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Thawley J, Colbert C, Eilbert W. Acute retinal necrosis. Am J Emerg Med 2024; 82:216.e1-216.e3. [PMID: 38806298 DOI: 10.1016/j.ajem.2024.05.017] [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: 03/22/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
Acute retinal necrosis (ARN) is a rare, progressive viral uveitis, with the majority of cases caused by herpesviruses. The diagnosis of ARN is often delayed, and most patients will have some degree of permanent visual loss. We report a case of ARN in a previously healthy 32-year-old patient.
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Affiliation(s)
- Jessica Thawley
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469 COME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
| | - Christopher Colbert
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469 COME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
| | - Wesley Eilbert
- Department of Emergency Medicine, University of Illinois Chicago, College of Medicine, Room 469 COME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
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Wang Y, Yang Z, Guo X, Jin W, Lin D, Chen A, Zhou M. Automated early detection of acute retinal necrosis from ultra-widefield color fundus photography using deep learning. EYE AND VISION (LONDON, ENGLAND) 2024; 11:27. [PMID: 39085922 PMCID: PMC11293155 DOI: 10.1186/s40662-024-00396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Acute retinal necrosis (ARN) is a relatively rare but highly damaging and potentially sight-threatening type of uveitis caused by infection with the human herpesvirus. Without timely diagnosis and appropriate treatment, ARN can lead to severe vision loss. We aimed to develop a deep learning framework to distinguish ARN from other types of intermediate, posterior, and panuveitis using ultra-widefield color fundus photography (UWFCFP). METHODS We conducted a two-center retrospective discovery and validation study to develop and validate a deep learning model called DeepDrARN for automatic uveitis detection and differentiation of ARN from other uveitis types using 11,508 UWFCFPs from 1,112 participants. Model performance was evaluated with the area under the receiver operating characteristic curve (AUROC), the area under the precision and recall curves (AUPR), sensitivity and specificity, and compared with seven ophthalmologists. RESULTS DeepDrARN for uveitis screening achieved an AUROC of 0.996 (95% CI: 0.994-0.999) in the internal validation cohort and demonstrated good generalizability with an AUROC of 0.973 (95% CI: 0.956-0.990) in the external validation cohort. DeepDrARN also demonstrated excellent predictive ability in distinguishing ARN from other types of uveitis with AUROCs of 0.960 (95% CI: 0.943-0.977) and 0.971 (95% CI: 0.956-0.986) in the internal and external validation cohorts. DeepDrARN was also tested in the differentiation of ARN, non-ARN uveitis (NAU) and normal subjects, with sensitivities of 88.9% and 78.7% and specificities of 93.8% and 89.1% in the internal and external validation cohorts, respectively. The performance of DeepDrARN is comparable to that of ophthalmologists and even exceeds the average accuracy of seven ophthalmologists, showing an improvement of 6.57% in uveitis screening and 11.14% in ARN identification. CONCLUSIONS Our study demonstrates the feasibility of deep learning algorithms in enabling early detection, reducing treatment delays, and improving outcomes for ARN patients.
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Affiliation(s)
- Yuqin Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Zijian Yang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xingneng Guo
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wang Jin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Dan Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Anying Chen
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, 315042, China
| | - Meng Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Ray IK, Sobrin L, Moorthy R, Yeh S, Thorne JE, Shantha JG. Common Practice Patterns in the Diagnosis and Management of Acute Retinal Necrosis: A Survey Study of Uveitis Specialists. Ocul Immunol Inflamm 2024:1-7. [PMID: 39074351 DOI: 10.1080/09273948.2024.2380902] [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: 05/30/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Due to lack of large randomized clinical trials to determine best practices in treating acute retinal necrosis (ARN), there is not a clear consensus amongst ophthalmologists on how to best manage this potentially blinding condition. The aim of this study is to survey common practice patterns and analyze the factors that affect ophthalmologists' management of ARN. METHODS An anonymous survey was distributed to uveitis and retina specialists who are members of the American Uveitis Society (AUS) via email to query practice patterns regarding ARN. The survey included 22 questions with an additional 10 questions based on response. Survey question topics included demographic information, diagnostic testing, antiviral therapy, corticosteroids, and surgical procedures. RESULTS 67 surveys were included for analysis. Most respondents (87%) always or frequently obtain intraocular aqueous fluid for diagnostic PCR testing. The majority of respondents would administer intravitreal antiviral injections to a unilateral immunocompetent ARN patient (67%), but would be even more likely to do so for a bilateral immunosuppressed ARN patient (87%). Respondents tend to treat ARN with systemic rather than local corticosteroids, with the majority (63%) of respondents initiating corticosteroid treatment 48 hours after treatment. Most respondents (79%) never perform a vitrectomy to manage ARN unless the patient has a retinal detachment or tear. The majority (63%) rarely or never perform prophylactic laser barricade, but may consider laser treatment if there is extensive retinal involvement. CONCLUSION Current practice patterns for diagnosis and management of ARN among AUS members generally align with the suggested practices outlined by the American Academy of Ophthalmology.
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Affiliation(s)
- Isabel K Ray
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ramana Moorthy
- AVRUC - Retina Consultants of America, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Truhlsen Eye Institute, Omaha, Nebraska, USA
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica G Shantha
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
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4
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Zhang H, Duan Y, Chen Z. Toxoplasma gondii infection or acute retinal necrosis in early stage: a case report. Int J Antimicrob Agents 2024:107280. [PMID: 39047912 DOI: 10.1016/j.ijantimicag.2024.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/03/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Hainan Zhang
- Changsha Aier Eye Hospital, Furong South Road, Changsha, CN, CHINA
| | - Yiqin Duan
- Changsha Aier Eye Hospital, Furong South Road, Changsha, CN, CHINA.
