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Mazzeo TJMM, Cristina Mendonça Freire R, Guimarães Machado C, Gomes AMV, Curi ALL. Vitreoretinal Surgery in Uveitis: From Old to New Concepts - A Review. Ocul Immunol Inflamm 2024; 32:740-753. [PMID: 37093650 DOI: 10.1080/09273948.2023.2193842] [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: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this article is to do a comprehensive literature review about the current role of pars plana vitrectomy in uveitis and in its different structural complications such as cystoid macular edema, epiretinal membrane, macular hole, and retinal detachment. METHODS This comprehensive literature review was performed based on a search on PubMed, BioMed Central, Science Open, and CORE databases, of relevant articles abording pars plana vitrectomy in uveitis. DISCUSSION Uveitis is a complex disease with multiple etiologies and pathogenic mechanisms. Therapeutic pars plana vitrectomy (PPV) may aid in uveitic structural complications such as cystoid macular edema, epiretinal membranes, macular hole, and retinal detachments even though some cases may present unpredictable visual outcomes. Diagnostic PPV with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients. CONCLUSION Over the years, pars plana vitrectomy has undergone significant transformations since its invention nearly 5 decades ago, however, the quality of evidence in the literature regarding its use for uveitis has not improved in the same way. Even though some structural uveitis complications (as previously mentioned) may respond well to surgery, there is still a certain unpredictability regarding its visual outcomes. On the other hand, diagnostic vitrectomy with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients.
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Affiliation(s)
| | | | - Cleide Guimarães Machado
- Retina and Vitreous Department, Suel Abujamra Institute, São Paulo, Brazil
- Retina and Vitreous Department, University of São Paulo (USP), São Paulo, Brazil
| | | | - André Luiz Land Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases (INI - Fiocruz), Rio de Janeiro, Brazil
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Khieu C, Chanthan D. Novel approach to Behçet's disease in the era of biologic agents. Curr Opin Ophthalmol 2023; 34:535-542. [PMID: 37610430 DOI: 10.1097/icu.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE This review aims to provide better understanding of modern modalities to investigate ocular symptoms of Behçet's disease in order to achieve appropriate management protocols and reduce irreversible visual loss. RELEVANT FINDINGS Current methods of diagnosing intraocular involvement in Behçet's disease gives clue to early diagnosis. In addition to standard ocular examination and fluorescein angiography, new noninvasive methods include ocular coherence tomography (OCT) and OCT angiography provide early detection of macular and retinal involvement that can be treated early to improve the prognosis. SUMMARY Over the last decade, new multimodal imagings are becoming more accessible; therefore, rapid diagnosis can be made. In addition to newer approved biologic agents, ocular Behçet's disease is seen to be in better controlled with fewer complications.
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Affiliation(s)
- Chansathya Khieu
- Department of Ophthalmology, Khmer-Soviet Friendship Hospital, Phnom Penh, Cambodia
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Zhong Z, Su G, Yang P. Risk factors, clinical features and treatment of Behçet's disease uveitis. Prog Retin Eye Res 2023; 97:101216. [PMID: 37734442 DOI: 10.1016/j.preteyeres.2023.101216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
Behçet's disease is a systemic vasculitis frequently associated with intraocular inflammation. Recent findings identified independent clinical clusters in Behçet's disease, each involving distinct combinations of affected organs. Ocular Behçet's disease, mainly manifested as uveitis, is characterized as an independent cluster with a low likelihood of association with other system involvements, such as intestinal, cardiovascular, or central nervous system. A prevailing theory suggests that the pathogenesis of the disease is multifactorial, where a variety of genetic and infectious agents may interact with each other to cause the disease. Among sporadic cases, the human leukocyte antigen (HLA) genes, including HLA-B51, HLA-A26, HLA-B15, and HLA-B5701, have been found to be a key component conferring genetic susceptibility. Outside the HLA region, a set of susceptibility variants are identified, closely related to interleukin (IL)-23/IL-17 pathway, tumor necrosis factor (TNF) signaling, and pattern recognition receptor systems. Microbial infections, such as Streptococcus sanguinis, Mycobacterium tuberculosis, and Herpes simplex virus (HSV), are linked to play the triggering of disease in immunogenetically predisposed individuals. Clinically, due to the notable relapsing-remitting course of ocular Behçet's disease, the prevention of recurrent attack would be the primary treatment goal. Combination of corticosteroids and immunomodulatory drugs, such as anti-TNF agents, interferon, and conventional immunosuppressants (e.g. cyclosporine, azathioprine), have been the mainstream regimen for the disease. Future research may focus on comparing the effectiveness of immunomodulatory drugs and identifying the most suitable subgroups for a specific drug on the basis of the knowledge of the molecular heterogeneity of the disease.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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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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Alsarhani WK, Saifaldein AA, Abu El-Asrar AM. A novel mechanism of macular holes in patients with Behçet's uveitis. Saudi J Ophthalmol 2022; 36:394-396. [PMID: 36618576 PMCID: PMC9811925 DOI: 10.4103/sjopt.sjopt_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023] Open
Abstract
To describe two cases of Behçet's retinitis lesions in the macula causing sloughing of retinal tissue forming a full-thickness macular hole. This was a case series study. Case 1 was a 26-year-old presented, known case of Behçet's disease, presented with a large area of retinitis involving the center of the macula with overlying vitritis. One day after the initiation of treatment, vitritis improved, but the retinitis patch sloughed and created a full-thickness macular hole. Case 2 was a 31-year-old male, known case of Behçet's uveitis, who presented vitritis and multiple retinitis patches involving the macula of the left eye. Two weeks after infliximab infusion, the inflammation resolved with medical management, however, the retinitis patch was complicated by a full-thickness macular hole with an inferior rhegmatogenous retinal detachment. Retinitis at the macula can be complicated by a full-thickness macular hole.
