the chronic phase, posterior manifestations included widespread patches of chorioretinal atrophy in the mid- and far-periphery (80%), peripapillary subretinal fibrosis (50%), and nummular perivascular atrophy (50%). CONCLUSIONS Sympathetic ophthalmia shows different posterior segment manifestations in the acute and chronic phase. Active sympathetic ophthalmia should be ruled out in eyes with a MEWDS-like presentation or rapidly progressing chorioretinitis, and history of trauma in the fellow eye. Peripapillary subretinal fibrosis and perivascular nummular atrophy may be useful features to suspect SO once acute inflammation has resolved.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Filipello
- Department of Pathology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Sanvito
- Department of Pathology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Federica Pedica
- Department of Pathology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Guan W, Zhang Y, Zhang X, Peng X. In Vivo Confocal Microscopy of Keratic Precipitates in Vitreoretinal Lymphoma. Ocul Immunol Inflamm 2024; 32:919-924. [PMID: 36508690 DOI: 10.1080/09273948.2022.2151020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the morphological features of keratic precipitates (KPs) with in vivo confocal microscopy (IVCM) in vitreoretinal lymphoma (VRL). METHODS Patients with biopsy-proven VRL were reviewed, and 12 patients (16 eyes) with KPs examined by IVCM were included. RESULTS Five distinct KP morphologies on IVCM were observed: dendritic, nibbling, linear, globular, and stippled. Dendritic KPs were discovered in 9 eyes (56.3%), with a hyperreflective core and multiple thin pseudopodia. Nibbling KPs were found in 8 eyes (50.0%), featuring irregularly hyperreflective borders and a mottled reflective interior. Linear, stippled, and globular KPs were self-explanatory and affected nearly all eyes. Globular KPs seem to be formed by hyperreflective cells with large nuclei and prominent nucleoli, similar to atypical lymphocytes in vitreous cytology. CONCLUSIONS IVCM could provide more insight into the morphological traits of KPs than clinical observation, highlighting its potential for identifying VRL involving the anterior segment.
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Affiliation(s)
- Wenxue Guan
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xu Zhang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Peng
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Cicinelli MV, Montesano G, Berni A, Scandale P, Ometto G, Introini U, Battaglia Parodi M, Bandello F, Miserocchi E, Marchese A. Photoreceptor Integrity in MEWDS: Longitudinal Structure-Function Correlations. Invest Ophthalmol Vis Sci 2024; 65:28. [PMID: 38630674 PMCID: PMC11033598 DOI: 10.1167/iovs.65.4.28] [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: 01/30/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose The purpose of this study was to investigate structure-function correlations in multiple evanescent white dot syndrome (MEWDS) using microperimetry (MP) and spectral-domain optical coherence tomography (SD-OCT). Methods Single-center prospective observational study including 14 eyes from 13 patients with MEWDS monitored over a median of 49.5 days (interquartile range = 29-92 days). Investigations focused on best-corrected visual acuity (BCVA), foveal granularity, and the Photoreceptor Reflectivity Ratio (PRR) as a measure of photoreceptor integrity. MP assessed average retinal threshold sensitivity (RTS) and bivariate contour ellipse area (BCEA) for fixation stability. A linear mixed model was used to test associations and interactions among RTS, time, and clinical variables. A hierarchical linear mixed model was used to analyze structure-function relationships, addressing both individual and location-specific variations. Results Overall, 2340 MP locations were tested. PRR revealed a transient decrease within 30 days post-presentation, indicative of early photoreceptor disruption, followed by a progressive increase, signaling recovery. Significantly lower foveal sensitivity (RTS = 14.8 ± 7.4 vs. 22.5 ± 4.4 decibel [dB], P = 0.04) and increased fixation spread (63% BCEA = 1.26 ± 0.97 vs. 0.48 ± 0.35 deg2, P = 0.06) were noted in eyes with foveal granularity compared to those without. A significant increase in RTS was demonstrated over time (0.066 dB/day, P < 0.001), with a central-to-peripheral gradient of improvement. The interaction between follow-up time and baseline BCVA (P < 0.001) indicated more rapid improvement in eyes with worse initial vision. There was a robust, nonlinear association between PRR and RTS across all tested locations (P < 0.001), becoming asymptotic for sensitivity losses exceeding 20 dB. Conclusions Photoreceptor reflectivity accurately aligned with visual function in MEWDS on longitudinal examinations. The central-to-peripheral gradient of improvement may suggest specific vulnerabilities underlying the area around the disc.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Montesano
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alessandro Berni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giovanni Ometto
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- London Northwest University Healthcare NHS Trust, London, United Kingdom
| | - Ugo Introini
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Battaglia Parodi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Rissotto F, Cicinelli MV, Servillo A, Berni A, Menean M, Bianco L, Antropoli A, Bandello F, Miserocchi E, Marchese A. Multimodal Imaging of Vitreo-Retinal Lymphoma: A Comprehensive Review. Ocul Immunol Inflamm 2024:1-7. [PMID: 38436928 DOI: 10.1080/09273948.2024.2311754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Vitreoretinal lymphoma (VRL) is a rare lymphoma affecting the vitreous and the retina. Clinical diagnosis is challenging and often delayed and may lead to aggravated prognosis. This study aims to review multimodal imaging findings in VRL. METHODS We performed a comprehensive narrative review of the multimodal imaging findings that might be useful in the detection of VRL lesions. RESULTS The most frequent ocular manifestations of VRL are vitritis, and retinal and sub-retinal Pigmented Epithelium (RPE) infiltrations. Color Fundus Photography (CFP) detects vitreous haze, optic nerve, retinal and sub-RPE infiltration. Ultra-wide field imaging allows visualization of different patterns of vitreous haze and monitoring of VRL evolution through the detection of chorio-retinal atrophy (CRA). Fundus Autofluorescence shows granular hypo- and hyper-autofluorescent pattern. Optical Coherence Tomography (OCT) reveals vitreous cells, vertical hyper-reflective lesions and sub-RPE infiltrates. Fluorescein Angiography (FA) shows hypo or hyperfluorescent round lesions at the late stages of the examination, while Indocyanine Green Angiography (ICGA) detects round areas of focal hypo-fluorescence in the early phases that gradually enlarge in the late phases. B-scan ultrasonography detects vitreous opacities and homogeneous hyperreflective corpuscular material in the vitreous, and is a strongly recommended tool in suspecting VRL and is particularly useful when vitreous haze is impeding retinal examination. CONCLUSION Diagnostic vitrectomy with cytopathological analysis remains the gold standard for VRL diagnosis, however multimodal imaging allows the identification of suggestive retinal and vitreal lesions for early suspicion, diagnosis, and treatment and monitoring disease progression and response to treatment.