| | - Zhongping Chen
- Changsha Aier Eye Hospital, Furong South Road, Changsha, CN, CHINA
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Kalogeropoulos D, Afshar F, Kalogeropoulos C, Vartholomatos G, Lotery AJ. Diagnostic and therapeutic challenges in acute retinal necrosis; an update. Eye (Lond) 2024; 38:1816-1826. [PMID: 38519714 PMCID: PMC11226642 DOI: 10.1038/s41433-024-03028-x] [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: 05/12/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
Acute retinal necrosis (ARN) is a rare but severe ophthalmic pathology defined by panuveitis, retinal necrosis, and high rates of retinal detachment. ARN may lead to poor visual outcomes even if promptly diagnosed and treated. ARN may present with a wide spectrum of clinical findings compatible with panuveitis including anterior uveitis, scleritis, vitritis, necrotizing retinitis, occlusive vasculitis, and optic disc edema. The American Uveitis Society introduced clinical criteria in 1994 for the diagnosis of ARN, while more recent criteria have been proposed by the Standardization of Uveitis Nomenclature (SUN) Working Group and the Japanese ARN Study Group. Multimodal imaging is a valuable tool in evaluating patients with ARN, particularly in unusual cases, while utilizing retinal imaging and applying AI algorithms in these areas of clinical research could be highly beneficial. Over the last few years, significant progress has been made in achieving timely diagnosis and treatment. The precise identification of the viral cause in suspected ARN cases has been greatly enhanced by the advancements in PCR techniques and flow cytometry used for intraocular fluids. systemic (intravenous or oral) antivirals with adjunctive intravitreal antiviral therapy are recommended as first-line therapy to reduce disease severity, the risk of vision loss, and retinal detachment incidence. Although aciclovir was the first existing antiviral agent, at present many clinicians prefer high-dose valaciclovir orally or intravenous aciclovir combined with intravitreal foscarnet. Despite significant progress in diagnosing and treating ARN, further research is needed to improve visual outcomes in this challenging clinical condition.
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Affiliation(s)
| | - Farid Afshar
- Southampton Eye Unit, University Hospital Southampton, Southampton, UK
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Andrew John Lotery
- Southampton Eye Unit, University Hospital Southampton, Southampton, UK.
- Faculty of Medicine, University of Southampton, Southampton, UK.
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Mimura T, Mizota A, Watanabe E, Terauchi G, Kawashima M, Inoue Y. A Single-Center Case Series of Acute Retinal Necrosis at Teikyo University: Clinical Characteristics and Treatment Outcomes. Cureus 2024; 16:e62343. [PMID: 39011222 PMCID: PMC11247251 DOI: 10.7759/cureus.62343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 07/17/2024] Open
Abstract
Aim To evaluate the clinical characteristics, treatment course, and prognosis of patients with acute retinal necrosis (ARN), which can rapidly progress and cause severe vision loss. Design Single-center retrospective case series. Subjects and methods Six patients and seven eyes diagnosed with ARN at Teikyo University Hospital were included in this study. The clinical presentation and treatment prognosis were investigated based on data obtained from medical records. Results The mean age of the patients at the initial diagnosis was 63.6 years. Although the mean Logarithm of the Minimum Angle of Resolution (LogMAR) visual acuity tended to decrease from 0.77 at the first visit to 1.29 at the last visit, the difference was not statistically significant. Intraocular manifestations observed during the study period included ocular hypertension (14.3%), anterior uveitis (100.0%), retinal hemorrhage (71.4%), vitreous opacity (100.0%), retinal exudative vasculitis (85.7%), optic nerve atrophy (85.7%), retinal vascular occlusion (85.7%), choroidal atrophy (85.7%), macular edema (100.0%), subretinal fluid in the macula (71.4%), and retinal detachment (85.7%). Treatment modalities included oral and intravitreal antivirals (85.7%), antiplatelet medications (85.7%), steroid eye drops (85.7%), subcapsular (57.1%) and vitreous (42.9%) steroid injections, oral steroids (71.4%), and surgical intervention (85.7%). Vitrectomy led to retinal recovery in all five eyes that underwent the procedure. Conclusions The visual prognosis of patients with ARN is poor, particularly in those with preexisting visual impairment. Early detection coupled with antiviral therapy and prompt surgical intervention have been identified as potential factors that influence visual outcomes. Given the severity of ARN, collecting data from multiple centers could aid in devising future diagnostic and therapeutic strategies.
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Affiliation(s)
- Tatsuya Mimura
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN
| | - Atsushi Mizota
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN
- Department of Ophthalmology, Nishikasai Inouye Eye Hospital, Tokyo, JPN
| | - Emiko Watanabe
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN
- Department of Ophthalmology, Nishikasai Inouye Eye Hospital, Tokyo, JPN
| | - Gaku Terauchi
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN
| | - Makoto Kawashima
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN
| | - Yuji Inoue
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, JPN
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Leong E, Cifuentes-González C, Hu Y W J, Perumal Samy R, Khairallah M, Rojas-Carabali W, Putera I, de-la-Torre A, Agrawal R. Clinical Insights: Antimicrobial Therapy for Infectious Uveitis. Ocul Immunol Inflamm 2024:1-21. [PMID: 38759216 DOI: 10.1080/09273948.2024.2345848] [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: 08/09/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
Infectious uveitis is a major global cause of vision impairment. Despite the eye's immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection's etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis.
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Affiliation(s)
- Evangeline Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeremy Hu Y W
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ramar Perumal Samy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alejandra de-la-Torre
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Harbeck K, Ericksen C, Johnson W, Massop D, Bracha P. Pachychoroid Associated With Acute Retinal Necrosis Secondary to Varicella Zoster Virus. JOURNAL OF VITREORETINAL DISEASES 2024; 8:196-199. [PMID: 38465350 PMCID: PMC10924601 DOI: 10.1177/24741264241228652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To report a case of pachychoroid associated with acute retinal necrosis secondary to the varicella zoster virus (VZV). Methods: A retrospective review of a single case was performed. Results: The VZV-related acute retinal necrosis with pachychoroid resolved with quiescence of the acute infectious process. Conclusions: Acute retinal necrosis can result in choroidal thickening adjacent to retinitis. Previous reports have described choroidal sparing in these cases.