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Affiliation(s)
- Waleed K. Alsarhani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amjad A. Saifaldein
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M. Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Prof. Ahmed M. Abu El-Asrar, Department of Ophthalmology, College of Medicine, King Saud University, P. O. Box: 245, Riyadh 11411, Saudi Arabia. E-mail:
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A Comprehensive Update on Retinal Vasculitis: Etiologies, Manifestations and Treatments. J Clin Med 2022; 11:jcm11092525. [PMID: 35566655 PMCID: PMC9101900 DOI: 10.3390/jcm11092525] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/18/2022] Open
Abstract
Retinal vasculitis is characterized by inflammatory involvement of retinal arterioles, venules and/or capillaries and can be associated with a myriad of systemic and ophthalmic diseases. In this review, we have comprehensively discussed the etiologies, clinical manifestations, and presentations of retinal vasculitis. We have also included newer advances in imaging in retinal vasculitis such as OCTA and widefield imaging.
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Khochtali S, Tugal-Tutkun I, Fardeau C, Maestri F, Khairallah M. Multimodality Approach to the Diagnosis and Assessment of Uveitic Macular Edema. Ocul Immunol Inflamm 2020; 28:1212-1222. [DOI: 10.1080/09273948.2020.1797112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Christine Fardeau
- Ophthalmology Department, Reference Centre for Rare Diseases, Pitié-Salpétrière Hospital, University Paris VI, DHU Sight Restore, Paris, France
| | - Federico Maestri
- Ophthalmology Department, Reference Centre for Rare Diseases, Pitié-Salpétrière Hospital, University Paris VI, DHU Sight Restore, Paris, France
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Yalçındağ FN, Temel E, Şekkeli MZ, Kar İ. Macular structural changes and factors affecting final visual acuity in patients with Behçet uveitis. Graefes Arch Clin Exp Ophthalmol 2020; 259:715-721. [PMID: 33037921 DOI: 10.1007/s00417-020-04958-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate macular structural changes during the active and remission periods in patients with Behçet uveitis and to further assess the factors affecting final visual acuity. METHODS Clinical records and spectral domain-optical coherence tomography (SD-OCT) findings of patients with Behçet uveitis were retrospectively reviewed. RESULTS Sixty-nine eyes of 35 patients were included in the study. SD-OCT findings in the active uveitis period included epiretinal membrane (ERM) in 26 (37.1%) eyes, ellipsoid zone (EZ) damage in 11 (15.7%), external limiting membrane (ELM) damage in 10 (14.3%), macular atrophy in 6 (8.6%), disruption of retinal pigment epithelium (RPE) in 11 (15.7%), a macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 15 (21.4%). There was macular edema in 23 eyes (32.9%) in the active uveitis period (11 (15.7%) cystoid macular edema, 10 (14.3%) diffuse macular edema, and 7 (10.0%) serous retinal detachment). In the remission period, SD-OCT findings included ERM in 37 (52.9%) eyes, EZ damage in 14 (20%), ELM damage in 14 (20%), macular atrophy in 7 (10%), disruption of RPE in 14 (20.0%), macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 17 (24.3%). The mean central macular thickness in the remission period was significantly lower than in the active uveitis period (p < 0.001). The presence of EZ damage and loss of normal foveal contour appearance in active uveitis period were the independent factors associated with final visual acuity (logMAR) (β = 0.736, p = 0.003; β = 0.682, p = 0.002, respectively). CONCLUSION Ellipsoid zone damage and loss of normal foveal contour appearance are important factors affecting visual acuity in Behçet uveitis.