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Affiliation(s)
- Federico Rissotto
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Servillo
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Berni
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Matteo Menean
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Bianco
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessio Antropoli
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
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Gaudric A. Value and Significance of Hypofluorescent Lesions Seen on Late-Phase Indocyanine Green Angiography. OPHTHALMOLOGY SCIENCE 2024; 4:100406. [PMID: 38524378 PMCID: PMC10960065 DOI: 10.1016/j.xops.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 03/26/2024]
Abstract
Background and Purpose The hypofluorescence of fundus lesions observed during the late phase of indocyanine green angiography (ICGA) in various diseases has often been overlooked or misinterpreted. This article explores the significance of fundus lesions that are initially isofluorescent during the early phase of ICGA but become hypofluorescent later in the examination. Findings Pathologies such as multiple evanescent white spot syndrome, acute posterior placoid syphilitic chorioretinitis, chronic central serous chorioretinopathy, choroidal hemangioma, and some fundus with drusen, present this phenomenon of late hypofluorescence. Interpretation The interpretation of ICGA images and the role of indocyanine green (ICG) uptake by the retinal pigment epithelium (RPE) in late fundus fluorescence is debated. Experimental evidence suggests that ICG accumulates progressively in the RPE after intravenous injection of the dye or after direct contact in vitro, making it a potential marker of RPE activity. Although the exact mechanisms of ICG diffusion through the choroid and its binding to the RPE require further investigation, the late hypofluorescence observed in certain ICGA diseases provides information on different modalities of RPE dysfunction. Financial Disclosures The author has no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Alain Gaudric
- Ophthalmology Department, Hopital Lariboisière, APHP, Université Paris Cité, Paris, France, and Centre d'Imagerie et Laser, Paris, France
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Saturno MC, Neri P, Pichi F. Fundus autofluorescence in uveitis: from pathogenesis to imaging interpretation. Int Ophthalmol 2023; 43:4359-4371. [PMID: 37418226 DOI: 10.1007/s10792-023-02803-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE This review aims to summarize the current fundus autofluorescence (FAF) ailment for diagnosis and follow-up of uveitis. METHODS A thorough literature search was performed in the PubMed database. RESULTS FAF maps the retinal pigment epithelium's (RPE) health. Therefore, several posterior infectious and non. This fast, easy-to-perform, noninvasive technique can detect and manage infectious uveitis. CONCLUSIONS FAF serves to understand pathophysiologic mechanisms of uveitis and is a valuable prognostic indicator of themselves.
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Affiliation(s)
| | - Piergiorgio Neri
- Eye Insitute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Francesco Pichi
- Eye Insitute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Invernizzi A, Carreño E, Pichi F, Munk MR, Agarwal A, Zierhut M, Pavesio C. Experts Opinion: OCTA vs. FFA/ICG in Uveitis - Which Will Survive? Ocul Immunol Inflamm 2023; 31:1561-1568. [PMID: 35797139 DOI: 10.1080/09273948.2022.2084421] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Will optical coherence tomography angiography (OCTA) replace invasive imaging techniques like fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography entirely? While OCTA is being increasingly applied in the field of medical retina, will we see this change in the subspeciality of uveitis? In this article, five uveitis specialists with renowned imaging expertise answer to 10 specific questions to address this issue. The final verdict based on the comments of the experts suggests that FFA and ICG cannot be replaced by OCTA in uveitis, at least for now. While OCTA can offer new insights into the pathogenesis of certain inflammatory conditions and help in the diagnosis of complications like inflammatory choroidal neovascularisation, multimodal imaging is still the preferred approach in the assessment of patients with uveitis.
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Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences "L. Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
- The Discipline of Clinical Ophthalmology and Eye Health, Save Sight Institute, Sydney Eye Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ester Carreño
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital NHSFT, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT, UCL Institute of Ophthalmology, London, UK
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Interlandi E, Pellegrini F, Giuffrè C, Cirone D, Brocca D, Lee AG, Casalino G. Acute-Onset Retinal Conditions Mimicking Acute Optic Neuritis: Overview and Differential Diagnosis. J Clin Med 2023; 12:5720. [PMID: 37685787 PMCID: PMC10488521 DOI: 10.3390/jcm12175720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Acute optic neuritis (AON) is a common cause of sudden visual loss in young patients. Because of the risk of demyelinating disease, patients affected by unilateral or bilateral optic neuritis should be evaluated and treated accordingly. Despite advancements in imaging of the brain and retina, misdiagnosis of AON is not uncommon. Indeed, some acute disorders of the retina have the potential to mimic AON and their prompt diagnosis may avoid unnecessary neurologic investigation, psychological stress to the patient, and delays in treatment. This review describes uncommon retinal disorders presenting with sudden-onset visual loss and absent or subtle funduscopic manifestation that can mimic AON. Multimodal retinal imaging is essential in detecting these conditions and in their differential diagnosis. It behooves neurologists and general ophthalmologists to be aware of these entities and be familiar with multimodal imaging of the retina.
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Affiliation(s)
- Emanuela Interlandi
- Department of Ophthalmology, “Ospedale del Mare”, ASL Napoli 1-Centro, 80147 Naples, Italy
| | | | - Chiara Giuffrè
- Centro Europeo di Oftalmologia, 90141 Palermo, Italy;
- Ophthalmology Department, San Raffaele Scientific Institute, University Vita-Salute, 20132 Milan, Italy
| | - Daniele Cirone
- Department of Ophthalmology, “Villa Anna” Hospital, 63074 San Benedetto del Tronto, Italy;
| | - Daniele Brocca
- Department of Ophthalmology, “De Gironcoli” Hospital, AULSS2 Marca Trevigiana, 31015 Conegliano, Italy;
| | - Andrew G. Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA;
- Departments of Ophthalmology, Neurology and Neurosurgery, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Texas A and M College of Medicine, Bryan, TX 77807, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Giuseppe Casalino
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
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Maltsev DS, Kulikov AN, Vasiliev AS. OPTICAL COHERENCE TOMOGRAPHY IMAGING OF RETINAL MACROPHAGE-LIKE CELLS IN PATIENTS WITH MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retin Cases Brief Rep 2023; 17:490-497. [PMID: 37364216 DOI: 10.1097/icb.0000000000001231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
PURPOSE To analyze the changes of macrophage-like cells (MLCs) on the inner retinal surface associated with multiple evanescent white dot syndrome using optical coherence tomography. METHODS Four eyes of four patients with multiple evanescent white dot syndrome were examined and followed with multimodal imaging, including optical coherence tomography angiography, to visualize MLC on en face structural projections. RESULTS On en face structural optical coherence tomography angiography projection at presentation, all multiple evanescent white dot syndrome eyes showed a decrease of the nearest neighbor distance of MLC within the region of interest and an increase of MLC density in the perifovea compared with the fellow unaffected eye. Three eyes demonstrated protrusion of MLC into the vitreous. At 1 to 3 months of follow-up, nearest neighbor distance increased, and MLC density decreased to the level of the fellow unaffected eye along with regression of multiple evanescent white dot syndrome symptoms. CONCLUSION Multiple evanescent white dot syndrome may be associated with increase of MLC population on the inner retinal surface, which can be tracked with clinical optical coherence tomography imaging.