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Affiliation(s)
- Katherine Harbeck
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
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Ong KTI, Kwon T, Jang H, Kim M, Lee CS, Byeon SH, Kim SS, Yeo J, Choi EY. Multitask Deep Learning for Joint Detection of Necrotizing Viral and Noninfectious Retinitis From Common Blood and Serology Test Data. Invest Ophthalmol Vis Sci 2024; 65:5. [PMID: 38306107 PMCID: PMC10851173 DOI: 10.1167/iovs.65.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose Necrotizing viral retinitis is a serious eye infection that requires immediate treatment to prevent permanent vision loss. Uncertain clinical suspicion can result in delayed diagnosis, inappropriate administration of corticosteroids, or repeated intraocular sampling. To quickly and accurately distinguish between viral and noninfectious retinitis, we aimed to develop deep learning (DL) models solely using noninvasive blood test data. Methods This cross-sectional study trained DL models using common blood and serology test data from 3080 patients (noninfectious uveitis of the posterior segment [NIU-PS] = 2858, acute retinal necrosis [ARN] = 66, cytomegalovirus [CMV], retinitis = 156). Following the development of separate base DL models for ARN and CMV retinitis, multitask learning (MTL) was employed to enable simultaneous discrimination. Advanced MTL models incorporating adversarial training were used to enhance DL feature extraction from the small, imbalanced data. We evaluated model performance, disease-specific important features, and the causal relationship between DL features and detection results. Results The presented models all achieved excellent detection performances, with the adversarial MTL model achieving the highest receiver operating characteristic curves (0.932 for ARN and 0.982 for CMV retinitis). Significant features for ARN detection included varicella-zoster virus (VZV) immunoglobulin M (IgM), herpes simplex virus immunoglobulin G, and neutrophil count, while for CMV retinitis, they encompassed VZV IgM, CMV IgM, and lymphocyte count. The adversarial MTL model exhibited substantial changes in detection outcomes when the key features were contaminated, indicating stronger causality between DL features and detection results. Conclusions The adversarial MTL model, using blood test data, may serve as a reliable adjunct for the expedited diagnosis of ARN, CMV retinitis, and NIU-PS simultaneously in real clinical settings.
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Affiliation(s)
- Kai Tzu-iunn Ong
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Taeyoon Kwon
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Harok Jang
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Yeo
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Liu M, He H, Zhang J, Xin S, Lu Q, Zhang L, Ren W. Retinitis after haematopoietic stem cell transplantation with multiple intraocular viral infections (cytomegalovirus, Epstein‒Barr virus and herpes simplex virus)- a case report. BMC Ophthalmol 2024; 24:38. [PMID: 38267915 PMCID: PMC10809542 DOI: 10.1186/s12886-024-03300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND To report a case of retinitis with multiple intraocular viral infections after second haematopoietic stem cell transplantation. CASE PRESENTATION A 39-year-old female patient developed retinitis after a second haematopoietic stem cell transplant. Right eye was tested for three viral infections- cytomegalovirus, Epstein‒Barr virus and herpes simplex virus, while left was infected with cytomegalovirus. The patient was subsequently treated with vitreous cavity ganciclovir injections, and 1 week later both eyes tested negative for aqueous humour viruses. DISCUSSION AND CONCLUSION CMV, EBV and HSV belong to the herpes virus family. They are all commonly observed in the body and represent opportunity infectious viruses. The retinitis they cause have different characteristics. But simultaneous infection of the eye by multiple viruses is quite rare. In this case, three viruses were detected in the patient's eye, but whether the retina was caused by all three viruses at the same time could not be determined. A satisfactory outcome was achieved after treatment with vitreous cavity ganciclovir injection.
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Affiliation(s)
- Mengyun Liu
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), 315040, Ningbo, People's Republic Of China
| | - Hengqian He
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), 315040, Ningbo, People's Republic Of China
| | - Juntao Zhang
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), 315040, Ningbo, People's Republic Of China
| | - Shuanghua Xin
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), 315040, Ningbo, People's Republic Of China
| | - Qinkang Lu
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), 315040, Ningbo, People's Republic Of China
| | - Lifang Zhang
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), 315040, Ningbo, People's Republic Of China
| | - Weina Ren
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), 315040, Ningbo, People's Republic Of China.
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11
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Wang P, An M, Zhang M, Yan X, Tong N. Acute retinal necrosis in a patient with cervical malignant tumor treated with sintilimab: a case report and literature review. Front Immunol 2024; 15:1301329. [PMID: 38322266 PMCID: PMC10844496 DOI: 10.3389/fimmu.2024.1301329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Acute retinal necrosis (ARN) is an inflammatory disease that is primarily caused by herpesvirus infection, most commonly varicella-zoster virus (VZV), followed by herpes simplex virus (HSV) and occasionally cytomegalovirus (CMV). Sintilimab is an immune checkpoint inhibitor (ICI) that can enhance the body's anti-tumor immune response. However, treatment with ICIs may lead to reactivation of the VZV. Here, we present a case of ARN caused by VZV infection in a patient receiving sintilimab for cervical cancer. A 64-year-old female patient developed vision loss and floaters with left eye redness for one week after 22 cycles of sintilimab for cervical cancer. Based on clinical manifestations, ophthalmological examination, and vitreous humor biopsy, the patient was diagnosed with acute retinal necrosis syndrome secondary to VZV. After receiving systemic antiviral and anti-inflammatory therapy, retinal necrosis lesions and visual function improved. In conclusion, clinicians should be aware of the risk of ARN when using sintilimab and should actively monitor patients for prompt diagnosis and optimal management of this rare adverse drug reaction.
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Affiliation(s)
- Pei Wang
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
- School of Medicine, Qingdao University, Qingdao, Shandong, China
| | - Ming An
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Mengmeng Zhang
- Department of Pathology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Xiaoran Yan
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Nianting Tong
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
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12
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Shiezadeh E, Hosseini SM, Bakhtiari E, Mojarrad A, Motamed Shariati M. Clinical characteristics and management outcomes of acute retinal necrosis. Sci Rep 2023; 13:16927. [PMID: 37805622 PMCID: PMC10560224 DOI: 10.1038/s41598-023-44310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/06/2023] [Indexed: 10/09/2023] Open
Abstract
This study investigates patient's clinical characteristics and management outcomes of PCR-positive Acute Retinal Necrosis (ARN). The patient's clinical characteristics of the disease, and therapeutic approaches were assessed. Data from the medical records of 40 eyes of 40 patients were analyzed. The mean ± standard deviation (SD) of the age of the patients was 47.8 ± 14.1 years (16-84 years old). The median follow-up time was 160 days, with a range of 120-370 days. The mean ± SD of patients' primary and final BCVA was 1.24 ± 0.78 and 1.08 ± 0.86 LogMAR, respectively. The final BCVA increased significantly after the treatment in the last follow-up period in patients who did not undergo PPV (p = 0.029). Although, vision changes were not statistically significant in patients who underwent PPV (p = 0.549). 75% of our patients had a positive aqueous PCR for VZV, and the second most common causative agents were CMV and HSV (10% for each). Besides, rhegmatogenous retinal detachment (RRD) occurred in 25% of our patients. Our analysis showed that the presenting visual acuity and RRD occurrence are the significant prognostic factors for final blindness in ARN.