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Affiliation(s)
- F Nilüfer Yalçındağ
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, 06620, Ankara, Turkey
| | - Emine Temel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, 06620, Ankara, Turkey.
| | - Mehmet Zahid Şekkeli
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, 06620, Ankara, Turkey
| | - İrem Kar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
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Abstract
PURPOSE To study the etiology, clinical features, management options, and visual prognosis in various types of atypical macular holes (MHs). METHODS A review of the literature was performed, which focused on the etiopathogenesis of atypical or secondary MHs, their differentiating clinical features, management strategies, and varied clinical outcomes. Idiopathic or age-related, myopic, and traumatic MHs were excluded. RESULTS Atypical or secondary MHs arise out of concurrent ocular pathologies (dystrophy, degeneration, or infections) and laser/surgery. The contributing factors may be similar to those responsible for idiopathic or typical MHs, i.e., tangential or anteroposterior vitreofoveal traction or cystoid degeneration. The management is either observation or treatment of the underlying cause. The prognosis depends on the background pathology, duration of disease, and baseline visual acuity governed by the size of MH and morphologic health of underlying RPE and photoreceptors. The closer the morphology of atypical MH is to that of an idiopathic MH, the better the surgical outcome is. CONCLUSION With the advancements in retinal imaging, atypical MHs are now more frequently recognized. With increasing understanding of the underlying disease processes, and improvement in investigations and surgical treatment, management of atypical MHs may improve in the future.
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Furundaoturan O, Barış M, Yılmaz S. A surprising intravitreal injection attempt: Ozurdex™ implantation for Behçet's disease. Indian J Ophthalmol 2020; 68:2634-2635. [PMID: 33120722 PMCID: PMC7774210 DOI: 10.4103/ijo.ijo_2241_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Türkcü FM, Şahin A, Karaalp Ü, Çınar Y, Şahin M, Özkurt ZG, Keklikçi U. Automated quantification of foveal avascular zone and vascular density in Behçet's disease. Ir J Med Sci 2019; 189:349-354. [PMID: 31267410 DOI: 10.1007/s11845-019-02051-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/20/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To measure the vascular density (VD) and foveal avascular zone (FAZ) area in patients with Behçet's disease (BD) obtained by optical coherence tomography angiography (OCTA). METHODS VD and FAZ area in the deep and superficial retinal vascular networks were measured in all eyes. RESULTS Thirty BD and 31 control subjects were included in the study. The mean overall VD measured in the entire scan was lower in BD compared with control group in both the superficial (49.52 ± 6.54 vs 53.57 ± 2.87%, respectively; p = 0.003) and deep (53.44 ± 7.44 vs 58.41 ± 3.01%, respectively; p = 0.002) areas. The FAZ in the BD group was significantly increased at the level of the superficial (0.52 ± 0.67 vs 0.28 ± 0.1 mm2, respectively; p = 0.05) and deep (0.91 ± 1.25 vs 0.39 ± 0.14 mm2, respectively; p = 0.024) areas compared with those of the control group. The deep and the superficial FAZ areas were positively correlated with disease duration and negatively with VA. CONCLUSION In the patients with BD, OCTA showed decreased VD in both the superficial and deep retinal vascular networks. Besides, the VA was correlated with the VD and FAZ.
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Affiliation(s)
| | - Alparslan Şahin
- Department of Ophthalmology, Batman Zilan Hospital, Batman, Turkey
| | - Ümit Karaalp
- Department of Ophthalmology, Batman State Hospital, Batman, Turkey
| | - Yasin Çınar
- School of Medicine, Department of Ophthalmology, Dicle University, Diyarbakir, Turkey
| | - Muhammed Şahin
- School of Medicine, Department of Ophthalmology, Dicle University, Diyarbakir, Turkey.