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Affiliation(s)
- Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
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10
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Agarwal A, Pichi F, Invernizzi A, Grewal DS, Singh RB, Upadhyay A. Stepwise approach for fundus imaging in the diagnosis and management of posterior uveitis. Surv Ophthalmol 2023; 68:446-480. [PMID: 36724831 DOI: 10.1016/j.survophthal.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
An array of retinochoroid imaging modalities aid in comprehensive evaluation of the immunopathological changes in the retina and choroid, forming the core component for the diagnosis and management of inflammatory disorders such as uveitis. The recent technological breakthroughs have led to the development of imaging platforms that can evaluate the layers of retina and choroid and the structural and functional alteration in these tissues. Ophthalmologists heavily rely on imaging modalities such as dye-based angiographies (fluorescein angiography and indocyanine green angiography), optical coherence tomography, fundus autofluorescence, as well as dye-less angiography such as optical coherence tomography angiograph,y for establishing a precise diagnosis and understanding the pathophysiology of the diseases. Furthermore, these tools are now being deployed with a 'multimodal' approach for swift and accurate diagnosis. In this comprehensive review, we outline the imaging platforms used for evaluation of posterior uveitis and discuss the organized, algorithmic approach for the assessment of the disorders. Additionally, we provide an insight into disease-specific characteristic pathological changes and the established strategies to rule out disorders with overlapping features on imaging.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, 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; Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, New South Wales, Australia
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Awaneesh Upadhyay
- Department of Ophthalmology, EyeQ Super-specialty Hospitals, Noida, Uttar Pradesh, India
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Use of optical coherence tomography angiography in the uveitis clinic. Graefes Arch Clin Exp Ophthalmol 2023; 261:23-36. [PMID: 35841398 DOI: 10.1007/s00417-022-05763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/04/2022] [Accepted: 07/09/2022] [Indexed: 01/04/2023] Open
Abstract
As optical coherence tomography angiography is revolutionizing the ophthalmology world, the uveitis community is learning to understand where and how this new powerful imaging tool fits into the management of the panorama of ocular inflammations and infections. A non-invasive method of studying the retinal and choroidal vasculature, OCTA allows for the assessment of vessel density changes during active and inactive uveitis making it the natural imaging application of choice in uveitis clinical trials. However, these data and results are of limited utility to the ophthalmologists who are looking to apply OCTA in their everyday uveitis clinic. If employed strategically, OCTA can be a powerful tool for the uveitis specialist to evaluate iris involvement in viral uveitis; to assess the integrity of the vascular layers in the settings of white dot syndromes; to distinguish inflammatory choroidal neovascularization from outer retinal avascular inflammatory material; and to diagnose and follow infectious choroidal granulomas and satellite foci of chorioretinal inflammation without the need to administer dyes. The present review will analyze all the recent publications that apply OCTA in uveitis to offer the reader a guide on how to maximize the utility of this imaging modality in a clinical practice.
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12
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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Mikowski M, Evans T, Wu L. Reversible Choriocapillaris Flow Voids in Acute Syphilitic Posterior Placoid Chorioretinitis. Ocul Immunol Inflamm 2022; 30:1964-1969. [PMID: 33998963 DOI: 10.1080/09273948.2021.1906912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To report two cases of acute syphilitic posterior placoid chorioretinitis (ASPPC) with choriocapillaris flow voids that partially resolved with systemic antibiotic treatment. METHODS Observational case report with multimodal imaging. RESULTS Two young healthy men suffered an acute monocular loss of vision. Spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCT-A) revealed outer retinitis with loss of the ellipsoid layer and choriocapillaris flow voids. Systemic work-up revealed syphilis. Upon systemic treatment with antibiotics, the patients recovered their vision and the OCT and OCT-A abnormalities partially resolved. CONCLUSIONS Transient choriocapillaris flow voids characterize ASPPC and may be responsible for the visual loss seen in these patients.
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Affiliation(s)
- Mia Mikowski
- Asociados de Macula, Vitreo y Retina de Costa Rica, San José, Costa Rica
| | - Teodoro Evans
- Vitreoretinal Department, Clinica 2020, San José, Costa Rica
| | - Lihteh Wu
- Asociados de Macula, Vitreo y Retina de Costa Rica, San José, Costa Rica.,Illinois Eye and Ear Infirmary, Department of Ophthalmology, University of Illinois School of Medicine, Chicago, Illinois, USA
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14
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Cicinelli MV, Miller V, Marchese A, Zaguia F, Miserocchi E, Goldstein DA. Outer Retinal Disruption in Early-Onset Birdshot Chorioretinopathy. Ophthalmol Retina 2022; 6:863-865. [PMID: 35550880 DOI: 10.1016/j.oret.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Victoria Miller
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fatma Zaguia
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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15
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Socci da Costa D, Gomes e Silva A, Melichar A, Neves DB, Correa PA, Moraes RT. Bacillary layer detachment in serpiginous-like choroiditis of presumed intraocular tuberculosis: Report of two cases. Am J Ophthalmol Case Rep 2022; 27:101653. [PMID: 35845750 PMCID: PMC9278036 DOI: 10.1016/j.ajoc.2022.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/05/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To describe the presence of bacillary layer detachment (BALAD) in serpiginous-like choroiditis (SLC) in presumed intraocular tuberculosis. Observations Clinical and multimodal imaging including fundus photography, fundus autofluorescence, and spectral domain and enhanced-deep imaging optical coherence tomography (OCT) of two cases of SLC in presumed intraocular tuberculosis. Two patients (26 and 38-year-old woman) presented with unilateral, decreased vision of acute onset. They were diagnosed with SLC in presumed intraocular tuberculosis, and OCT revealed splitting of the ellipsoid zone, resembling BALAD. All two patients showed complete resolution after treatment with antitubercular therapy (ATT). Conclusions and Importance BALAD appears in the acute stage of SLC in presumed intraocular tuberculosis and resolves rapidly at the beginning of ATT.
