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Khadka P, Thapaliya J. New option: targeting RNase J and RNase HI in the fight against multi-drug-resistant tuberculosis. Ann Med Surg (Lond) 2024; 86:2376-2378. [PMID: 38694338 PMCID: PMC11060219 DOI: 10.1097/ms9.0000000000001859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/13/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Priyatam Khadka
- Tribhuvan University, Trichandra Multiple Campus, Kirtipur, Nepal
- State University of New York, Upstate Medical University, Syracuse, NY
| | - Januka Thapaliya
- Tribhuvan University, Trichandra Multiple Campus, Kirtipur, Nepal
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2
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Chawla R, Singh UB, Kumawat D, Venkatesh P. Presumed ocular tuberculosis - need for caution before considering anti-tubercular therapy. Eye (Lond) 2023; 37:3716-3717. [PMID: 37316712 PMCID: PMC10698026 DOI: 10.1038/s41433-023-02628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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3
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Ireni S, Mooss VS, Kelgaonkar A, Babu K, Basu S. Tubercular Serpiginous-Like Choroiditis in Patients with Negative TB-Immunoreactivity Tests. Ocul Immunol Inflamm 2023:1-7. [PMID: 37769244 DOI: 10.1080/09273948.2023.2258399] [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] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Serpiginous-like choroiditis (SLC) denotes ocular tuberculosis (TB), in the presence of positive tuberculin skin test (TST) or interferon gamma release assay (IGRA). METHODS Retrospective review of SLC patients from a TB-endemic country, with negative TST and IGRA tests, but responsive to anti-TB therapy. RESULTS Fifteen patients (13 bilateral) with active SLC were included. Eleven (73.3%) patients had received corticosteroids ± immunosuppressive therapy prior to presentation. Chest radiographic abnormalities were found in four (26.7%) patients. We treated all patients with a combination of anti-TB therapy (ATT) and corticosteroids. Paradoxical worsening was noted in nine (60%) patients, complete resolution of lesions in 12 (80%), persistent inflammation (post-ATT) in one, while two were yet to complete ATT. None had recurrence after complete resolution of lesions (median follow-up of 71 weeks [range 15-676 weeks]). CONCLUSIONS TB-SLC may present with negative TST and IGRA tests but may still have clinical appearance, and treatment response, like test-positive disease.
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Affiliation(s)
- Sucheta Ireni
- Uveitis and Ocular Immunology, LV Prasad Eye Institute, Hyderabad, India
| | - Vidya S Mooss
- Department of Uveitis & Ocular Inflammation, Vittala International Institute of Ophthalmology & Prabha Eye Clinic and Research Center, Bangalore, India
| | - Anup Kelgaonkar
- Retina and Uveitis services, LV Prasad Eye Institute, Bhubaneswar, India
| | - Kalpana Babu
- Uveitis and Ocular Immunology, LV Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Uveitis and Ocular Immunology, LV Prasad Eye Institute, Hyderabad, India
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4
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Putera I, Schrijver B, Ten Berge JCEM, Gupta V, La Distia Nora R, Agrawal R, van Hagen PM, Rombach SM, Dik WA. The immune response in tubercular uveitis and its implications for treatment: From anti-tubercular treatment to host-directed therapies. Prog Retin Eye Res 2023:101189. [PMID: 37236420 DOI: 10.1016/j.preteyeres.2023.101189] [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: 03/07/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023]
Abstract
Tubercular uveitis (TB-uveitis) remains a conundrum in the uveitis field, which is mainly related to the diverse clinical phenotypes of TB-uveitis. Moreover, it remains difficult to differentiate whether Mycobacterium tuberculosis (Mtb) is present in the ocular tissues, elicits a heightened immune response without Mtb invasion in ocular tissues, or even induces an anti-retinal autoimmune response. Gaps in the immuno-pathological knowledge of TB-uveitis likely delay timely diagnosis and appropriate management. In the last decade, the immunopathophysiology of TB-uveitis and its clinical management, including experts' consensus to treat or not to treat certain conditions with anti-tubercular treatment (ATT), have been extensively investigated. In the meantime, research on TB treatment, in general, is shifting more toward host-directed therapies (HDT). Given the complexities of the host-Mtb interaction, enhancement of the host immune response is expected to boost the effectiveness of ATT and help overcome the rising burden of drug-resistant Mtb strains in the population. This review will summarize the current knowledge on the immunopathophysiology of TB-uveitis and recent advances in treatment modalities and outcomes of TB-uveitis, capturing results gathered from high- and low-burden TB countries with ATT as the mainstay of treatment. Moreover, we outline the recent progress of HDT development in the pulmonary TB field and discuss the possibility of its applicability to TB-uveitis. The concept of HDT might help direct future development of efficacious therapy for TB-uveitis, although more in-depth research on the immunoregulation of this disease is still necessary.
