1
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Di Nardo G, Di Pippo M, Zenzeri L, Mennini M, Piccirillo M, Furio S, Quatrale G, Evangelisti M, Parisi P, Lucchini L, Ferretti A, Villa MP, Scuderi G, Amadè DS, Abdolrahimzadeh S. Ocular endothelial dysfunction in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024; 78:1297-1304. [PMID: 38587115 DOI: 10.1002/jpn3.12208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES To assess ocular microvasculature changes using optical coherence tomography angiography (OCTA) in pediatric patients with inflammatory bowel disease (IBD). METHODS Patients (aged 6-18 years) with IBD were recruited between September 2021 and May 2023. All eligible participants underwent comprehensive clinical assessment and laboratory investigation. Patients with functional gastrointestinal disorders served as the controls. This study assessed specific IBD phenotypes, disease duration, clinical and endoscopic activity indices, laboratory markers, and medication histories. OCTA was utilized to evaluate ocular microvasculature changes in both groups. RESULTS A total of 63 children (mean age 12.9 ± 3.3 years) were enrolled, comprising 38 in the IBD group (16 ulcerative colitis, 22 Crohn's disease, and 25 in the control group). Most patients in the IBD group were in remission or had mild-to-moderate disease activity at enrollment. Analysis of the OCTA results revealed significant differences in the choroidal luminal area and total choroidal area between the IBD and control groups. CONCLUSIONS The study identified distinct ocular microvasculature changes in pediatric IBD patients through OCTA, suggestive of potential systemic endothelial dysfunction. These findings underscore the utility of OCTA in evaluating microvascular alterations associated with pediatric IBD, offering insights into potential systemic complications linked to inflammation in IBD patients.
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Affiliation(s)
- Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Mariachiara Di Pippo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Ophthalmology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Letizia Zenzeri
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maurizio Mennini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Marisa Piccirillo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Silvia Furio
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanna Quatrale
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Melania Evangelisti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Pasquale Parisi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Livia Lucchini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Alessandro Ferretti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Maria Pia Villa
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Gianluca Scuderi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Ophthalmology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - David Sarzi Amadè
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Stomatology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Ophthalmology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
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2
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Coskun C, Coskun Y. Evaluation of optic coherence tomography findings in patients with inflammatory bowel disease. Photodiagnosis Photodyn Ther 2023; 44:103788. [PMID: 37666381 DOI: 10.1016/j.pdpdt.2023.103788] [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: 05/06/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Ocular complications are known to appear in inflammatory bowel disease (IBD). Among these, posterior segment complications can lead to substantial morbidity. The aim of the study is to evaluate the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and macula thickness measurement in patients with IBD. METHODS A total of 118 patients with IBD (42 Crohn's disease (CD), 76 ulcerative colitis (UC)) and 52 healthy subjects were included in the study. RNFL, GCIPL, and macula thickness were measured using spectral-domain optical coherence tomography (SD-OCT). RESULTS The central macular thickness was increased, mean and all superior quadrants of GCIPL thickness measurements were significantly decreased, but RNFL thickness wasn't changed in CD compared to healthy subjects. Although the central macular thickness increased, no change was observed in mean RNFL and GCIPL in UC compared to healthy subjects. Mean RNFL, GCIPL, and macular thickness did not differ during the remission and active phases of the disease in IBD. There was no difference in RNFL, GCIPL, and macular thicknesses in CD patients in terms of the location and behavior of the disease. A significant thickness increase was found in extensive type UC for inferior RNFL value compared to the left side and proctitis. CONCLUSIONS IBD may cause an increase in macular thickness. This finding may be related to the inflammation or ischemia of the retina. The use of SD-OCT in ophthalmologic examination in patients with IBD may enable early detection of retinal changes and alert the clinician to complications of IBD.
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Affiliation(s)
- Cigdem Coskun
- Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Yusuf Coskun
- Department of Gastroenterology, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey
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Milstein Y, Haiimov E, Slae M, Davidovics Z, Millman P, Birimberg-Schwartz L, Benson A, Wilschanski M, Amer R. Increased Risk of Celiac Disease in Patients with Uveitis. Ocul Immunol Inflamm 2023:1-5. [PMID: 37579242 DOI: 10.1080/09273948.2023.2243497] [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: 05/19/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To examine whether patients with non-infectious uveitis (NIU) are at increased risk for celiac disease (CeD). METHODS Celiac antibody testing was completed in 112 patients. The control group included patients who had undergone upper endoscopy for suspicion of CeD. RESULTS 2/112 (1.79%) of patients with NIU had positive anti-tTG serology and CeD was confirmed in both patients. When compared to the expected risk of CeD in the general Israeli population of 0.31%, this corresponded to an odds ratio of 5.77 (95% CI 1.4118 to 23.4737, P = 0.049). Three additional patients had positive serology for CeD but the diagnosis was not confirmed. CONCLUSIONS An increased risk of CeD was detected in patients with NIU. We therefore recommend screening for CeD in NIU patients. Larger prospective studies are required to further validate these results.