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16
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Acute syphilitic posterior placoid chorioretinitis as the presenting symptom of syphilis in an immunocompetent patient. Am J Ophthalmol Case Rep 2022; 28:101695. [PMID: 36217438 PMCID: PMC9547151 DOI: 10.1016/j.ajoc.2022.101695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/14/2022] [Accepted: 08/28/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Observations Conclusions and Importance
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17
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AAV2-hCHM Subretinal Delivery to the Macula in Choroideremia: Two Year Interim Results of an Ongoing Phase I/II Gene Therapy Trial. Ophthalmology 2022; 129:1177-1191. [PMID: 35714735 DOI: 10.1016/j.ophtha.2022.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the safety of the subretinal delivery of a recombinant adeno-associated virus serotype 2 (AAV2) vector carrying a human CHM-encoding cDNA in choroideremia (CHM). DESIGN Prospective, open-label, non-randomized, dose-escalation, phase 1/2 clinical trial. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS Fifteen CHM patients (ages 20-57 years at dosing). METHODS, INTERVENTION, OR TESTING Patients received uniocular subfoveal injections of low dose (up to 5x1010 vector genome (vg) per eye, n=5) or high dose (up to 1x1011 vg per eye, n=10) AAV2-hCHM. Patients were evaluated pre- and post-operatively for two years with ophthalmic examinations, multimodal retinal imaging and psychophysical testing. MAIN OUTCOME Measures: visual acuity (VA), perimetry (10-2 protocol), spectral-domain optical coherence tomography (SD-OCT) and short-wavelength fundus autofluorescence (SW-FAF). RESULTS We detected no vector-related or systemic toxicities. VA returned to within 15 letters of baseline in all but two patients (one developed acute foveal thinning, another patient, a macular hole); the rest showed no gross changes in foveal structure at two years. There were no significant differences between intervention and control eyes in mean light-adapted sensitivity by perimetry, or in the lateral extent of retinal pigment epithelium (RPE) relative preservation by SD-OCT and SW-FAF. Microperimetry showed non-significant (<3SD of the intervisit variability) gains in sensitivity in some locations and participants in the intervention eye. There were no obvious dose-dependent relationships. CONCLUSIONS VA was within 15 letters of baseline after the subfoveal AAV2-hCHM injections in 13/15 (87%) of the patients. Acute foveal thinning with unchanged perifoveal function in one patient and macular hole in a second suggests foveal vulnerability to the subretinal injections. Longer observation intervals will help establish the significance of the minor differences in sensitivities and rate of disease progression observed between intervention and control eyes.
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18
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Agarwal A, Invernizzi A. The Role of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Differential Diagnosis of Posterior Uveitis. Ocul Immunol Inflamm 2022; 30:682-689. [PMID: 35593586 DOI: 10.1080/09273948.2022.2071743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The purpose of this study is to review role of OCT and OCTA in differential diagnosis of certain posterior uveitic entities. METHODS Narrative review. RESULTS In this review, we have comprehensively summarized the utility of OCT and OCTA in helping the clinician diagnose common but challenging inflammatory conditions including ocular toxoplasmosis, viral retinitis, and vitreoretinal lymphoma, among others. OCT and OCTA can also be used to assess the choriocapillaris involvement in conditions such as multiple evanescent white dot syndrome, and choroidal granulomas in tubercular and sarcoid uveitis. CONCLUSIONS Fundus imaging with OCT and OCTA has assumed a significant role in establishing the diagnosis in uveitis apart from microbiological and other laboratory analysis. Advantages such as rapidity and non-invasiveness make these imaging modalities very useful and convenient.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan, Milan, Italy.,The Discipline of Clinical Ophthalmology and Eye Health, Save Sight Institute, Sydney Eye Hospital, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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19
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Pradas M, Rodriguez-Merchante MP, Estébanez N, Sarraf D, Freund KB, Fawzi A, Pichi F, Carreño E. Navigating the White Dot Syndromes with Optical Coherence Tomography (OCT) and OCT Angiography (OCT-A). Ocul Immunol Inflamm 2022; 30:664-674. [PMID: 35412934 DOI: 10.1080/09273948.2022.2046798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION White dot syndromes are a heterogeneous group of diseases that affect different layers in the retina and choroid. Multimodal imaging is fundamental in the diagnosis, but also can be crucial in unveiling the pathogenesis of these entities. MATERIAL AND METHODS Literature review. RESULTS Optical coherence tomography (OCT) provides depth-resolved, histological grade images of the vitreous, retina, and choroid. This technology is very useful to localize the primary nature and level of pathology of the various white dot syndromes. En face OCT can provide additional information regarding the interrelationship of lesion types. Vascular involvement at the level of the retina, choriocapillaris or choroid can be assessed by en face OCT angiography (OCT-A) and is not limited by masking, leakage or staining as can occur with conventional angiography (fluorescein or indocyanine green angiography) which requires dye injection. CONCLUSION OCT and OCTA are fundamental in the diagnosis and follow-up of white dots syndromes.
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Affiliation(s)
- Marta Pradas
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | - Nuria Estébanez
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, USA
| | - Amani Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Francesco Pichi
- Department of Ophthalmology, Cleveland Clinic, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Ester Carreño
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
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20
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Nicolau ZFM, Araújo DL, Nakayama LF, Bergamo VC, Meirelles RL, Júnior OM. White dot syndrome in a patient with presumed ocular tuberculosis: a case report. Int J Retina Vitreous 2022; 8:25. [PMID: 35382874 PMCID: PMC8981752 DOI: 10.1186/s40942-022-00372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background This manuscript describes a case of a patient with presumed ocular tuberculosis masquerading as multiple evanescent white dot syndrome. Case presentation A 32-year-old male patient presented with a complaint of reduced visual acuity in the left eye. Retinal fundus exam of the left eye revealed gray-whitish deep lesions predominantly nasal to the optic disc. The lesions were more clearly identifiable on fundus autofluorescence (FAF) imaging, fluorescein angiography (FA) and en face optical coherence tomography (OCT). FA also indicated retinal vasculitis and papillitis. Swept-source OCT B-scan demonstrated loss of the ellipsoid layer in the regions corresponding to the lesions detected by FAF. A positive tuberculin skin test (TST) confirmed presumed tuberculosis, and a related WDS diagnosis was made. Specific antituberculosis therapy was instituted with favorable anatomical recovery and visual outcome. Conclusion Multiple evanescent white dot syndrome (MEWDS) may be manifestation of presumed ocular tuberculosis, and multimodal retinal exams can provide a better understanding of atypical diseases and their follow-up.
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21
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Begaj T, Sobrin L. Ophthalmic Consequences of Syphilis. Int Ophthalmol Clin 2022; 62:251-268. [PMID: 35325922 DOI: 10.1097/iio.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Abstract
BACKGROUND Syphilis is an uncommon cause of optic nerve head edema; however, differentiating syphilis from other etiologies of optic nerve head swelling may be challenging. We describe 4 cases of ocular syphilis presenting with swollen optic nerve head(s) without overt signs of intraocular inflammation to better define the phenotypic presentation of this condition to allow its early recognition and treatment and discuss potential pathophysiological mechanisms of syphilitic optic neuropathy. METHODS Retrospective case series of patients presenting to a tertiary neuro-ophthalmology practice with a swollen optic nerve head(s) but no overt signs of intraocular inflammation, which was eventually determined to be secondary to syphilis. RESULTS Four patients were included in the study. The mean age was 43 years, 2 were women and 2 had bilateral involvement. Two patients had a recent history of skin rash, and one patient was investigated for abdominal pain and elevated liver enzymes. Two patients presented with photopsias and preserved visual function, whereas 2 presented with vision loss. Although chorioretinitis was present in all cases, it was very subtle in all and was only appreciated on fundus autofluorescence (FA) in 3 of 4 cases. Three patients demonstrated evidence of optic perineuritis on neuro-imaging. All patients were treated with a course of intravenous penicillin with a variable degree of visual recovery. CONCLUSIONS Systemic symptoms are common in patients with syphilic optic neuropathy. Optic disc edema as a manifestation of syphilis is usually accompanied by subtle chorioretinitis, which is best appreciated on FA. Optic perineuritis is common in patients with syphilitic optic neuropathy, with its pathophysiology likely similar to meningitis seen in neurosyphilis.