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Affiliation(s)
- Ikhwanuliman Putera
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Benjamin Schrijver
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Vishali Gupta
- Retina and Uvea Services, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rina La Distia Nora
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke NUS University, Singapore; Singapore Eye Research Institute, Singapore; Moorfields Eye Hospital, London, United Kingdom
| | - P Martin van Hagen
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S M Rombach
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Willem A Dik
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
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5
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Gupta A. My tryst with academia - Reflections from an era gone by. Indian J Ophthalmol 2023; 71:1675-1680. [PMID: 37203016 PMCID: PMC10391421 DOI: 10.4103/ijo.ijo_865_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Amod Gupta
- Emeritus Professor, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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6
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Agarwal M, Gupta C, Mohan KV, Upadhyay PK, Dhawan A, Jha V. Adjunctive Intravitreal Anti-vascular Endothelial Growth Factor and Moxifloxacin Therapy in Management of Intraocular Tubercular Granulomas. Ocul Immunol Inflamm 2023; 31:158-167. [PMID: 34919497 DOI: 10.1080/09273948.2021.2002367] [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: 01/29/2023]
Abstract
PURPOSE To report pre and post treatment levels of VEGF-A in the aqueous humour of patients with intraocular tubercular granulomas and study the effect of a combined intravitreal anti-VEGF bevacizumab and moxifloxacin therapy on their regression. METHODS Aqueous samples of 10 consecutive patients with intraocular tubercular granulomas obtained before and after initiating treatment were subjected to ELISA for analysing intraocular VEGF-A levels. Intravitreal injections of bevacizumab and moxifloxacin were given weekly till complete regression of these granulomas. All patients received the usual four-drug ATT and oral corticosteroids. RESULTS Mean baseline VEGF-A level was 1004.27±411.40 pg/ml (401.32-1688.95) that reduced significantly to 27.62±46.86 pg/ml (6.9-131.83) at the last injection. Meannumber of intravitreal injections was 3.1 (2-4). We found significant correlation of decreasing levels of aqueous VEGF-A with the clinical regression of these tubercular granulomas. CONCLUSIONS Intraocular TB granulomas have high levels of VEGF-A. Weekly intravitreal injections of anti-VEGF bevacizumab with moxifloxacin as an adjunct to the standard care may cause prompt regression of tubercular granulomas. ABBREVIATIONS TB: Tuberculosis; IOTB: Intraocular tuberculosis; VEGF: Vascular endothelial growth factor; RD: Retinal detachment; Mtb: Mycobacterium tuberculosis; ATT: Antitubercular therapy; AMD: Age-related macular degeneration; SRF: Subretinal fluid; ELISA: Enzyme immunosorbent assay; PCR: Polymerase chain reaction; ONH: Optic nerve head; MDR-TB: Multidrug-resistant tuberculosis; pg/ml: picogram/milliliter; ESR: Erythrocyte sedimentation rate; CECT: Contrast enhanced computed tomography; DNA: Deoxyribonucleic acid; RNA: Ribonucleic acid; BSL: Biosafety level; BCVA: Best corrected visual acuity; HM: Hand movements; KP: Keratic precipitates; PSC: Posterior subcapsular cataract; PS: Posterior synechiae; CRA: Chorio-retinal atrophy; IVMP: Intravenous methyl prednisolone; OCT: Optical coherence tomography; RPE: Retinal pigment epithelium; FFA: Fundus fluorescein angiography; ICG: Indocyanine angiography; RAP: Retinal arterial proliferans.
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Affiliation(s)
- Manisha Agarwal
- Vitreoretina Department, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Chanda Gupta
- Vitreoretina Department, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - K Varsha Mohan
- Product Development Cell, National Institute of Immunology, New Delhi, India
| | - Pramod K Upadhyay
- Product Development Cell, National Institute of Immunology, New Delhi, India
| | - Aditi Dhawan
- Product Development Cell, National Institute of Immunology, New Delhi, India
| | - Vivek Jha
- Vitreoretina Department, Dr Shroff's Charity Eye Hospital, New Delhi, India
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7
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Tubercular serpiginous choroiditis. J Ophthalmic Inflamm Infect 2022; 12:37. [PMID: 36352169 PMCID: PMC9645760 DOI: 10.1186/s12348-022-00312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022] Open
Abstract
Tubercular association with serpiginous choroiditis, also called ‘serpiginous-like choroiditis’ or ‘multifocal serpiginoid choroiditis’ (MSC) is reported from world over, especially from endemic countries. Though the exact mechanism is not yet clear, a direct or indirect infectious trigger by Mycobacterium tuberculosis (MTB) is believed to cause choroiditis. The link of immune mechanisms with ocular inflammation caused by MTB is emerging, and has been supported by both experimental and human data. The molecular and histopathological findings of tubercular serpiginous-like choroiditis have been demonstrated in clinicopathological reports, as well as in animal models. Young to middle-aged healthy males are more frequently affected. The choroiditis lesions of tubercular serpiginous-like choroiditis evolve as multifocal lesions, affecting the retinal periphery as well as posterior pole. They begin as discrete lesions, and spread in a serpiginoid pattern to become confluent. Fundus imaging including autofluorescence is extremely helpful in monitoring patients for response to therapy. Its diagnosis is essentially clinical. Corroborative evidence is obtained by a positive tuberculin skin test, or a positive QuantiFERON-TB Gold (Cellestis, Carnegie, Victoria, Australia) test, and/or radiological (chest X-ray or chest CT scan) evidence of TB elsewhere in the body. Systemic corticosteroids are the mainstay of therapy to control active inflammation, while ATT helps to reduce recurrence of inflammatory attacks. Immunosuppressive agents are indicated in cases with relentless progression, paradoxical worsening, or recurrent choroiditis.
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8
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Hung JH, Rao NA, Chiu WC, Sheu SJ. Vitreoretinal surgery in the management of infectious and non-infectious uveitis - a narrative review. Graefes Arch Clin Exp Ophthalmol 2022; 261:913-923. [PMID: 36220982 DOI: 10.1007/s00417-022-05862-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/09/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to conduct a narrative review about the current role of vitreoretinal surgery in the management of infectious and non-infectious uveitis. METHODS This review was performed based on a search of the PubMed database or on relevant published papers according to our current knowledge. RESULTS A total of 91 articles were identified in the literature review. With the advance of microincision vitrectomy surgery (MIVS), pars plana vitrectomy (PPV) has gained increasing popularity in the management of infectious and non-infectious uveitis. For diagnostic purposes, larger amounts of sample can be obtained by MIVS than traditional vitreous aspiration using needles. For treatment purposes, PPV removes vitreous opacities, decreases inflammatory cytokines and mediators of inflammation, and tackles related complications, including hypotony, epiretinal membrane, macular holes, and retinal detachment. Achieving optimum control of inflammation prior to surgery is important for surgical interventions for non-emergent therapeutic indications and complications of uveitis. Peri-operative inflammation management is essential for decreasing the risk of surgical intervention. An overall complication rate of 42-54% was reported with cataract to be the leading cause of complications. CONCLUSION Most reports affirm the role of PPV in the management of infectious and non-infectious uveitis, although the quality of data remains limited by a lack of applying standardized reporting outcomes, limitations in study design, and a paucity of prospective data.