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Affiliation(s)
- Elham Shiezadeh
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Seyedeh Maryam Hosseini
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Elham Bakhtiari
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Alireza Mojarrad
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran
| | - Mehrdad Motamed Shariati
- Eye Research Center, Khatam Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Gharani Boulevard, Mashhad, Iran.
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13
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Ng SMS, Low R, Pak C, Lai S, Lee B, McCluskey P, Symes R, Invernizzi A, Tsui E, Sitaula RK, Kharel M, Khatri A, Utami AN, La Distia Nora R, Putera I, Sen A, Agarwal M, Mahendradas P, Biswas J, Pavesio C, Cimino L, Sobrin L, Kempen JH, Gupta V, Agrawal R. The role of a multicentre data repository in ocular inflammation: The Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS). Eye (Lond) 2023; 37:3084-3096. [PMID: 36918629 PMCID: PMC10564879 DOI: 10.1038/s41433-023-02472-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
In the current literature, clinical registry cohorts related to ocular inflammation are few and far between, and there are none involving multi-continental international data. Many existing registries comprise administrative databases, data related to specific uveitic diseases, or are designed to address a particular clinical problem. The existing data, although useful and serving their intended purposes, are segmented and may not be sufficiently robust to design prognostication tools or draw epidemiological conclusions in the field of uveitis and ocular inflammation. To solve this, we have developed the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) Clinical Registry. OASIS collects prospective and retrospective data on patients with all types of ocular inflammatory conditions from centers all around the world. It is a primarily web-based platform with alternative offline modes of access. A comprehensive set of clinical data ranging from demographics, past medical history, clinical presentation, working diagnosis to visual outcomes are collected over a range of time points. Additionally, clinical images such as optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography studies may be uploaded. Through the capturing of diverse, well-structured, and clinically meaningful data in a simplified and consistent fashion, OASIS will deliver a comprehensive and well organized data set ripe for data analysis. The applications of the registry are numerous, and include performing epidemiological analysis, monitoring drug side effects, and studying treatment safety efficacy. Furthermore, the data compiled in OASIS will be used to develop new classification and diagnostic systems, as well as treatment and prognostication guidelines for uveitis.
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Affiliation(s)
- Sean Ming Sheng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Clara Pak
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - SerSei Lai
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Richard Symes
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Alessandro Invernizzi
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA
| | - Ranju Kharel Sitaula
- Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Muna Kharel
- Nepal Army Institute of Health Sciences, Kathmandu, Nepal
| | | | | | | | | | - Alok Sen
- Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff's Charity Eye Hospital Daryaganj, New Delhi, India
| | | | | | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, 42121, Reggio Emilia, Italy
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
- Department of Ophthalmology, Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
- Sight for Souls, Fort Myers, FL, USA
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
- Singapore Eye Research Institute, The Academia, Singapore, Singapore.
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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14
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Yu G, Wang T, Xu W, Zhang C. "The Dead Zone": Images of acute retinal necrosis. J Fr Ophtalmol 2023; 46:815-816. [PMID: 37120346 DOI: 10.1016/j.jfo.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 05/01/2023]
Affiliation(s)
- G Yu
- Jinan-Mingshui Eye Hospital, PGH3+HFW, Gongyeer Road, Zhangqiu District, 250200 Jinan, Shandong, China
| | - T Wang
- Jinan-Mingshui Eye Hospital, PGH3+HFW, Gongyeer Road, Zhangqiu District, 250200 Jinan, Shandong, China
| | - W Xu
- Jinan-Mingshui Eye Hospital, PGH3+HFW, Gongyeer Road, Zhangqiu District, 250200 Jinan, Shandong, China
| | - C Zhang
- Jinan-Mingshui Eye Hospital, PGH3+HFW, Gongyeer Road, Zhangqiu District, 250200 Jinan, Shandong, China.
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15
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Dutta Majumder P, Mochizuki M, González-López JJ, Gonzales J, Sharma M, Sharma K, Biswas J. Laboratory Investigations in Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1405-1415. [PMID: 36698066 DOI: 10.1080/09273948.2022.2164728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/27/2023]
Abstract
Laboratory investigations can play a significant role in the diagnosis and decision-making of infectious uveitis. Though direct demonstration of the infective organism remains the gold standard of diagnosis, it is not always possible with ocular tissues. Recent advancements in molecular techniques have made it possible to overcome these limitations and to identify the genomic DNA of pathogens associated with infectious uveitis. Techniques such as next-generation sequencing can analyze all DNA-based lifeforms, regardless of whether they are bacteria, fungi, viruses, or parasites and have been used in the laboratory diagnosis of intraocular inflammation. On the other hand, serological tests, though they dominate the diagnostic landscape of various infectious etiologies in uveitis in routine clinical practice, have varied specificities and sensitivities in different infectious uveitis. In this review, we focus on various methods of laboratory diagnosis of infectious uveitis and discuss the recent advances in molecular diagnosis and their role in various infectious clinical entities.
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Affiliation(s)
| | - Manabu Mochizuki
- Miyata Eye Hospital, Miyakonojo, Japan
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Julio J González-López
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Surgery Department, Universidad de Alcalá, Madrid, Spain
| | - John Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Kusum Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Jyotirmay Biswas
- Director of Uveitis & Ocular Pathology, Sankara Nethralaya, Chennai, India
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16
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Servillo A, Berni A, Marchese A, Bodaghi B, Khairallah M, Read RW, Miserocchi E. Posterior Herpetic Uveitis: A Comprehensive Review. Ocul Immunol Inflamm 2023; 31:1461-1472. [PMID: 37364039 DOI: 10.1080/09273948.2023.2221338] [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: 10/11/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE To report and illustrate the main clinical presentations of posterior herpetic uveitis. METHODS Narrative review. RESULTS The ocular manifestations of posterior herpetic uveitis include different clinical presentations. Herpes simplex and varicella zoster can cause acute retinal necrosis, progressive outer retinal necrosis, and non-necrotizing herpetic retinopathies. Cytomegalovirus has been associated with fulminant retinitis with confluent areas of retinal necrosis and retinal hemorrhages, indolent/granular retinitis, and frosted branch angiitis. These diverse clinical presentations are often associated with specific risk factors and different immunological profiles of the host. CONCLUSIONS Herpetic viruses can cause posterior uveitis, presenting various clinical findings. Specific ocular manifestations and the immunological status of the host can help to differentiate the various herpetic entities before laboratory tests confirm the diagnosis.