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Affiliation(s)
- Anna Kabanovski
- Faculty of Medicine, University of Toronto (AK); Department of Ophthalmology and Vision Sciences, Faculty of Medicine (LD, TJ-P, EM); Division of Neurology, Department of Medicine, Faculty of Medicine (EM), University of Toronto, Toronto, Canada
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23
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Pichi F, Carreño E, Pavesio C, Denniston AK, Grewal DS, Deak G, Khairallah M, Ruiz-Cruz M, de Oliveira Dias JR, Adan A, Burke T, Invernizzi A, Schlaen A, Tian M, Agarwal AK, Tucker WR, Sen HN, Lin P, Lim LL, Pepple KL, Munk MR. Consensus-based recommendations for optical coherence tomography angiography reporting in uveitis. Br J Ophthalmol 2022:bjophthalmol-2021-320021. [PMID: 35135783 DOI: 10.1136/bjophthalmol-2021-320021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To establish a consensus in the nomenclature for reporting optical coherence tomography angiography (OCTA findings in uveitis. METHODS The modified Delphi process consisted of two rounds of electronic questionnaires, followed by a face-to-face meeting conducted virtually. Twenty-one items were included for discussion. The three main areas of discussion were: wide field OCTA (WF-OCTA), nomenclature of OCTA findings and OCTA signal attenuation assessment and measurement. Seventeen specialists in uveitis and retinal imaging were selected by the executive committee to constitute the OCTA nomenclature in Uveitis Delphi Study Group. The study endpoint was defined by the degree of consensus for each question: 'strong consensus' was defined as >90% agreement, 'consensus' as 85%-90% and 'near consensus' as >80% but <85%. RESULTS There was a strong consensus to apply the term 'wide field' to OCTA images measuring over 70° of field of view, to use the terms 'flow void' and 'non-detectable flow signal' to describe abnormal OCTA flow signal secondary to vessels displacement and slow flow respectively, to use the terms 'loose' and 'dense' to describe the appearance of inflammatory choroidal neovascularisation, and to use the percentage of flow signal decrease to measure OCTA ischaemia with a threshold greater than or equal to 30% as a 'large area'. CONCLUSIONS This study sets up consensus recommendations for reporting OCTA findings in uveitis by an expert panel, which may prove suitable for use in routine clinical care and clinical trials.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Ester Carreño
- Ocular Inflammation Unit, Ophthalmology Department, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Dilraj S Grewal
- Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gabor Deak
- Department of Ophthalomology, Medical University Vienna, Vienna, Austria
| | - Moncef Khairallah
- Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | | | | | - Alfredo Adan
- Ophthalmology Department, Hospital Clinic, Barcelona, Spain
| | - Tomas Burke
- Bristol Eye Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Alessandro Invernizzi
- Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Ariel Schlaen
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Meng Tian
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Aniruddha Kishandutt Agarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - William R Tucker
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Kathryn L Pepple
- Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Marion R Munk
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland.,Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Fogel-Levin M, Sadda SR, Rosenfeld PJ, Waheed N, Querques G, Freund KB, Sarraf D. Advanced retinal imaging and applications for clinical practice: A consensus review. Surv Ophthalmol 2022; 67:1373-1390. [DOI: 10.1016/j.survophthal.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 01/20/2023]
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25
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Takase H, Arai A, Iwasaki Y, Imai A, Nagao T, Kawagishi M, Ishida T, Mochizuki M. Challenges in the diagnosis and management of vitreoretinal lymphoma – Clinical and basic approaches. Prog Retin Eye Res 2022; 90:101053. [DOI: 10.1016/j.preteyeres.2022.101053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/30/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
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Amaral C, Joy L, Jimenez H, Cruz-Inñigo YJ, Ulloa-Padilla JP, Oliver AL. Syphilitic Outer Retinopathy: A Case Report and Review of the Literature. JOURNAL OF VITREORETINAL DISEASES 2022; 6:63-70. [PMID: 37007722 PMCID: PMC9976216 DOI: 10.1177/24741264211018300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work presents a case of syphilitic outer retinopathy with findings similar to those of acute zonal occult outer retinopathy (AZOOR). We also discuss the clinical characteristics, treatment, and prognosis of this entity. Methods: A case report and systematic literature review are presented. Results: A 56-year-old woman presented with acute vision loss, localized photopsia, a central scotoma, and retinal findings that were all consistent with AZOOR. A further workup led to a diagnosis of syphilis. Oral prednisone and intravenous penicillin resulted in the resolution of the posterior uveitis and the restoration of visual acuity. However, the central scotoma remained at the 3-year follow-up visit. Conclusions: Syphilitic outer retinopathy is a distinct entity characterized by the disruption of the ellipsoid zone visible on optical coherence tomography and a corresponding increase in fundus hyperautofluorescence in the affected areas. Although some patients may present with a demarcation line, as is seen with AZOOR, the fundus is oftentimes unremarkable or may show only subtle retinal pigment epithelium changes. Uveitis resolution and visual acuity restoration may be expected following treatment; however, visual field disturbances may persist.
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Affiliation(s)
- Claudia Amaral
- University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR, USA
| | - Leilani Joy
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Hiram Jimenez
- University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, PR, USA
| | - Yousef J. Cruz-Inñigo
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Jan P. Ulloa-Padilla
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Armando L. Oliver
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
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27
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Papasavvas I, Mantovani A, Tugal-Tutkun I, Herbort CP. Multiple evanescent white dot syndrome (MEWDS): update on practical appraisal, diagnosis and clinicopathology; a review and an alternative comprehensive perspective. J Ophthalmic Inflamm Infect 2021; 11:45. [PMID: 34921620 PMCID: PMC8684571 DOI: 10.1186/s12348-021-00279-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition affecting the outer retina as a consequence of choriocapillaris non perfusion. The pathophysiology of MEWDS will be discussed based clinical appraisal and on multimodal imaging appraisal. METHODS Narrative review and perspective opinion. RESULTS Literature review results helped us to put forward (1) the specific symptomatology (decreased/blurred vision, photopsia, subjective scotomas), (2) the ill-asserted character of clinical findings (foveal granularity, white dots in fundoscopy), (3) and the crucial importance of multimodal imaging with the diagnostic triad of ICGA hypofluorescent areas, BL-FAF hyperautofluorescent areas and loss/damage of IS/OS-ellipsoid zone on SD-OCT that characterise the disease and can practically help the clinician to diagnose MEWDS. A comprehensive alternative perspective of the disease was formulated. CONCLUSIONS The bulk of evidence that we are presenting in this review, thanks to new performing non-invasive and invasive imaging modalities, is sufficiently compelling to consider MEWDS as a primary choriocapillaritis/inflammatory choriocapillaropathy. Multimodal imaging allows the clinician to diagnose MEWDS with a high level of certainty and ensures a precise follow-up.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, CH-1003, Lausanne, Switzerland.
| | | | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, CH-1003, Lausanne, Switzerland.