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Affiliation(s)
- Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Narsing A Rao
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Wei-Chun Chiu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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9
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Kon OM, Beare N, Connell D, Damato E, Gorsuch T, Hagan G, Perrin F, Petrushkin H, Potter J, Sethi C, Stanford M. BTS clinical statement for the diagnosis and management of ocular tuberculosis. BMJ Open Respir Res 2022; 9:9/1/e001225. [PMID: 35379660 PMCID: PMC9021811 DOI: 10.1136/bmjresp-2022-001225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022] Open
Abstract
The BTS clinical statement for the diagnosis and management of ocular tuberculosis (TB) draws on the expertise of both TB and and ophthalmic specialists to outline the current understanding of disease pathogenesis, diagnosis and management in adults. Published literature lacks high-quality evidence to inform clinical practice and there is also a paucity of data from animal models to elucidate mechanisms of disease. However, in order to improve and standardise patient care, this statement provides consensus points with the currently available data and agreed best practice.
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Affiliation(s)
- Onn Min Kon
- Chest and Allergy Clinic, Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Nicholas Beare
- St Paul's Eye Unit, Liverpool University Hospitals, Liverpool, UK
- Department of Eye and Vision Research, University of Liverpool, Liverpool, UK
| | - David Connell
- Respiratory Medicine, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Erika Damato
- Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Gorsuch
- Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Guy Hagan
- Respiratory Medicine, City Hospital, Birmingham, UK
| | - Felicity Perrin
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Harry Petrushkin
- Ophthalmology, Moorfields Eye Hospital City Road Campus, London, UK
| | - Jessica Potter
- Respiratory Medicine, North Middlesex University Hospital NHS Trust, London, UK
| | - Charanjit Sethi
- Ophthalmology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Miles Stanford
- Ophthalmology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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10
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La Distia Nora R, Putera I, Khalisha DF, Septiana I, Sitompul R. The diagnostic value of polymerase chain reaction for ocular tuberculosis diagnosis in relation to antitubercular therapy response: a meta-analysis. Int J Infect Dis 2021; 110:394-402. [PMID: 34364996 DOI: 10.1016/j.ijid.2021.07.075] [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: 01/11/2021] [Revised: 07/05/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Polymerase chain reaction (PCR) is currently considered the method of choice for diagnosing ocular tuberculosis. However, the sensitivity and specificity of PCR using ocular samples remain uncertain. Our meta-analysis aimed to review the diagnostic accuracy of PCR testing in confirming ocular tuberculosis, with responses to antitubercular therapy (ATT) as reference indices. METHODS A systematic literature search of the PubMed, EBSCOHost, Scopus, and Google Scholar databases was performed using the standardized PRISMA guideline. Observational studies reporting both PCR MTb positivity and ATT response were included. Meta-analysis was performed to estimate the pooled positivity rate, sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios (DOR), and summary receiver operating curves (SROC). RESULTS The pooled positivity rate for PCR MTb was 0.55 (95% CI 0.44-0.67). The overall sensitivity and specificity were 88% (95% CI 83-92) and 71% (95% CI 60-80), respectively. The pooled DOR was 12.15 (95% CI 5.55-26.62). The area under the SROC was 0.83. CONCLUSIONS The diagnostic accuracy of PCR Mtb is not sufficient for use as a benchmark for ocular TB diagnosis routinely based on ATT response. A negative result may help avoid prescribing unnecessary ATT in dilemmatic cases.
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Affiliation(s)
- Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; University of Indonesia Hospital (RSUI), Depok, West Java, Indonesia.
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia.
| | - Dhiya Farah Khalisha
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Indah Septiana
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Ratna Sitompul
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
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11
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Bansal R, Dogra M, Chawla R, Kumar A. Pars plana vitrectomy in uveitis in the era of microincision vitreous surgery. Indian J Ophthalmol 2021; 68:1844-1851. [PMID: 32823401 PMCID: PMC7690537 DOI: 10.4103/ijo.ijo_1625_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pars plana vitrectomy (PPV) in uveitis is indicated for various diagnostic and therapeutic indications. With the advent of microincision vitreous surgery (MIVS), the use of PPV in uveitis has increased with a wider spectrum of indications due to shorter surgical time, less patient discomfort, less conjunctival scarring, and a decreased rate of complications as compared to standard 20G vitrectomy. Because of faster post-operative recovery in terms of visual improvement and reduction of inflammation, and reduced duration of systemic corticosteroids, MIVS has gained popularity in uveitis as an adjunctive therapy to the standard of care medical therapy. The safety and efficacy of MIVS is related to the emerging vitrectomy techniques with better and newer cutters, illuminating probes, and accessory instruments. Because of the instrumentation and fluidics of MIVS, PPV is emerging as a safe and useful alternative for diagnostic challenges in uveitis, aiding in earlier diagnosis and better outcome of inflammatory disease, even in the presence of severe and active inflammation, which was once considered a relative contraindication for performing vitreous surgery. However, for surgical interventions for therapeutic indications and complications of uveitis, it is advisable to achieve an optimum control of inflammation for best results. The increasing reports of the use of MIVS in uveitis have led to its wider acceptance among clinicians practicing uveitis.
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohan Chawla
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Kumar
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Mehta S, Peters RP, Smit DP, Gupta V. Ocular Tuberculosis in HIV-infected Individuals. Ocul Immunol Inflamm 2020; 28:1251-1258. [PMID: 32809898 DOI: 10.1080/09273948.2020.1776882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aim: To review the current literature and publications to assess the clinical features, recommended investigations and treatment for ocular tuberculosis in HIV infected patients. Methods: Literature review. Results: The human immunodeficiency virus (HIV) epidemic affects as many as 37.9 million people. Mycobacterium tuberculosis infection is common in HIV infection and is a leading cause of death and morbidity. Common clinical presentations include anterior uveitis (granulomatous or otherwise), choroidal granulomas/tubercles, chorioretinitis, subretinal abscess, panophthalmitis, retinal detachment and vasculitis. The majority of clinical findings were in the posterior segment, appeared primarily infective (tubercles/chorioretinitis/abscess) and were largely seen in the context of pulmonary tuberculosis or disseminated disease. Current investigational patterns include corroborative tests such as tuberculin skin test or Interferon-γ release assay. Systemic testing includes Computed Tomography, MRI or PET/CT scans. Newer Molecular techniques such as GeneXpert MTB/RIF assay and Line Probe assays (LPA) are increasingly important. Apart from standard ocular anti-inflammatory protocols, anti-tubercular treatment as per the clinical staging (latent or active) needs to be initiated. Initiation of anti-retroviral therapy (ART) is important and can be started soon after ATT. Conclusions: Ocular manifestations within this group are distinct and unique investigational and therapeutic approaches are needed.