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Affiliation(s)
- Andrea Servillo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Berni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Russell W Read
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Elisabetta Miserocchi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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17
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Rangel CM, Restrepo-Arango M, Mejía-Salgado G, Gómez-Rocha MA, Gómez Velasco M, García MF, Moreno JJ. Acute Retinal Necrosis: Experience in a Reference Center in Santander - Colombia. Ocul Immunol Inflamm 2023:1-9. [PMID: 37582226 DOI: 10.1080/09273948.2023.2244076] [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: 05/08/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is crucial for optimal visual outcomes. OBJECTIVE We present an ARN case series showcasing treatment experience and results. METHODOLOGY Patients diagnosed with ARN based on SUN Working Group 2021 criteria were included; all underwent comprehensive eye exams, PCR analysis, and imaging. RESULTS Eight patients were studied; PCR confirmed ARN in six. Induction treatment, either oral valacyclovir (5/8) or intravenous acyclovir (3/8), lasted 10-14 days. Maintenance included oral valacyclovir (6/8), oral valganciclovir (2/8) for six months, along with intravitreal ganciclovir. Visual outcomes were similar for oral and intravenous therapies; poor baseline acuity and macular involvement tend to result in a worse final acuity. CONCLUSIONS Swift treatment is vital to ARN management. Our findings emphasize effective treatment strategies' role in visual prognosis. ABBREVIATIONS ACV: Acyclovir; BCVA: Best Corrected Visual Acuity; CMV: Cytomegalovirus; EBV: Epstein Barr Virus; FTA-ABS: Fluorescent treponemal antibody absorption test; HSV 1-2: Herpes simplex virus 1-2; HIV: Human Immunodeficiency Virus; IV-ACV: Intravenous- Acyclovir; PCR: Polymerase Chain Reaction;Tg: Toxoplasma gondii; VZV: Varicella Zoster Virus; VCV: Valacyclovir; VDRL: Venereal disease research laboratory test.
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Affiliation(s)
- Carlos Mario Rangel
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | | | - Germán Mejía-Salgado
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - María Alejandra Gómez-Rocha
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Maira Gómez Velasco
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - María Fernanda García
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Juan José Moreno
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
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18
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Kawali A, Patil A, Mishra SB, Mahendradas P, Shetty R. Choroidal Involvement and Chronic Macular Edema in Acute Retinal Necrosis: A Novel Finding and a Novel Treatment. Ocul Immunol Inflamm 2023:1-5. [PMID: 37339500 DOI: 10.1080/09273948.2023.2220785] [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: 03/21/2023] [Revised: 05/05/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
Acute retinal necrosis (ARN) as the term suggests is recognized as necrotic inflammation of retina, in contrast to toxoplasma retinochoroiditis where involvement of choroid can be appreciated as choroidal thickening on optical coherence tomography scan during active stage. Secondly, sequelae of ARN, such as chronic anterior uveitis and cystoid macular edema, could be challenging to manage as steroid use in various forms poses a risk of virus reactivation. We present a case of ARN caused by varicella zoster virus with an initial confusing clinical picture with toxoplasma retinochoroiditis, documented with choroidal involvement. The patient also developed a chronic anterior uveitis with macular edema after resolution of ARN which was treated with topical interferon (IFN) alfa 2b therapy with successful outcome. This report supports the recently described choroidal involvement in ARN and suggests topical IFN as a novel treatment in management of chronic macular edema post ARN.
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Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Aditya Patil
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | | | - Rohit Shetty
- Department of Refractive Surgery, Narayana Nethralaya, Bangalore, India
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19
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Sanjay S, Sharief S, Joshi A, Yadav NK. Long-term follow-up of acute retinal necrosis with retinal detachment secondary to herpes simplex virus type 2 with a successful visual outcome. BMJ Case Rep 2023; 16:e252913. [PMID: 37185312 PMCID: PMC10151916 DOI: 10.1136/bcr-2022-252913] [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] [Indexed: 05/17/2023] Open
Abstract
A man in his early 20s presented with acute loss of vision in his only eye, the left eye (OS), and was on oral steroids. He had lost vision in his right eye during his childhood and the cause was unknown. There was no history of trauma. Best-corrected visual acuity (BCVA) in OS was 20/100 and in the right eye was hand movements. OS showed non-granulomatous keratic precipitates on the cornea, anterior chamber flare 1+ and cell 1+, early cataract, vitreous haze and cells 2+ with nasal retinal detachment and superior full thickness retinitis. He underwent pars plana vitrectomy with intravitreal ganciclovir and barrage laser away from the necrotic retina. PCR for herpes simplex virus 2 was positive from the aqueous and vitreous sample. He was started on oral valacyclovir 1 g three times a day and continued on tapering dose of oral steroids. BCVA in OS at 6-month follow-up was 20/25.
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Affiliation(s)
- Srinivasan Sanjay
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Shama Sharief
- Vitreo-retina, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aishwarya Joshi
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
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20
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Loubsens E, Adam R, Debard A, Barioulet L, Varenne F, Fournié P, Sales de Gauzy T, Ollé P, Martin-Blondel G, Soler V. First-line management of necrotizing herpetic retinitis by prioritizing the investigation of immune status and prognostic factors for poor visual outcomes. Int Ophthalmol 2023:10.1007/s10792-023-02656-8. [PMID: 36920634 DOI: 10.1007/s10792-023-02656-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE To review management, treatment, and outcomes of patients with necrotizing herpetic retinitis (NHR) to propose an algorithm for first-line management of NHR. METHODS Retrospective evaluation of a series of patients with NHR at our tertiary center between 2012 and 2021 using demographic, clinical, ophthalmologic, virological, therapeutic, and prognostic characteristics was performed. Patients were classified by NHR type: acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis. RESULTS Forty-one patients with NHR were included: 59% with ARN, 7% with PORN, and 34% with CMV retinitis. All patients with CMV retinitis and PORN were immunocompromised versus 21% of patients with ARN. CMV infection was found in 14 (34%) patients, varicella zoster virus infection in 14 (34%) patients, herpes simplex virus type 2 infection in 8 (20%) and type 1 infection in 5 (12%) patients. Intravenous antiviral therapy was received by 98% of patients and intravitreal antiviral injections by 90% of patients. The overall complication rate during follow-up was 83% of eyes. Most frequent complications were retinal detachment (33% eyes) and retinal break (29% eyes). Prognostic factors for poor visual outcomes were pre-existing monocular vision loss in contralateral eye among 17% of patients, bilateral NHR in 17% of patients, posterior pole involvement in 46% of eyes, and involvement > 2 retinal quadrants in 46% of eyes. CONCLUSIONS The visual prognosis of patients with NHR remains poor. Prompt investigation of immune status and presence of factors justifying intravitreal antiviral injections must be prioritized to initiate and adapt management while awaiting causative virus confirmation.