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28
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A Multiple Evanescent White Dot Syndrome–like Reaction to Concurrent Retinal Insults. ACTA ACUST UNITED AC 2021; 5:1017-1026. [DOI: 10.1016/j.oret.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022]
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29
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Moraes RT, Peixoto AL, Moraes LS, Lima LH, Balaratnasingam C, Sarraf D, Vianna RNG. MULTIPLE EVANESCENT WHITE DOT SYNDROME MASQUERADER. Retin Cases Brief Rep 2021; 15:S45-S48. [PMID: 34171902 DOI: 10.1097/icb.0000000000001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Remo T Moraes
- Instituto Brasileiro de Oftalmologia (IBOL), Rio de Janeiro, Brazil
| | - Ana L Peixoto
- Instituto Brasileiro de Oftalmologia (IBOL), Rio de Janeiro, Brazil
| | - Lucas S Moraes
- Department of Ophthalmology, Hospital da Gamboa, Rio de Janeiro, Brazil
| | - Luiz H Lima
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Chandrakumar Balaratnasingam
- Center for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - David Sarraf
- Jules Stein Eye Institute, University of California, Los Angeles, California; and
| | - Raul N G Vianna
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
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30
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Sobolewska B, Chee SP, Zaguia F, Goldstein DA, Smith JR, Fend F, Mochizuki M, Zierhut M. Vitreoretinal Lymphoma. Cancers (Basel) 2021; 13:3921. [PMID: 34439078 PMCID: PMC8394064 DOI: 10.3390/cancers13163921] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
Vitreoretinal lymphoma (VRL) is a rare variant of primary central nervous system lymphoma (PCNSL), mostly of diffuse large B cell lymphoma, which affects the retina and/or the vitreous with or without optic nerve involvement. The disease course is aggressive. Up to 90% of the patients develop central nervous system lymphoma within one year. The diagnosis of VRL is challenging due to nonspecific chronic and relapsing uveitis and is made by anterior chamber tab or vitreous aspirate biopsy. There is no established treatment protocol for VRL patients with bilateral involvement without CNS involvement. There are suggestions to use only intravitreal chemotherapy with methotrexate and/or rituximab. Alternatively, systemic high-dose MTX treatment or external beam radiotherapy is used. Further studies are needed to prove and confirm the prophylactic systemic therapy in preventing CNS involvement in limited VRL.
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Affiliation(s)
- Bianka Sobolewska
- Center of Ophthalmology, University of Tuebingen, 72076 Tuebingen, Germany;
| | - Soon-Phaik Chee
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore;
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 168751, Singapore
- Duke-NUS Medical School, Singapore 168751, Singapore
| | - Fatma Zaguia
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (F.Z.); (D.A.G.)
| | - Debra Anne Goldstein
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (F.Z.); (D.A.G.)
| | - Justine R. Smith
- College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia;
| | - Falko Fend
- Institute for Pathology and Neuropathology, University of Tuebingen, 72076 Tuebingen, Germany;
| | | | - Manfred Zierhut
- Center of Ophthalmology, University of Tuebingen, 72076 Tuebingen, Germany;
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Classification Criteria For Multiple Evanescent White Dot Syndrome. Am J Ophthalmol 2021; 228:198-204. [PMID: 33845025 PMCID: PMC8594763 DOI: 10.1016/j.ajo.2021.03.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to determine classification criteria for multiple evanescent white dot syndrome (MEWDS). DESIGN Machine learning of cases with MEWDS and 8 other posterior uveitides. METHODS Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior, or panuveitides. The resulting criteria were evaluated in the validation set. RESULTS A total of 1,068 cases of posterior uveitides, including 51 cases of MEWDS, were evaluated by machine learning. Key criteria for MEWDS included: 1) multifocal gray-white chorioretinal spots with foveal granularity; 2) characteristic imaging on fluorescein angiography ("wreath-like" hyperfluorescent lesions) and/or optical coherence tomography (hyper-reflective lesions extending from retinal pigment epithelium through ellipsoid zone into the retinal outer nuclear layer); and 3) absent to mild anterior chamber and vitreous inflammation. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval: 94.3-99.3) in the validation set. Misclassification rates for MEWDS were 7% in the training set and 0% in the validation set. CONCLUSIONS The criteria for MEWDS had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
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Furtado JM, Simões M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, Gordon DL, Smith JR. Ocular syphilis. Surv Ophthalmol 2021; 67:440-462. [PMID: 34147542 DOI: 10.1016/j.survophthal.2021.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
Multiple studies around the world suggest that syphilis is re-emerging. Ocular syphilis - with a wide range of presentations, most of which are subtypes of uveitis - has become an increasingly common cause of ocular inflammation over the past 20 years. Its rising incidence, diagnostic complexity, and manifestations that have only recently been characterized make ocular syphilis relevant from the public health, clinical, and scientific perspectives. We review the demographics, epidemiology, clinical features, ocular imaging findings, diagnosis, and medical management of this condition.
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Affiliation(s)
- João M Furtado
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Milena Simões
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Daniel Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Genevieve F Oliver
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Mudit Tyagi
- Ocular Inflammation and Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Heloisa Nascimento
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia-IPEPO, São Paulo, Brazil
| | - David L Gordon
- Flinders University College of Medicine and Public Health, Adelaide, Australia; SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, South Australia
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
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Ramakrishnan MS, Patel AP, Melles R, Vora RA. Multiple Evanescent White Dot Syndrome: Findings from a Large Northern California Cohort. Ophthalmol Retina 2020; 5:850-854. [PMID: 33271345 DOI: 10.1016/j.oret.2020.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the clinical and imaging characteristics of multiple evanescent white dot syndrome (MEWDS) from a large single-center cohort. DESIGN Single-center, retrospective cohort study. PARTICIPANTS A total of 111 patients previously diagnosed with MEWDS in the Kaiser Permanente Northern California system from 2012 to 2019. METHODS Two retina specialists reviewed the medical records and all available retinal imaging, including Humphrey visual field testing, fundus photography (FP), OCT, fluorescein angiogram (FA), and fundus autofluorescence (FAF). Patients were excluded from analysis if confirmatory imaging was unavailable. MAIN OUTCOME MEASURES Patient characteristics, visual acuity, clinical examination and imaging findings, and final diagnosis. RESULTS Seventy-three patients (65.8%) were confirmed to have the diagnosis of MEWDS. Fifty-eight (79.5%) were female, with a mean (standard deviation [SD]) age at presentation of 35.2 (14.2) years, and mean refractive error of -1.6 diopters. Initial mean (SD) visual acuity was logarithm of the minimum angle of resolution (logMAR) 0.39 (0.31) and improved to mean (SD) logMAR 0.07 (0.15) at final follow-up. Presenting symptoms included blurred vision (82%), scotomas (56%), photopsias (43%), and floaters (23%). Nine patients (12%) had a previously diagnosed autoimmune condition, and 2 patients (3%) had documentation of a recent vaccination. Antecedent upper respiratory infection was documented in 15 of 66 patients (23%). Noted clinical and imaging features include ellipsoid zone disruption (100%), white fundus lesions (92%), FA hyperfluorescence (92%), foveal granularity (74%), vitreous cell (53%), and optic disc edema (52%). Twenty-nine of the 111 patients (26%) were initially misdiagnosed with MEWDS and subsequently given an alternative diagnosis, including other white dot syndromes, syphilis, primary vitreoretinal lymphoma, myopic degeneration, and central serous chorioretinopathy. CONCLUSIONS Multiple evanescent white dot syndrome is a rare self-limiting condition of the outer retina. Although a distinct set of clinical exam and imaging findings permit recognition of this disease, misdiagnosis is not uncommon.