| | - Zeynep Gürsel Özkurt
- School of Medicine, Department of Ophthalmology, Dicle University, Diyarbakir, Turkey
| | - Uğur Keklikçi
- School of Medicine, Department of Ophthalmology, Dicle University, Diyarbakir, Turkey
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Ksiaa I, Abroug N, Kechida M, Zina S, Jelliti B, Khochtali S, Attia S, Khairallah M. Œil et maladie de Behçet. J Fr Ophtalmol 2019; 42:626-641. [DOI: 10.1016/j.jfo.2018.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 09/03/2018] [Indexed: 12/30/2022]
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Eye and Behçet's disease. J Fr Ophtalmol 2019; 42:e133-e146. [DOI: 10.1016/j.jfo.2019.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 12/25/2018] [Accepted: 02/07/2019] [Indexed: 12/30/2022]
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Branson SV, McClafferty BR, Kurup SK. Vitrectomy for Epiretinal Membranes and Macular Holes in Uveitis Patients. J Ocul Pharmacol Ther 2017; 33:298-303. [PMID: 28112568 DOI: 10.1089/jop.2016.0142] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Macular pathology, including macular holes (MHs), epiretinal membranes (ERMs), and macular edema, is a cause of irreversible vision loss in the setting of uveitis. Medical management involves corticosteroids, immunomodulatory medications, and biologics to control inflammation. Pars plana vitrectomy (PPV) has been suggested as a therapy for uveitis, with reports of reduced inflammation and decreased dependence on medication postoperatively. Currently, PPV is reserved for retinal detachments, vitreous opacities, and ERMs, causing vitreomacular traction. However, little is known about the visual outcomes of PPV with ERM peel for MH, or in ERM without evidence of traction in the context of uveitis. METHODS Review of small case series and case reports support both conservative medical treatment and vitrectomy, independently, and in combination, in the management of macular pathology in the setting of uveitis. RESULTS AND CONCLUSIONS Further studies are required to study uveitic etiologies separately with respect to visual outcomes after vitreoretinal surgery and medical management.
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Affiliation(s)
- Sara V Branson
- 1 Ophthalmology Department, Emory University School of Medicine , Atlanta, Georgia
| | - Brendan R McClafferty
- 2 Departments of Ophthalmology and Family Medicine, Wake Forest University , Winston-Salem, North Carolina
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Ghassemi F, Mirak SA, Chams H, Sabour S, Ahmadabadi MN, Davatchi F, Shahram F. Characteristics of Macular Edema in Behcet Disease after Intravitreal Bevacizumab Injection. J Ophthalmic Vis Res 2017; 12:44-52. [PMID: 28299006 PMCID: PMC5340063 DOI: 10.4103/jovr.jovr_254_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: To investigate the effect of intravitreal bevacizumab (IVB) injection on macular edema (ME) secondary to Behcet's disease. Methods: This prospective case series included 15 patients with bilateral ME due to Behcet's disease. Intravitreal bevacizumab was injected into the more severely involved eye; the contralateral eye was evaluated as the control. Patients were followed up with comprehensive ocular examination, optical coherence tomography, and fluorescein angiography (FA) for a minimum of 6 months by a single ophthalmologist. Results: Patients with a mean age of 30.6 ± 7.4 years received a mean number of 3.3 IVB injections during the 6 months. The mean preinjection vision was 0.6 ± 0.3 and 0.4 ± 0.4 LogMAR in the case and control groups, respectively, with no significant improvement at 6 months. Mean central foveal thickness was 375.3 ± 132.1 and 307.2 ± 84.5 μm in the case and control groups, respectively, and these changed to 401 ± 199.9 (P = 0.65) and 307.7 ± 82.8 μm (P = 0.73) at month 6, respectively. A statistically nonsignificant improvement in ME was observed during the first 3 months in the case group. However, it did not persist up to month 6 on an as-needed basis. IVB injections caused a disproportionate decrease in the thickness of macular subfields. A reduction in disc leakage was observed on FA (P = 0.058). Logistic regression analysis revealed no statistically significant predictive factor for an improvement in visual acuity (VA) and a reduction in foveal thickness. Conclusion: During a 6-month period, IVB injections based on an as-needed protocol provided no statistically significant improvement in VA and ME.