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Affiliation(s)
- Emmanuelle Loubsens
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Raphaël Adam
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Alexa Debard
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Lisa Barioulet
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Fanny Varenne
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Pierre Fournié
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France.,University of Toulouse III, Toulouse, France
| | - Thomas Sales de Gauzy
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Priscille Ollé
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France.,University of Toulouse III, Toulouse, France.,INSERM U1043-CNRS UMR 5282, Centre for Physiopathology of Toulouse-Purpan, Toulouse, France
| | - Vincent Soler
- Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, CHU Toulouse, Place Baylac, 31059, Toulouse, France. .,University of Toulouse III, Toulouse, France.
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21
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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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22
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Sutra P, Pokawattana I. Retinal vasculopathy following varicella zoster virus infection. Curr Opin Ophthalmol 2022; 33:557-563. [PMID: 36165416 DOI: 10.1097/icu.0000000000000899] [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: 11/27/2022]
Abstract
PURPOSE OF REVIEW Varicella zoster virus (VZV) ocular infection can manifest purely as a vasculopathy that leads to retinal arteriole occlusion, without any retinitis or vasculitis. This review summarizes our current knowledge of such VZV ocular infection phenotype, incorporating initial descriptions from 1988. We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed. RECENT FINDINGS Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely affected, neither in the form of vasculitis nor retinitis. Diagnosis is typically made from positive polymerase chain reaction (PCR) for VZV from extracted intraocular fluid or positive serum or cerebrospinal fluid (CSF) anti-VZV immunoglobulin G antibody in the context of compatible ocular findings. In addition, retinal vasculopathy occurring in the setting of confirmed varicella or zoster rashes could be considered potentially pathognomonic. Pathological concepts, including direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability are also discussed. SUMMARY VZV may produce a wide spectrum of ocular manifestations with isolated VZV retinal vasculopathy being a rarer presentation. A prompt diagnosis followed by an early treatment of systemic acyclovir with or without corticosteroids is the mainstay of treatment.
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Affiliation(s)
- Plern Sutra
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Jabs DA, McCluskey P, Palestine AG, Thorne JE. The standardisation of uveitis nomenclature (SUN) project. Clin Exp Ophthalmol 2022; 50:10.1111/ceo.14175. [PMID: 36164924 PMCID: PMC10040472 DOI: 10.1111/ceo.14175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022]
Abstract
The uveitides are a collection of over 30 diseases characterised by intraocular inflammation. Previous work demonstrated that the agreement among uveitis experts on diagnosis was modest at best with some pairs of experts having chance alone agreement on selected diseases. The Standardisation of Uveitis Nomenclature (SUN) is a17-year collaboration among experts in uveitis, ocular image grading, informatics, and machine learning to improve clinical and translational uveitis research. The SUN "Developing Classification Criteria for the Uveitides" project used a rigorous, multi-phase approach to develop classification criteria for 25 of the most common uveitic diseases. The project's phases were: (1) informatics; (2) case collection; (3) case selection; (4) machine learning; and (5) consensus review and publication. The results were classification criteria with a high degree of accuracy (93.3%-99.3% depending on anatomic class of the uveitis), the goal of which is to form the basis for future uveitis research.
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Affiliation(s)
- Douglas A Jabs
- The Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter McCluskey
- Save Sight Institute, Discipline of Ophthalmology, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Alan G Palestine
- Department of Ophthalmology, The University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer E Thorne
- The Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gueudry J, Bodaghi B. Advances in the microbiological diagnosis of herpetic retinitis. FRONTIERS IN OPHTHALMOLOGY 2022; 2:990240. [PMID: 38983563 PMCID: PMC11182275 DOI: 10.3389/fopht.2022.990240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/24/2022] [Indexed: 07/11/2024]
Abstract
Viral retinitis associated with herpesvirus is one of the most severe forms of uveitis and is a potentially sight-threatening ophthalmologic disease. The prognosis is poor and a rapid and aggressive management is necessary to improve the visual and sometimes vital prognosis of these patients. The treatments used are not without side effects, while many differential diagnoses exist, such as toxoplasmic retinochoroiditis, syphilitic retinitis, endogenous endophthalmitis and intraocular lymphoma. Causatives viruses are herpes simplex virus, varicella-zoster virus, and cytomegalovirus, which require rapid detection in ocular fluid, mainly aqueous humor. However, only a small amount of intraocular fluid is available for analysis. Advances in microbiological diagnostic techniques therefore were key factors in improving the management of these diseases. Historically, the diagnosis was based on immunological tests but more recently advances in molecular biology, in particular polymerase chain reaction, have played a crucial role to obtain a reliable and rapid diagnosis of viral retinitis associated with herpesvirus, as discussed in this review.
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Affiliation(s)
- Julie Gueudry
- Department of Ophthalmology - Charles Nicolle University Hospital, CHU Charles Nicolle, Rouen, France
| | - Bahram Bodaghi
- Department of Ophthalmology, DHU ViewRestore, Sorbonne Université, Pitié Salpêtrière Hospital, Paris, France
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25
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Hoogewoud F, Rossi DC, Stappler T, Guex-Crosier Y. Acute retinal necrosis: A mini review. FRONTIERS IN OPHTHALMOLOGY 2022; 2:916113. [PMID: 38983554 PMCID: PMC11182167 DOI: 10.3389/fopht.2022.916113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/04/2022] [Indexed: 07/11/2024]
Abstract
Acute retinal necrosis is a rare but potentially devastating disease. Even in the era of modern medicine, retinal detachment is a frequent complication leading to vison loss, as well as phthisis bulbi. Whereas IV acyclovir still remains the standard of care, high doses of valacyclovir with/without additional intravitreal injections of foscarnet have been used. In an attempt to reduce the retinal detachment rate, prophylactic laser treatment and early vitrectomy have been proposed. In this article, we aim to review current diagnostic and treatment modalities.