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Affiliation(s)
| | - Amar P Patel
- Kaiser Permanente Northern California, Oakland, California
| | - Ronald Melles
- Kaiser Permanente Northern California, Oakland, California
| | - Robin A Vora
- Kaiser Permanente Northern California, Oakland, California.
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Mizuuchi K, Saito W, Namba K, Ishida S. Multiple evanescent white dot syndrome and panuveitis: a case report. J Ophthalmic Inflamm Infect 2020; 10:26. [PMID: 33123841 PMCID: PMC7596130 DOI: 10.1186/s12348-020-00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022] Open
Abstract
Aim To report a patient with multiple evanescent white dot syndrome (MEWDS) complicated by iridocyclitis and vitritis. Case description A 70-year-old woman developed multiple subretinal white dots, iritis, and diffuse vitreous opacity. Angiographic and macular morphological features were consistent with those of MEWDS. Inflammatory findings including the white dots improved following only topical dexamethasone within 1 month after the initial visit. Best-corrected visual acuity recovered to 1.0 with restored photoreceptor structure. Conclusion The presence of iridocyclitis and vitritis, atypical to MEWDS, indicates the concurrent development of panuveitis associated with MEWDS. These results suggest that MEWDS is a clinical entity of uveitis.
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Farley N, Pellegrini M, Marlow E, Ruby A, Randhawa S. Optical Coherence Tomography Angiography Findings in Patients With Acute Syphilitic Posterior Placoid Chorioretinopathy. JOURNAL OF VITREORETINAL DISEASES 2020; 4:515-521. [PMID: 37007664 PMCID: PMC9976075 DOI: 10.1177/2474126420936193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is an uncommon and distinct manifestation of ocular syphilis necessitating immediate treatment. ASPPC is attributed to disruption of the choriocapillaris, retinal pigment epithelium, and photoreceptors. Optical coherence tomography angiography (OCTA) can evaluate choriocapillaris vascular flow and may provide further information about ASPPC’s disease process. Methods: OCTA images from 7 eyes of 4 patients with ASPPC were compared before and after treatment when available. Results: All eyes demonstrated increased choriocapillaris vascular flow voids in the distribution of the ASPPC lesions at initial testing. Following treatment, decreased placoid lesion size was associated with decreased flow voids on OCTA along with improved ellipsoid zone integrity in 2 patients. Conclusions: Disruption of choriocapillaris vascular flow in ASPPC that causes outer retinal changes can improve following treatment as suggested by OCTA imaging. Some cases may continue to demonstrate decreased flow even after appropriate therapy.
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Affiliation(s)
- Nathan Farley
- Associated Retinal Consultants, P.C., Royal Oak, MI, USA
| | - Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | | - Alan Ruby
- Associated Retinal Consultants, P.C., Royal Oak, MI, USA
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36
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Levine ES, Mendonça LSM, Baumal CR, Chin AT, Rifkin L, Waheed NK. Choroidal nonperfusion on optical coherence tomography angiography in a case of unilateral posterior segment ocular sarcoidosis misdiagnosed as MEWDS. Am J Ophthalmol Case Rep 2020; 20:100944. [PMID: 33024892 PMCID: PMC7528049 DOI: 10.1016/j.ajoc.2020.100944] [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] [Received: 04/28/2020] [Revised: 09/04/2020] [Accepted: 09/20/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To report a case of presumed ocular sarcoidosis initially presenting with features of multiple evanescent white dot syndrome (MEWDS) with atypical optical coherence tomography angiography (OCTA) findings. OBSERVATIONS A 23 year-old woman presented with a unilateral central scotoma, photophobia, and decreased visual acuity after a viral illness. Examination of the right eye revealed multiple round white macular spots and stippled granularity at the fovea. Multimodal imaging with fluorescein angiography (FA), indocyanine green angiography (ICG), fundus autofluorescence (FAF), and optical coherence tomography (OCT) was consistent with a diagnosis of MEWDS. However, OCTA demonstrated choriocapillaris (CC) flow deficits, which is not typical for MEWDS. The clinical course was initially consistent with MEWDS, with spontaneous recovery of symptoms over ensuing months. The patient presented five months later with floaters and a central scotoma. Examination showed panuveitis, and systemic evaluation revealed an elevated angiotensin converting enzyme (ACE) and hilar lymphadenopathy on chest x-ray consistent with presumed sarcoidosis. CONCLUSIONS AND IMPORTANCE A case of MEWDS atypically demonstrated CC flow deficits on OCTA and subsequently presented as uveitis secondary to presumed sarcoidosis. Atypical features in MEWDS may be a sign of another disorder masquerading early on as MEWDS and ought to prompt further investigation.
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Affiliation(s)
- Emily S Levine
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Luísa S M Mendonça
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Adam T Chin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Lana Rifkin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
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Mohd Fauzi Yap MFB, Mohd Zain A, Tumian NR, Palaniappan S, Nasaruddin RA, Md Din N. Optic Nerve Infiltration in Systemic Metastatic Retinal Lymphoma (SMRL): Multimodal Imaging and Challenges in Diagnosis. Ocul Immunol Inflamm 2020; 29:479-484. [PMID: 32967510 DOI: 10.1080/09273948.2020.1800050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 45-year-old man was diagnosed with diffuse large B-cell lymphoma stage IV which was confirmed by celiac lymph node biopsy. He subsequently completed six cycles of R-CHOP chemotherapy. Six months later, he presented with panuveitis OU with positive relative afferent pupillary defect OD. OCT revealed hyper-reflective lesions and irregularity of the retinal pigment epithelium OU. Fundus fluorescein angiogram shows hyper-auto fluorescence and granular changes on the retina. A month later, he developed swollen optic disc OD and hemorrhagic retinitis OU and treated as presumed CMV retinitis. Anti-TB was started after a positive Mantoux test. He finally consented for a vitreous biopsy which showed atypical lymphoid cells highly suggestive for vitreoretinal lymphoma and subsequently received intravitreal methotrexate OU.Conclusion: Optic nerve infiltration in systemic metastatic retinal lymphoma may have initial occult signs but with profound visual loss. Ocular infections like CMV retinitis and tuberculosis may mask and delay the diagnosis in immunocompromised patients.