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Affiliation(s)
- Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Centre , Mumbai, India
| | - Remco Ph Peters
- Department of Medical Microbiology, University of Pretoria , Pretoria, South Africa.,Department of Medical Microbiology, Maastricht University Medical Centre , Maastricht, The Netherlands.,Foundation for Professional Development, Research Unit , East London, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute , Chandigarh, India
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13
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Testi I, Agrawal R, Mehta S, Basu S, Nguyen Q, Pavesio C, Gupta V. Ocular tuberculosis: Where are we today? Indian J Ophthalmol 2020; 68:1808-1817. [PMID: 32823397 PMCID: PMC7690544 DOI: 10.4103/ijo.ijo_1451_20] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/14/2023] Open
Abstract
Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.
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Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
| | - Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Mumbai, India
| | | | - Quan Nguyen
- Byres Eye Institute, Stanford University, Palo Alto, California, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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14
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Sharma K, Singh S, Sharma M, Batra N, Kaur V, Modi M, Sharma A, Ray P. Multi-targeted loop mediated amplification PCR for diagnosis of extrapulmonary tuberculosis. Indian J Tuberc 2020; 67:479-482. [PMID: 33077047 DOI: 10.1016/j.ijtb.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
AIMS The present study was conceived to evaluate multi-targeted loop mediated amplification (MLAMP) for the rapid diagnosis of extrapulmonary tuberculosis (EPTB). METHODS AND RESULTS A total of 700 patients were included who were classified into 2 groups: Group 1 (n = 400) included a 100 culture confirmed EPTB patients and 300 culture negative, suspected EPTB patients. Group 2 (n = 300) included negative controls from non-tubercular patients. All samples were subjected to Ziehl-Neelsen microscopy, solid culture on Lowenstein Jensen media, Polymerase chain reaction (PCR) targeting IS6110 gene and LAMP targeting both IS6110 and MPB64 individually and as MLAMP. The overall sensitivity of microscopy, culture, IS6110 PCR, IS6110 LAMP, MPB64 LAMP and the MLAMP assay were 12%, 25%, 72.5%, 80% and 86.6% respectively and the specificity of all the tests was 100%. CONCLUSION MLAMP is a rapid robust tool for the diagnosis of EPTB and utilizing two targets for M. tuberculosis can improve the overall sensitivity and increase the yield of detection from extrapulmonary samples. The rapidity, ease of performance and low cost make MLAMP an excellent alternative in low-income, resource limited settings.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nitya Batra
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Varpreet Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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15
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Shah A, Biswas J. Cytopathology and Polymerase Chain Reaction of Vitreous Fluid in Tubercular Intermediate Uveitis. Ocul Immunol Inflamm 2020; 29:854-856. [PMID: 31906764 DOI: 10.1080/09273948.2019.1697825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose: Cytopathology of vitreous is most commonly done to diagnose vitreoretinal lymphoma in eyes with nonspecific inflammation. Vitreous cytopathology features of tuberculous intermediate uveitis have not been described in literature.Case report: We report a case of a healthy 35-year-old female who showed granulomatous inflammatory changes on vitreous cytopathology with polymerase chain reaction confirming a diagnosis of intraocular tuberculosis.Conclusion: This case highlights the role of cytopathology in determining the etiology and pathogenesis behind the elusive diagnosis of intermediate uveitis. Polymerase chain reaction can further help in confirming the diagnosis and allowing commencement of appropriate therapy.
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Affiliation(s)
- Amravi Shah
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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16
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Abstract
Serpiginous choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like choroiditis (SLC) and multifocal serpiginoid choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC.
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Affiliation(s)
| | - Jyotirmay Biswas
- Department of Uvea and Department of Larsen and Toubro Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Amod Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Agarwal A, Aggarwal K, Gupta V, Agrawal R, Nguyen QD. Advances in imaging and molecular diagnostics of ocular tuberculosis and selected observations from the Collaborative Ocular Tuberculosis Study (COTS). EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1555472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medicine and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Post Graduate Institute of Medicine and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medicine and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Quan Dong Nguyen
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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18
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Sharma RK, Sharma J, Khan ZK, Pattekar A, Gupta V, Bansal R, Sharma K, Aggarwal AN, Gupta A, Sachdeva N. Diminished TLR2-TLR9 mediated CD4+ T cell responses are associated with increased inflammation in intraocular tuberculosis. Sci Rep 2018; 8:13812. [PMID: 30218032 PMCID: PMC6138653 DOI: 10.1038/s41598-018-32234-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 09/05/2018] [Indexed: 12/18/2022] Open
Abstract
Intraocular tuberculosis (IOTB) is amongst the leading causes of uveitis in tropical countries. Despite reports on involvement of proinflammatory cytokines, studies on innate immune responses in disease pathogenesis are lacking. Reports from animal models and patients with pulmonary tuberculosis indicate that defects in toll like receptor (TLR)2 and TLR9 signalling predispose them to tuberculosis. In this context, we investigated the role of TLR2, TLR4 and TLR9 in generation of CD4+ T effector (Teff) cell responses during IOTB. Firstly, the cells in vitreous fluids showed lower expression of TLR2 and TLR9 in IOTB as compared to non-uveitis and non-TB uveitis groups. Next, peripheral CD4+ Teff cells of subjects with IOTB showed decreased proliferative responses and lower induction of Tregs following TLR2 and TLR9 stimulation. Further, TLR9 ligation resulted in increased IFN-γ and IL-17a but decreased expression of IL-10 and TGF-β. Lastly, lower expression of genes involved in TLR9 signalling after direct TLR9 ligation was observed in IOTB. Collectively, our results show that a subdued response to direct TLR2 and TLR9 stimulation in CD4+ T cells is associated with increased proinflammatory responses in IOTB. These findings reveal an important link between innate immune signalling and ensuing adaptive immune responses in IOTB with implications in other forms of extrapulmonary tuberculosis.