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Mudie LI, Reddy AK, Patnaik JL, Pecen P, Kim E, Cole K, Palestine AG. Evaluation of the SUN Classification Criteria for Uveitides in an Academic Uveitis Practice. Am J Ophthalmol 2022; 241:57-63. [PMID: 35469789 DOI: 10.1016/j.ajo.2022.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the new Standardization of Uveitis Nomenclature (SUN) classification criteria for uveitides by applying them to patients in an academic uveitis practice. DESIGN Evaluation of classification criteria. METHODS The charts of all patients attending the uveitis service at the University of Colorado Hospital between January 1, 2013, and December 31, 2020, were reviewed. Patients with scleritis, ocular cicatricial pemphigoid, and peripheral ulcerative keratitis were excluded. We attempted to classify each patient's uveitis using the SUN classification criteria. Classification attempts were made within the relevant anatomical or infectious categories for their pathology but did not necessarily have to match their clinical diagnosis by a uveitis specialist. We recorded whether classification was possible as well as their clinical diagnosis by a uveitis specialist. RESULTS All patients attending the uveitis clinic at our academic institution between January 1, 2013, and December 31, 2020, were reviewed. Of the 1143 patients with uveitis, 572 (50.0%) had a disease that was not listed in the SUN classification system, and so no attempt to classify these patients was possible. Of the remaining 571 patients, 522 (91.4%) were able to be classified by SUN and in 492 (94.3%) of the 522 cases, their SUN classification matched their clinical diagnosis by a uveitis specialist. CONCLUSIONS Half of the patients at an academic uveitis practice had a disease for which no SUN classification criteria existed. In cases where classification by SUN could be attempted, the system performed well and generally agreed with their clinical diagnosis.
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Affiliation(s)
- Lucy I Mudie
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Amit K Reddy
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Jennifer L Patnaik
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Paula Pecen
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA; Carolina Eye Associates (P.P.), Greensboro, North Carolina, USA
| | - Emmeline Kim
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Kaylee Cole
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA
| | - Alan G Palestine
- From the Department of Ophthalmology, University of Colorado School of Medicine (L.I.M., A.K.R., J.L.P., P.P., E.K., K.C., A.G.P.), 1675 Aurora Ct, Aurora, CO, USA.
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Julian LK, Balfour G, Forgues RF, de Smet M, Suburo A. Uveitis Patterns and Severity: An Epidemiologic Study from a Tertiary Care Private Referral Center in Buenos Aires, Argentina. Ocul Immunol Inflamm 2022; 31:710-716. [PMID: 35404742 DOI: 10.1080/09273948.2022.2053546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report uveitis' spectrum in a private practice cohort in the city of Buenos Aires, Argentina. METHODS Retrospective review at Instituto de la Visión (November 2011-October 2015). Standard demographics, ethnicity and Native American aboriginal ancestry were recorded. RESULTS Among 212 patients, median age 45 (6-97), 10% pediatric, 35% bilateral, 72% non-idiopathic, 36% infectious. Anterior uveitis presented in 50%, followed by posterior (32%), intermediate (9%) and panuveitis (8%). Frequent visits (≥ 6 per year) needed by 29%: posterior, non-idiopathic disease with 79% systemic immunosuppression requirement was their main presentation. Native American aboriginal ancestry was reported by 22.64% of the whole cohort and 37% of frequent visits' subgroup. CONCLUSIONS Unilateral, non-idiopathic, non-infectious anterior uveitis was the most frequent presentation, in agreement with reports coming from western developed cities. The multi-racial Argentinian population with specific Native American aboriginal ancestry might contribute to certain forms of posterior uveitis and their response to treatment.
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Affiliation(s)
- L. K. Julian
- Department of Ophthalmology, Instituto de la Visión, Buenos Aires, Argentina
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - G. Balfour
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
| | - R. F. Forgues
- Department of Ophthalmology, Instituto de la Visión, Buenos Aires, Argentina
| | - M.D. de Smet
- Department of Ophthalmology, MicroInvasive Ocular Surgery Center (MIOS), Lausanne, Switzerland
- Department of Ophthalmology, Leiden University, The Netherlands
| | - A. Suburo
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
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He L, Duan J, Shang Q. Case Report: Herpes Simplex Virus Type 2 Acute Retinal Necrosis With Viral Encephalitis in Children. Front Med (Lausanne) 2022; 9:815546. [PMID: 35372449 PMCID: PMC8967414 DOI: 10.3389/fmed.2022.815546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Few cases concerning acute retinal necrosis with viral encephalitis in children have been reported, especially cases where the fundus cannot be identified due to severe vitreous opacity in the early stage that makes diagnosis difficult. Methods We conducted a retrospective review of an unusual case of herpes simplex virus-2 (HSV-2) acute retinal necrosis with viral encephalitis in an immunocompetent child, along with a review of relevant literature published up to September 2021. Result An 11-year-old girl presented with an approximate 20-day history of ocular redness and decreased visual acuity in the left eye. Examination revealed anterior uveitis and vitreous opacity in the left eye. An anterior chamber tap was performed because the fundus could not be observed clearly, and the aqueous humor was positive for HSV-2 DNA. Cerebrospinal fluid also tested positive for HSV-2. She was diagnosed with acute retinal necrosis syndrome and viral encephalitis. The condition was controlled with timely antiviral and steroid therapy. She was also treated with prophylactic laser therapy to prevent retinal detachment during subsequent follow-up. The pathogenesis, diagnosis, and treatment of HSV-2 acute retinal necrosis in children and the association between acute retinal necrosis and viral encephalitis are further discussed, based on published literature. Conclusion HSV-2-related pediatric acute retinal necrosis may be due to the acquisition of subclinical infection with HSV-2 during parturition, followed by reactivation of the virus latent in the body on account of certain factors. Moreover, it may be complicated with viral encephalitis. For suspected cases with invisible fundus, early intraocular fluid examination is especially helpful for differential diagnosis. Early diagnosis, early treatment, and timely prophylactic laser treatment to prevent retinal detachment are key to a better prognosis. Physicians need to pay attention to such suspected cases during diagnosis and treatment.
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Affiliation(s)
- Luyao He
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jialiang Duan
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingli Shang
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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29
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Abellanas M, Elena MJ, Keane PA, Balaskas K, Grewal DS, Carreño E. Artificial Intelligence and Imaging Processing in Optical Coherence Tomography and Digital Images in Uveitis. Ocul Immunol Inflamm 2022; 30:675-681. [PMID: 35412935 DOI: 10.1080/09273948.2022.2054433] [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 Computer vision, understood as the area of science that trains computers to interpret digital images through both artificial intelligence (AI) and classical algorithms, has significantly advanced the analysis and interpretation of optical coherence tomography (OCT) in retina research. The aim of this review is to summarise the recent advances of computer vision in imaging processing in uveitis, with a particular focus in optical coherence tomography images. MATERIAL AND METHODS Literature review. RESULTS The development of computer vision to assist uveitis diagnosis and prognosis is still undergoing, but important efforts have been made in the field. CONCLUSION The automatising of image processing in uveitis could be fundamental to establish objective and standardised outcomes for future clinical trials. In addition, it could help to better understand the disease and its progression.