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Affiliation(s)
| | - Ayesha Mohd Zain
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nor Rafeah Tumian
- Haematology Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Sivakumar Palaniappan
- Haematology Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rona Asnida Nasaruddin
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norshamsiah Md Din
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss. Curr Neurol Neurosci Rep 2020; 20:51. [PMID: 32930896 DOI: 10.1007/s11910-020-01071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses. RECENT FINDINGS Retinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal ischemia, acute macular neuroretinopathy, Acute zonal occult outer retinopathy (AZOOR) complex diseases, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophthalmic imaging including optical coherence tomography and fundus autofluorescence imaging. Looking into the future, translation of adaptive optics ophthalmoscopy into clinical practice may facilitate early detection of microscopic retinal abnormalities that characterize these conditions. With conventional methods of physical examination, diagnosis of retinal diseases that may masquerade as neurological causes of vision loss can be challenging. Current advance in multimodal ophthalmic imaging along with electrophysiologic studies enhances the provider's ability to make early diagnosis and monitor progression of these conditions.
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Azar G, Wolff B, Azam S, Mauget-Faÿsse M. Acute syphilitic posterior placoid chorioretinopathy presenting as atypical multiple evanescent white dot syndrome. Eur J Ophthalmol 2020; 31:NP141-NP144. [PMID: 32878455 DOI: 10.1177/1120672120957589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This paper reports the case of a young man who presented with syphilis masquerading as multiple evanescent white dots syndrome (MEWDS), which turned out to be an acute syphilitic posterior placoid chorioretinopathy (ASPPC) during follow-up. CASE PRESENTATION A 59-year-old healthy male consulted for a three days' history of visual impairment in both eyes. On multimodal imaging, he was diagnosed as MEWDS. Fundus fluorescein angiography (FFA) showed early peripheral bilateral granular hyperfluorescence that correlated with the yellow-white dots found on fundus exam. Indocyanine green angiography (ICGA) depicted hypofluorescent dots on late phase. Spectral-domain optical coherence tomography (SD-OCT) revealed numerous inner retinal highly reflective deposits in the outer nuclear layer and disruption of the ellipsoid zone. After initial improvement, he presented again for a sudden visual loss at 3 weeks. FFA, ICGA and SD-OCT demonstrated the same but more numerous and outer lesions suggesting an ASPPC. A full inflammatory work-up revealed highly positive titers of rapid plasma regain (RPR) and fluorescent treponemal antibody absorption (FTA-Abs), suggesting a syphilis infection. The ophthalmological manifestations dramatically improved after the patient was admitted for high-dose intravenous penicillin G 24 million per day for 2 weeks. CONCLUSION This is the first case that reports an ocular syphilitic infection masquerading as MEWDS at presentation and that turns to be an ASPPC. Syphilis serology should be routinely done in every case of atypical MEWDS especially when unusually presented in a young healthy man, with bilateral involvement and a bad clinical evolution.
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Affiliation(s)
- Georges Azar
- Eye & Ear Hospital International, Beirut, Lebanon.,Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Benjamin Wolff
- Fondation Ophtalmologique Adolphe de Rothschild, Service du Professeur Sahel, Paris, France
| | - Stéphane Azam
- Fondation Ophtalmologique Adolphe de Rothschild, Service du Professeur Sahel, Paris, France
| | - Martine Mauget-Faÿsse
- Fondation Ophtalmologique Adolphe de Rothschild, Service du Professeur Sahel, Paris, France
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Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis. Int Ophthalmol 2020; 41:211-219. [PMID: 32875361 DOI: 10.1007/s10792-020-01569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe two distinct presentations of syphilitic fundus features in a series of patients with ocular syphilis. METHODS This is a retrospective, interventional case series of 22 eyes from 16 serology confirmed cases. Clinical examination, fluorescein angiography, and optical coherence tomography were performed at presentation and following high-dose intravenous penicillin G. RESULTS In our cohort, the mean age was 47.6 years (range 24-59 years) and 14 patients were male (87.5%), 11 patients were positive for human immunodeficiency virus (68.8%), and 6 had bilateral involvement (37.5%). Mean best-corrected visual acuity improved from 0.99 ± 0.79 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation to 0.29 ± 0.36 LogMAR on final visit (P < 0.01). Posterior segment examinations in eyes with retinitis showed two distinct types (1) discrete, placoid lesions in the macula consistent with acute syphilitic posterior placoid chorioretinitis or (2) punctate inner retinitis with corresponding fluorescein pooling in a segmental pattern. These findings rapidly resolved after antibiotic therapy. CONCLUSION In the era of resurgence, ocular syphilis may present with two phenotypes of discrete retinal lesions. Recognition of the characteristic ocular features may help make the diagnosis and monitor treatment response.
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Pichi F, Salas EC, D de Smet M, Gupta V, Zierhut M, Munk MR. Standardisation of optical coherence tomography angiography nomenclature in uveitis: first survey results. Br J Ophthalmol 2020; 105:941-947. [DOI: 10.1136/bjophthalmol-2020-316881] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
AimTo standardise the nomenclature for reporting optical coherence angiography (OCT-A) findings in the field of uveitis.MethodsMembers of the International Uveitis Study Group, of the American Uveitis Society and of the Sociedad Panamericana de Infermedades Oculares that choose to participate responded to an online questionnaire about their preferred terminology when reporting on OCT-A findings in uveitis. The response of individuals with several publications on OCT-A (experts) was compared with uveitis specialists (users) who have less than five publications on the field of uveitis and OCT-A.ResultsA total of 108 uveitis specialists who participated in the survey were included in the analysis. Of those, 23 were considered OCT-A ‘experts’. There was an agreement in both groups for the definition of wide-field (WF)-OCT-A, and definition of neovascularisation in uveitis. Moreover, there was a difference in the responses in other areas, such as quantification of ischaemia, definition of ‘large’ areas of ischaemia or terms to describe decreased OCT-A signal from different causes. There was an unanimous need of ‘users’ and ‘experts’ to distinguish size of decreased OCT-A signal in uveitis, to implement a quantitative measurement of decreased flow specifically for WF-OCT-A and to use different terms for different causes of decreased OCT-A signal.ConclusionsWhile there was considerable agreement in the terminology used by all uveitis experts, significant differences in terminology were noted between ‘users’ and ‘experts’. These differences indicate the need for standardisation of nomenclature among all uveitis specialists both for the purpose of reporting and in clinical use.
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