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Affiliation(s)
- Ravi Kumar Sharma
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Microbiology and Immunology and the Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jyoti Sharma
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Zafar K Khan
- Department of Microbiology and Immunology and the Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ajinkya Pattekar
- Department of Microbiology and Immunology and the Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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19
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Agrawal R, Gunasekeran DV, Agarwal A, Carreño E, Aggarwal K, Gupta B, Raje D, Murthy SI, Westcott M, Chee SP, McCluskey P, Ling HS, Teoh S, Cimino L, Biswas J, Narain S, Agarwal M, Mahendradas P, Khairallah M, Jones N, Tugal-Tutkun I, Babu K, Basu S, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Herbort CP, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Mahajan S, Esposti S, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Lord J, Singh R, Sharma A, Sharma K, Zierhut M, Kon OM, Kempen J, Cunningham ET, Rousselot A, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Description of the Spectrum of Choroidal Involvement in 245 Patients with Tubercular Uveitis. Ocul Immunol Inflamm 2018; 28:38-48. [DOI: 10.1080/09273948.2018.1489061] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rupesh Agrawal
- Department of Medical retina and uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Dinesh Visva Gunasekeran
- Department of Medical retina and uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- School of Medicine, National University of Singapore, Singapore
| | - Aniruddha Agarwal
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ester Carreño
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Kanika Aggarwal
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhaskar Gupta
- Department of Ophthalmology, Royal Berkshire Hospital, NHS Foundation Trust, Reading, UK
| | | | - Somasheila I. Murthy
- Dept of Statistics, Tej Kohli Cornea Institute, LV Prasad Eye Institute, Nagpur, India
| | - Mark Westcott
- Department of Medical retina and uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Soon Phaik Chee
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
| | - Peter McCluskey
- Department of Clinical Ophthalmology & Eye Health, Central Clinical School, Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Ho Su Ling
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Stephen Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Luca Cimino
- Ocular Immunology Unit, Department of Ophthalmology, Arcispedale-IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Shishir Narain
- Department of Ophthalmology, Shroff Eye Centre, New Delhi, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff’s Charity Eye Hospital Daryaganj, New Delhi, India
| | | | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nicholas Jones
- Department of Ophthalmology, University of Manchester, Manchester, UK
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kalpana Babu
- Department of Ophthalmology, Prabha Eye Clinic & Research centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Soumayava Basu
- Department of Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, India
| | - Richard Lee
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Hassan Al-Dhibi
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bahram Bodaghi
- Department of Ophthalmology, DHU SightRestore, University of Pierre and Marie Curie, Paris, France
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Debra A. Goldstein
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carl P. Herbort
- Centre for Ophthalmic Specialised Care & University of Lausanne, Laussane, Switzerland
| | - Talin Barisani-Asenbauer
- Laura Bassi Centre of Expertise Ocuvac, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Vienna, Austria
| | | | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Thessaly, Greece
| | - Reema Bansal
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bruttendu Moharana
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sarakshi Mahajan
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Simona Esposti
- Department of Medical retina and uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Anastasia Tasiopoulou
- Department of Medical retina and uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Sengal Nadarajah
- Department of Medical retina and uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Mamta Agarwal
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India
| | | | - Ruchi Vala
- Department of Ophthalmology, Narayana Nethralaya, Bangalore, India
| | - Joanne Lord
- Southampton Health Technology Assessments Centre (SHTAC), Southampton, United Kingdom
| | - Ramandeep Singh
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Rheumatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manfred Zierhut
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, USA
- The Discovery Eye Center, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Emmett T. Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- The Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Stanford, California, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Andres Rousselot
- Department of Ophthalmology, Universidad del Salvador of Buenos Aires, Buenos Aires, Argentina
| | - Quan Dong Nguyen
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Carlos Pavesio
- Department of Medical retina and uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Vishali Gupta
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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20
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Dutta Majumder P, Palkar A, Annamalai R, Biswas J. Laboratory investigations in uveitis: current practice and future directions. Can J Ophthalmol 2018; 53:193-198. [PMID: 29784152 DOI: 10.1016/j.jcjo.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 11/24/2022]
Abstract
Diagnosis and management of uveitis always remains a challenge to the treating ophthalmologists. Rapid diagnosis and timely initiation of appropriate, effective treatment in uveitis are the critical determinants that lead to good visual outcome and reduce the risk of ocular morbidity. In the last decade, significant progress has been made in molecular diagnostic modalities and in development of newer diagnostic tools, which included serological tests and imaging techniques. However, a tailored approach to laboratory investigations based on meticulous history and comprehensive ocular evaluation has been propounded as the gold standard for successful management of an uveitic entity. In this article, we review the laboratory diagnostic tests in uveitis as well as recent technological advances in laboratory science, which may be the future direction for diagnosis of uveitis.
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Affiliation(s)
| | - Amit Palkar
- Department of Uvea, Sankara Nethralaya, Chennai, India
| | | | - Jyotirmay Biswas
- Department of Uvea and Ocular Pathology, Sankara Nethralaya, Chennai, India..
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21
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Moharana B, Bansal R, Singh R, Sharma A, Gupta V, Gupta A. Enhanced Depth Imaging by High-Resolution Spectral Domain Optical Coherence Tomography in Tubercular Multifocal Serpiginoid Choroiditis. Ocul Immunol Inflamm 2018; 27:781-787. [DOI: 10.1080/09273948.2018.1465101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Bruttendu Moharana
- Advanced Eye Centre, and Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Advanced Eye Centre, and Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, and Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Advanced Eye Centre, and Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, and Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, and Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Agarwal A, Agrawal R, Gunasekaran DV, Raje D, Gupta B, Aggarwal K, Murthy SL, Westcott M, Chee SP, McCluskey P, Ling HS, Teoh S, Cimino L, Biswas J, Narain S, Agarwal M, Mahendradas P, Khairallah M, Jones N, Tugal-Tutkun I, Babu K, Basu S, Carreño E, Lee R, Al-Dhibi H, Bodaghi B, Invernizzi A, Goldstein DA, Herbort CP, Barisani-Asenbauer T, González-López JJ, Androudi S, Bansal R, Moharana B, Mahajan S, Esposti S, Tasiopoulou A, Nadarajah S, Agarwal M, Abraham S, Vala R, Singh R, Sharma A, Sharma K, Zierhut M, Kon OM, Cunningham E, Nguyen QD, Pavesio C, Gupta V. The Collaborative Ocular Tuberculosis Study (COTS)-1 Report 3: Polymerase Chain Reaction in the Diagnosis and Management of Tubercular Uveitis: Global Trends. Ocul Immunol Inflamm 2017; 27:465-473. [PMID: 29261089 DOI: 10.1080/09273948.2017.1406529] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To analyze the role of polymerase chain reaction (PCR) of ocular fluids in management of tubercular (TB) anterior, intermediate, posterior, and panuveitis. Methods: In Collaborative Ocular Tuberculosis Study (COTS)-1 (25 centers, n = 962), patients with TB-related uveitis were included. 59 patients undergoing PCR of intraocular fluids (18 females; 53 Asian Indians) were included. Results: 59 (6.13%) of COTS-1 underwent PCR analysis. PCR was positive for Mycobacterium TB in 33 patients (23 males; all Asian Indians). 26 patients were PCR negative (18 males). Eight patients with negative PCR had systemic TB. Anti-TB therapy was given in 18 negative and 31 PCR cases. At 1-year follow-up, five patients with positive PCR (15.15%) and three with negative PCR (11.54%) had persistence/worsening of inflammation. Conclusions: Data from COTS-1 suggest that PCR is not commonly done for diagnosing intraocular TB and positive/negative results may not influence management or treatment outcomes in the real world scenario.