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Affiliation(s)
- Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; The Retina and vitreous surgery service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sohrab Afshari Mirak
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hormoz Chams
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; The Retina and vitreous surgery service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Sabour
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Nilli Ahmadabadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; The Retina and vitreous surgery service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Davatchi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shahram
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ischemic retinal vasculitis and its management. J Ophthalmol 2014; 2014:197675. [PMID: 24839552 PMCID: PMC4009272 DOI: 10.1155/2014/197675] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/21/2014] [Accepted: 03/25/2014] [Indexed: 12/14/2022] Open
Abstract
Ischemic retinal vasculitis is an inflammation of retinal blood vessels associated with vascular occlusion and subsequent retinal hypoperfusion. It can cause visual loss secondary to macular ischemia, macular edema, and neovascularization leading to vitreous hemorrhage, fibrovascular proliferation, and tractional retinal detachment. Ischemic retinal vasculitis can be idiopathic or secondary to systemic disease such as in Behçet's disease, sarcoidosis, tuberculosis, multiple sclerosis, and systemic lupus erythematosus. Corticosteroids with or without immunosuppressive medication are the mainstay treatment in retinal vasculitis together with laser photocoagulation of retinal ischemic areas. Intravitreal injections of bevacizumab are used to treat neovascularization secondary to systemic lupus erythematosus but should be timed with retinal laser photocoagulation to prevent further progression of retinal ischemia. Antitumor necrosis factor agents have shown promising results in controlling refractory retinal vasculitis excluding multiple sclerosis. Interferon has been useful to control inflammation and induce neovascular regression in retinal vasculitis secondary to Behçet's disease and multiple sclerosis. The long term effect of these management strategies in preventing the progression of retinal ischemia and preserving vision is not well understood and needs to be further studied.
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Uçar D, Atalay E, Özyazgan Y, Özkök A, Yıldırım Y. An Exceptional Case of Full-thickness Macular Hole Closure in a Patient with Behçet Disease. Ocul Immunol Inflamm 2013; 22:79-81. [DOI: 10.3109/09273948.2013.829107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bonnin N, Cornut PL, Chaise F, Labeille E, Manificat HJ, Feldman A, Perard L, Bacin F, Chiambaretta F, Burillon C. Spontaneous closure of macular holes secondary to posterior uveitis: case series and a literature review. J Ophthalmic Inflamm Infect 2013; 3:34. [PMID: 23514634 PMCID: PMC3605119 DOI: 10.1186/1869-5760-3-34] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/25/2013] [Indexed: 12/25/2022] Open
Abstract
The occurrence of a macular hole due to posterior uveitis is infrequently reported. We report the evolution of three cases of macular holes secondary to posterior segment inflammation. A complete inflammatory and infectious assessment found one case of toxocariasis, one of sarcoidosis, and one of syphilis. After medical etiological treatment, macular hole closure was rapidly obtained in all the cases and confirmed by spectral domain optic coherence tomography, with visual acuity improvement. Fibrous scarring developed in two cases, and foveal photoreceptor complex normalization was observed in the sarcoidosis case. These observations demonstrate that macular holes secondary to posterior uveitis frequently resolve without surgical intervention and so could be underdiagnosed if the patient is not evaluated at the time of onset before spontaneous hole closure.
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Affiliation(s)
- Nicolas Bonnin
- Service d'Ophtalmologie, Pôle Médecine Interne-Ophtalmologie-ORL, CHU Clermont-Ferrand, Clermont-Ferrand, 63003, France
| | - Pierre-Loïc Cornut
- Department of Ophthalmology, Hospices Civils de Lyon, University Hospital, Claude Bernard Lyon I University, Lyon, 69008, France
| | - Florian Chaise
- Department of Ophthalmology, Hospices Civils de Lyon, University Hospital, Claude Bernard Lyon I University, Lyon, 69008, France
| | - Elodie Labeille
- Department of Ophthalmology, Hospices Civils de Lyon, University Hospital, Claude Bernard Lyon I University, Lyon, 69008, France
| | - Helene Janin Manificat
- Department of Ophthalmology, Hospices Civils de Lyon, University Hospital, Claude Bernard Lyon I University, Lyon, 69008, France
| | - Audrey Feldman
- Department of Ophthalmology, Hospices Civils de Lyon, University Hospital, Claude Bernard Lyon I University, Lyon, 69008, France
| | - Laurent Perard
- Department of Internal Medicine, Edouard-Herriot Hospital, place d'Arsonval, Lyon, 69008, France
| | - Franck Bacin
- Service d'Ophtalmologie, Pôle Médecine Interne-Ophtalmologie-ORL, CHU Clermont-Ferrand, Clermont-Ferrand, 63003, France
| | - Frédéric Chiambaretta
- Service d'Ophtalmologie, Pôle Médecine Interne-Ophtalmologie-ORL, CHU Clermont-Ferrand, Clermont-Ferrand, 63003, France
| | - Carole Burillon
- Department of Ophthalmology, Hospices Civils de Lyon, University Hospital, Claude Bernard Lyon I University, Lyon, 69008, France
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Khairallah M, Ben Yahia S, Kahloun R, Khairallah-Ksiaa I, Messaoud R. Œil et maladie de Behçet. J Fr Ophtalmol 2012; 35:826-37. [DOI: 10.1016/j.jfo.2012.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/23/2012] [Accepted: 06/25/2012] [Indexed: 01/01/2023]
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