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Affiliation(s)
- María Abellanas
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - María José Elena
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, UK and University College London (UCL) Institute of Ophthalmology, UK
| | - Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, UK and University College London (UCL) Institute of Ophthalmology, UK
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ester Carreño
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
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Mapelli C, Milella P, Donà C, Nassisi M, Osnaghi S, Viola F, Agostoni C, Minoia F, Filocamo G. Acute Retinal Necrosis: Clinical Features, Diagnostic Pitfalls, Treatment, and Outcome of an Insidious Disease in Children. Case Report and Review of the Literature. Front Pediatr 2022; 10:854325. [PMID: 35433555 PMCID: PMC9010776 DOI: 10.3389/fped.2022.854325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to explore clinical features, diagnostic work-up, treatment, and outcomes of pediatric patients with acute retinal necrosis (ARN), and to propose a standardized management of this condition in childhood. METHODS Clinical manifestations, diagnostic work-up, and treatment of three pediatric cases with ARN were analyzed. Furthermore, a review of the literature was performed from January 1990 to November 2021, focused on 1) clinical presentation; 2) differential diagnosis, including both infectious and non-infectious conditions; 3) key role of diagnostic techniques; and 4) currently available treatments. RESULTS Data from 72 children with ARN (69 from literature and 3 from our center) were analyzed. The most frequent presenting symptoms were red eye resistant to topical treatment (57%) and altered vision (58%), 25 patients had bilateral involvement. In 30% a known history of herpetic infection was reported. PCR testing on anterior chamber and/or vitreous sampling was performed in 46 cases (64%) and was diagnostic in 88% of them, with herpes simplex virus (HSV) 2 being the most frequently identified pathogen (57%). All patients underwent systemic antiviral therapy (16% only oral); adjunctive intravitreal injections were performed in 21% of them. CONCLUSIONS ARN is a rare but severe ocular infection presenting as a panuveitis with occlusive retinal vasculitis and peripheral retinal necrosis. Varicella-zoster virus and HSV 1-2 are most frequently implicated. Due to a high incidence of rhegmatogenous retinal detachment and optic atrophy, ARN has a poor prognosis with a potentially severe impact on visual function. Although a prompt recognition is crucial to prevent complications, ARN diagnosis in children is still challenging.
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Affiliation(s)
- Chiara Mapelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Paolo Milella
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Caterina Donà
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Nassisi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Silvia Osnaghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Francesco Viola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Minoia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Filocamo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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Heiligenhaus A, Rothaus K, Pleyer U. [Development of classification criteria for uveitis by the standardization of uveitis nomenclature (SUN) working group]. Ophthalmologe 2021; 118:913-918. [PMID: 34459962 PMCID: PMC8413183 DOI: 10.1007/s00347-021-01486-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Hintergrund Die Standardization of Uveitis Nomenclature (SUN) Working Group ist eine internationale Expertenkommission, die das Ziel verfolgt, eine standardisierte und international anerkannte Terminologie für das Gebiet der Uveitis zu erarbeiten. Dies erscheint angesichts der Forderung nach evidenzbasierter Medizin gerade bei relativ seltenen Erkrankungen wie der Uveitis wichtig. Methoden Unter Verwendung formaler Konsensustechniken wurde eine Datenbank von > 4000 Uveitispatienten erstellt, bei denen zuvor eine Mehrheitsübereinstimmung in der Diagnose erzielt wurde. Die Patientendaten wurden innerhalb der Uveitissubklasse analysiert und in einen Trainingssatz und einen Validierungssatz aufgeteilt. Mit maschinellem Lernen (ML) wurden multinomiale logistische Regressionen mit Lasso-Regularisierung auf dem Trainingssatz durchgeführt. Die Genauigkeit der Regeln, die entwickelt wurden, um die Kriterien des maschinellen Lernens auszudrücken, wurde von einem maskierten Beobachter in einer 10 %igen Zufallsstichprobe bewertet. Ergebnisse Die Schätzungen der Gesamtgenauigkeit nach Uveitisklassen im Validierungsset waren für alle Uveitisformen hoch: anteriore Uveitiden 96,7 % (95 %-Konfidenzintervall [CI] 92,4–98,6); intermediäre Uveitiden 99,3 % (95 %-CI 96,1–99,9); posteriore Uveitiden 98,0 % (95 %-CI 94,3–99,3); Panuveitiden 94,0 % (95 %-CI 89,0–96,8) und infektiöse posteriore Uveitiden/Panuveitiden 93,3 % (95 %-CI 89,1–96,3). Schlussfolgerungen Es werden Klassifikationskriterien präsentiert, die einen hohen Grad an Genauigkeit (geringe Fehlklassifikationsraten) aufweisen und sich daher gut für die künftige klinische und translationale Forschung eignen.
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Affiliation(s)
- Arnd Heiligenhaus
- Augenzentrum, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland. .,Universität Duisburg-Essen, Essen, Deutschland.
| | - Kai Rothaus
- Augenzentrum, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - Uwe Pleyer
- Berliner Institut für Gesundheitsforschung in der Charité (BIH), Campus Virchow Klinikum, Augenklinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Van Gelder RN, Sen HN, Tufail A, Lee AY. Here Comes the SUN (Part 2): Standardization of Uveitis Nomenclature for Disease Classification Criteria. Am J Ophthalmol 2021; 228:A2-A6. [PMID: 33992617 DOI: 10.1016/j.ajo.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Russell N Van Gelder
- Department of Ophthalmology, University of Washington School of Medicine; Departments of Biological Structure and Laboratory Medicine and Pathology, University of Washington School of Medicine; Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine.
| | - H Nida Sen
- National Eye Institute, U.S. National Institutes of Health; Department of Ophthalmology, George Washington University, Washington, DC; Jannsen Pharaceuticals, Raritan, NJ
| | - Adnan Tufail
- Department of Ophthalmology, University College, London, UK; Medical Retina Service, Moorfields Eye Hospital, London, UK
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington School of Medicine; Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine
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