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Affiliation(s)
- Aniruddha Agarwal
- a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | - Rupesh Agrawal
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore, Singapore.,c Moorfields Eye Hospital , NHS Foundation Trust , London , UK.,d Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,e Singapore Eye Research Institute , Singapore , Singapore
| | - Dinesh Visva Gunasekaran
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore, Singapore.,c Moorfields Eye Hospital , NHS Foundation Trust , London , UK.,d Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | | | - Bhaskar Gupta
- g Royal Berkshire Hospital , NHS Foundation Trust , Reading , UK
| | - Kanika Aggarwal
- a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | - Somasheila L Murthy
- h Tej Kohli Cornea Institute, LV Prasad Eye Institute , Kallam Anji Reddy Campus , Hyderabad , India
| | - Mark Westcott
- c Moorfields Eye Hospital , NHS Foundation Trust , London , UK
| | - Soon Phaik Chee
- d Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,e Singapore Eye Research Institute , Singapore , Singapore.,i Singapore National Eye Centre , Singapore, Singapore.,j Duke-NUS Medical School , Singapore , Singapore
| | - Peter McCluskey
- k Department of Clinical Ophthalmology & Eye Health , Central Clinical School, Save Sight Institute, The University of Sydney , Sydney , Australia
| | - Ho Su Ling
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore, Singapore
| | - Stephen Teoh
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore, Singapore
| | - Luca Cimino
- l Ocular Immunology Unit, Department of Ophthalmology Arcispedale-IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia , Italy
| | | | | | - Manisha Agarwal
- o Dr Shroff's Charity Eye Hospital Daryaganj , New Delhi , India
| | | | - Moncef Khairallah
- q Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir , Tunisia
| | | | - Ilknur Tugal-Tutkun
- s Istanbul Faculty ofMedicine, Department of Ophthalmology , Istanbul University , Istanbul , Turkey
| | - Kalpana Babu
- t Department of Ophthalmology, Prabha Eye Clinic & Research centre , Vittala International Institute of Ophthalmology , Bangalore , India
| | | | | | | | - Hassan Al-Dhibi
- w King Khaled Eye Specialist Hospital , Riyadh , Kingdom of Saudi Arabia
| | - Bahram Bodaghi
- x DHU SightRestore , University of Pierre andMarie Curie , Paris , France
| | - Alessandro Invernizzi
- y Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco" , Luigi Sacco Hospital, University of Milan , Milan , Italy
| | - Debra A Goldstein
- z Feinberg School of Medicine, Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA
| | - Carl P Herbort
- aa Centre for Ophthalmic Specialised Care & University of Lausanne , Lausanne , Switzerland
| | - Talin Barisani-Asenbauer
- ab Laura Bassi Centre of Expertise Ocuvac, Center for Pathophysiology, Immunology and Infectiology , Medical University of Vienna , Vienna , Austria
| | | | - Sofia Androudi
- ad Department of Ophthalmology , University of Thessaly , Volos , Greece
| | - Reema Bansal
- a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | - Bruttendu Moharana
- a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | - Sarakshi Mahajan
- a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | - Simona Esposti
- c Moorfields Eye Hospital , NHS Foundation Trust , London , UK
| | | | | | | | | | - Ruchi Vala
- p Narayana Nethralaya , Bangalore , India
| | - Ramandeep Singh
- a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
| | - Aman Sharma
- ae Department of Rheumatology , PGIMER , Chandigarh, India
| | - Kusum Sharma
- af Department ofMicrobiology , PGIMER , Chandigarh, India
| | - Manfred Zierhut
- ag Centre of Ophthalmology, University of Tuebingen , Tuebingen , Germany
| | - Onn Min Kon
- ah Chest and Allergy Clinic, St Mary's Hospital , Imperial College HealthcareNHS Trust , London , UK
| | - Emmett Cunningham
- ai Francis I. Proctor Foundation for Research in Ophthalmology , University of California , San Francisco , USA
| | - Quan Dong Nguyen
- aj Byers Eye Institute , Stanford University , Palo Alto , CA , USA
| | - Carlos Pavesio
- c Moorfields Eye Hospital , NHS Foundation Trust , London , UK
| | - Vishali Gupta
- a Advanced Eye Centre , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh, India
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23
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Damato EM, Dawson S, Liu X, Mukherjee C, Horsburgh J, Denniston AK, Moran E, Dedicoat M, Murray PI. A retrospective cohort study of patients treated with anti-tuberculous therapy for presumed ocular tuberculosis. J Ophthalmic Inflamm Infect 2017; 7:23. [PMID: 29204932 PMCID: PMC5714940 DOI: 10.1186/s12348-017-0141-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Uveitis involving the posterior segment is a significant and potentially blinding condition. The diagnosis and treatment of patients with uveitis associated with tuberculosis remains controversial, and commonly, patients are systemically well. Use of the interferon-gamma release assays has added to the controversy, as the significance of a positive test may be uncertain. We aim to report the outcomes of anti-tuberculous treatment in a cohort of patients treated in Birmingham, for presumed "ocular tuberculosis", based on clinical findings, systemic assessment and specific testing for tuberculosis. RESULTS We found that in our cohort of 41 patients treated between 2010 and 2014, the majority achieved disease-free remission, even in cases where anti-tuberculous treatment was delayed. CONCLUSIONS Despite controversy, this study strongly supports the use of anti-tuberculous therapy in such patients and highlights the need for formal prospective trials and treatment protocols.
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Affiliation(s)
- Erika Marie Damato
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
| | - Sarah Dawson
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
| | - Xiaoxuan Liu
- Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ UK
| | - Chandoshi Mukherjee
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
| | - John Horsburgh
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair K. Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Edward Moran
- Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Dedicoat
- Birmingham Chest Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Philip Ian Murray
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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Sharma K, Gupta A, Sharma M, Sharma A, Singh R, Aggarwal K, Bansal R, Thakur A, Prakash S, Gupta V. MTBDRplus for the rapid diagnosis of ocular tuberculosis and screening of drug resistance. Eye (Lond) 2017; 32:451-456. [PMID: 29052602 DOI: 10.1038/eye.2017.214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022] Open
Abstract
PurposeTimely diagnosis of intraocular tuberculosis (IOTB) along with detection of drug resistance can save many eyes from visual impairment. With the growing incidence of IOTB and rising drug resistance, a reliable diagnostic platform for simultaneous detection of the agent and mutated gene is urgently needed. The MTBDRplus assay was evaluated directly on vitreous fluid samples for the same.Patients and methodsIn a prospective study, The MTBDRplus assay was performed on 127 vitreous fluid samples (77 'study group' comprising cases of presumed ocular tuberculosis and 50 'control group' cases of disease controls (n=25) and non-uveitic controls (n=25)). All samples positive by MTBDRplus assay were subjected to gene sequencing to confirm the mutations for rifampicin and isoniazid resistance.ResultsThe MTBDRplus assay produced a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 36.36%, 100%, 100%, and 50.50%, respectively, for the detection of IOTB. Among the 28 cases from study group that were positive by MTBDRplus assay, rifampicin resistance was reported in six and isoniazid resistance in two cases. On sequencing of rpoB and katG gene, one case of false rifampicin-resistant by MTBDRplus was found. The other resistant isolates showed concordant mutations between MTBDRplus assay and sequencing.ConclusionThe MTBDRplus assay is an effective tool for the rapid diagnosis of IOTB along with detection of drug resistance, thereby improving the outcome in IOTB.
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Affiliation(s)
- K Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Aggarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Bansal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Thakur
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Prakash
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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25
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Diagnostic and Therapeutic Challenges. Retina 2017; 38:1436-1441. [PMID: 28834945 DOI: 10.1097/iae.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kumar P, Kakkar P, Ravani R, Karthikeya R, Kumar A. Splenic tuberculosis and multifocal serpiginoid choroiditis. Int Ophthalmol 2017; 38:2191-2194. [PMID: 28798995 DOI: 10.1007/s10792-017-0689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
Serpiginoid multifocal choroiditis is a distinct morphological identity with a reported causal association with Mycobacterium tuberculosis. We report a case of serpiginoid multifocal choroiditis in a 17-year-old boy who was suffering from isolated splenic tuberculosis. He was treated with systemic steroids along with anti-tubercular treatment with good visual recovery. This case was unique as no other organs except spleen and choroid showed tubercular involvement. We hereby emphasize association of extrapulmonary sites with multifocal serpiginoid choroiditis and propose a thorough investigation for primary to be included in routine protocol of choroiditis workup.
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Affiliation(s)
- Pradeep Kumar
- Unit 2, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Prateek Kakkar
- Unit 2, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raghav Ravani
- Unit 2, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Karthikeya
- Unit 2, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Atul Kumar
- Unit 2, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, Gupta V, Gupta A, Do DV, Nguyen QD. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary-referral institutions. Clin Exp Ophthalmol 2017; 46:62-74. [DOI: 10.1111/ceo.12997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Aniruddha Agarwal
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Samendra Karkhur
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital; University of Milan; Milan Italy
| | - Ramandeep Singh
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Mangat R Dogra
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Amod Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Diana V Do
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
| | - Quan D Nguyen
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
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Dalvin LA, Smith WM. Intraocular manifestations of mycobacterium tuberculosis: A review of the literature. J Clin Tuberc Other Mycobact Dis 2017; 7:13-21. [PMID: 31723696 PMCID: PMC6850243 DOI: 10.1016/j.jctube.2017.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 01/04/2017] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
Mycobacterium tuberculosis: is most commonly associated with pulmonary infection. However, tuberculosis (TB) can also affect the eye. TB can affect nearly any tissue in the eye, and a high index of suspicion is required for accurate diagnosis, as many of the intraocular manifestations of TB can mimic other, more common diseases. Correct diagnosis is critical because systemic anti-tuberculosis treatment may be required, and vision loss or even loss of the affected eye can occur without proper treatment. Thus, it is important for ophthalmologists and infectious disease specialists to work together to accurately diagnose and treat intraocular TB. This article reports the various known presentations of intraocular TB and reviews important elements of diagnosis and treatment.
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Affiliation(s)
| | - Wendy M. Smith
- Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Aggarwal K, Agarwal A, Sehgal S, Sharma S, Singh N, Sharma K, Samanta R, Invernizzi A, Sharma A, Gupta V. An unusual presentation of intraocular tuberculosis in a monocular patient: clinicopathological correlation. J Ophthalmic Inflamm Infect 2016; 6:46. [PMID: 27888495 PMCID: PMC5124017 DOI: 10.1186/s12348-016-0118-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022] Open
Abstract
Background Lack of uniform diagnostic criteria often poses a challenge in the diagnosis and management of tubercular uveitis. The index case describes an unusual presentation of tubercular panuveitis initially misdiagnosed as sympathetic ophthalmia, where the appropriate diagnosis was made using various imaging and laboratory investigations. Results A 52-year-old Indian woman underwent multimodal imaging, extensive clinical and laboratory work-up, and analysis of microbiological and histopathological specimens. At presentation, her best-corrected visual acuity (BCVA) was 20/30 in OD and no perception of light in OS. Ocular examination revealed multiple grayish-yellow choroiditis lesions resembling Dalen-Fuch’s nodules, vitritis, and disc edema. Diagnosis of sympathetic ophthalmia was made and patient treated with intravenous and oral corticosteroids and immunosuppressive therapy. After an initial favorable response, the lesions progressively increased with worsening of vitritis. Due to worsening of chorioretinal lesions which were atypical for sympathetic ophthalmia, further investigations were performed that revealed positive tuberculin skin test and contrast-enhanced computerized tomography chest showed calcified mediastinal lymph nodes. Enucleation of OS confirmed acid-fast bacilli on Ziehl-Neelsen staining, tubercular granulomas on histopathology, and positive polymerase chain reaction. Anti-tubercular therapy and oral steroids were started with good healing response. Conclusions Tubercular uveitis may have protean clinical manifestations. Thorough clinical evaluation and molecular/histopathological evaluation helps in establishing the diagnosis and the institution of appropriate therapy.
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Affiliation(s)
- Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Shobha Sehgal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suryaprakash Sharma
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Nirbhai Singh
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Kusum Sharma
- Department of Medical Microbiology, Division of Mycobacteriology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramanuj Samanta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Aman Sharma
- Department of Internal Medicine, Division of Rheumatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
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30
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Sharma K, Gupta V, Sharma A, Singh R, Sharma M, Aggarwal K, Bansal R, Fiorella PD, Prakash S, Gupta A. Gene Xpert MTB/RIF assay for the diagnosis of intra-ocular tuberculosis from vitreous fluid samples. Tuberculosis (Edinb) 2016; 102:1-2. [PMID: 28061946 DOI: 10.1016/j.tube.2016.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 11/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vishali Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Surya Prakash
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Ang M, Chee SP. Controversies in ocular tuberculosis. Br J Ophthalmol 2016; 101:6-9. [DOI: 10.1136/bjophthalmol-2016-309531] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 11/04/2022]
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Ang M, Vasconcelos-Santos DV, Sharma K, Accorinti M, Sharma A, Gupta A, Rao NA, Chee SP. Diagnosis of Ocular Tuberculosis. Ocul Immunol Inflamm 2016; 26:208-216. [PMID: 27379384 DOI: 10.1080/09273948.2016.1178304] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ocular tuberculosis remains a presumptive clinical diagnosis, as the gold standard tests for diagnosing ocular tuberculosis are often not useful: Mycobacterium tuberculosis cultures require weeks to process on Lowenstein-Jenson media and have low yield from ocular samples; while acid-fast bacilli smears or polymerase chain reaction detection of M. tuberculosis DNA have low sensitivities. Thus, diagnosis is often based on suggestive clinical signs, which are supported by positive investigations: tuberculin skin test or interferon-gamma release assays; chest X-ray findings suggestive of pulmonary tuberculosis, and/or evidence of associated systemic tuberculosis infections in the absence of other underlying disease. The aim of this review is to provide an update on the methods of diagnosing ocular tuberculosis, and discuss the challenges of its diagnosis. We also suggest a step-ladder approach to a more accurate diagnosis of ocular tuberculosis by combining the available diagnostic tests.
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Affiliation(s)
- Marcus Ang
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,d Department of Ophthalmology and Visual Sciences , Duke-National University of Singapore, Graduate Medical School , Singapore
| | - Daniel V Vasconcelos-Santos
- e Department of Ophthalmology , Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,f Hospital São Geraldo/HC - Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Kusum Sharma
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Massimo Accorinti
- h Department of Ophthalmology , Sapienza University of Rome , Rome , Italy
| | - Aman Sharma
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Amod Gupta
- g Department of Medical Microbiology, Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India.,i Department of Ophthalmology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Narsing A Rao
- j USC Eye Institute , Los Angeles , USA.,k Keck School of Medicine, University of Southern California , Los Angeles , USA
| | - Soon-Phaik Chee
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,d Department of Ophthalmology and Visual Sciences , Duke-National University of Singapore, Graduate Medical School , Singapore
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Bansal R, Gupta A, Gupta V, Mulkutkar S, Dogra M, Katoch D, Dogra MR, Sharma K, Singh MP, Sharma A, Kamal S, Sharma SP. Safety and Outcome of Microincision Vitreous Surgery in Uveitis. Ocul Immunol Inflamm 2016; 25:775-784. [PMID: 27191861 DOI: 10.3109/09273948.2016.1165259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report the outcome of microincision vitreous surgery (MIVS) in uveitis. METHODS In total, 103 patients (106 eyes) underwent diagnostic MIVS between March 2012 and April 2015. Postoperative evaluation included vitreous haze grading from clinical/electronic records, best-corrected visual acuity (BCVA), and complications. RESULTS Mean age was 36.8 ± 13.9 years (range: 8-80 years). Mean follow-up after MIVS was 12.2 ± 7.2 months (median 12 months). Mean vitreous haze grading was 2.39 ± 0.98 (preoperatively), 0.36 ± 0.73 postoperatively (1 week), and 0.02 ± 0.2 at 1 month (p < 0.001). Mean BCVA was 1.5 ± 1.0 logMAR preoperatively and 0.72 ± 0.68 logMAR at 1 month (p = 0.000). Postoperative complications included cataract (14.6%), rise in intraocular pressure (13.2%), vitreous hemorrhage (4.7%), hypotony (3.2%), retinal detachment (2.8%), epiretinal membrane (2.8%), and worsening of inflammation (0.9%). CONCLUSIONS MIVS is safe and may have a therapeutic role in uveitis.
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Affiliation(s)
- Reema Bansal
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Amod Gupta
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Vishali Gupta
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Samyak Mulkutkar
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Mohit Dogra
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Deeksha Katoch
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Mangat R Dogra
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Kusum Sharma
- b Departments of Medical Microbiology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Mini P Singh
- c Virology, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Aman Sharma
- d Medicine, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Shivali Kamal
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Surya P Sharma
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
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Gupta B, Agrawal R, Swampillai AJ, Lim RHF, Kee A, Gunasekaran D, Pavesio C. Ocular manifestations of tuberculosis: an update. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1152887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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