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Affiliation(s)
- Yosef Milstein
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Elianora Haiimov
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mordechai Slae
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zev Davidovics
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peri Millman
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liron Birimberg-Schwartz
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Hadassah Organoid Center, Hadassah Medical Organization, Jerusalem, Israel
| | - Ariel Benson
- Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michael Wilschanski
- Department of Pediatric Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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4
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Lo TC, Chen YY, Chen HH. Risk of inflammatory bowel disease in uveitis patients: a population-based cohort study. Eye (Lond) 2022; 36:1288-1293. [PMID: 34155367 PMCID: PMC9151650 DOI: 10.1038/s41433-021-01645-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate the potential association between uveitis and an increased risk of developing inflammatory bowel disease (IBD). METHODS We conducted a retrospective cohort study by interrogating data from the Taiwan National Health Insurance Research Database entered between January 1, 2001 and December 31, 2013 to identify uveitis patients and age- and gender-matched controls. The cumulative incidence rates of subsequent IBD in the two groups were compared. The adjusted hazard ratio (HR) of IBD related to uveitis was generated by a multivariate cox regression model after adjustment for hypertension, diabetes, hyperlipidaemia, obesity and smoking. Furthermore, the HRs of the Crohn's disease (CD) and ulcerative colitis (UC) IBD subtypes were calculated separately. RESULTS A total of 198,923 subjects with uveitis and 397,846 controls were enroled. The mean age of the cohort was 47.7 ± 18.9 years. A significantly higher cumulative incidence of IBD was found in the uveitis group than in controls (4.13% vs. 1.48%, p < 0.0001). Under univariate cox regression analysis, uveitis patients had a significantly higher risk of IBD (HR = 1.47; 95% confidence interval (CI): 1.43-1.52, p < 0.0001). The association remained significant in the multivariate regression model, with an adjusted HR of 1.44 (95% CI: 1.39-1.49, p < 0.0001). Moreover, in subgroup analysis, uveitis was significantly associated with an increased risk of Crohn's disease (adjusted HR = 1.49; 95% CI: 1.44-1.54), but not with ulcerative colitis (adjusted HR = 1.03; 95% CI: 0.92-1.15). CONCLUSIONS Patients with uveitis are at significantly greater risk of developing IBD than individuals without uveitis.
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Affiliation(s)
- Tzu-Chen Lo
- grid.410764.00000 0004 0573 0731Department of Medical Education, Taichung Veterans General Hospital, Taichung, 407 Taiwan ,grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112 Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan. .,Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, 407, Taiwan. .,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan.
| | - Hsin-Hua Chen
- grid.260539.b0000 0001 2059 7017School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, 112 Taiwan ,grid.411641.70000 0004 0532 2041School of Medicine, Chung Shan Medical University, Taichung, 402 Taiwan ,grid.265231.10000 0004 0532 1428Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, 407 Taiwan ,grid.410764.00000 0004 0573 0731Division of Allergy, Immunology, and Rheumatology & Division of General Internal Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407 Taiwan ,grid.260542.70000 0004 0532 3749Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, 402 Taiwan
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5
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Lin TY, Lai YF, Chen PH, Chung CH, Chen CL, Chen YH, Chen JT, Kuo PC, Chien WC, Hsieh YH. Association Between Ischemic Optic Neuropathy and Inflammatory Bowel Disease: A Population-Based Cohort Study in Taiwan. Front Med (Lausanne) 2021; 8:753367. [PMID: 34651004 PMCID: PMC8509714 DOI: 10.3389/fmed.2021.753367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Ischemic optic neuropathy (ION) is a possible extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). We investigate the relation between IBD and ION and possible risk factors associated with their incidence. Methods: Medical records were extracted from the National Health Insurance Research Database (NHIRD) from January 1, 2000, to December 31, 2013. The main outcome was ION development. Univariate and multivariate Cox regression analyses were performed. Results: We enrolled 22,540 individuals (4,508 with IBD, 18,032 without). The cumulative risk of developing ION was significantly greater for patients with IBD vs. patients without (Kaplan–Meier survival curve, p = 0.009; log-rank test). Seven (5%) and five (0.03%) patients developed ION in the IBD and control groups, respectively. Patients with IBD were significantly more likely to develop ION than those without IBD [adjusted hazard ratio (HR) = 4.135; 95% confidence interval: 1.312–11.246, p = 0.01]. Possible risk factors of ION development were age 30–39 years, diabetes mellitus (DM), hypertension, ischemic heart disease (IHD), atherosclerosis, and higher Charlson comorbidity index revised (CCI_R) value. Conclusion: Patients with IBD are at increased risk of subsequent ION development. Moreover, for patients with comorbidities, the risk of ION development is significantly higher in those with IBD than in those without.
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Affiliation(s)
- Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Fen Lai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Po-Chen Kuo
- Department of Colon and Rectal Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan
| | - Yun-Hsiu Hsieh
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
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6
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Joltikov KA, Lobo-Chan AM. Epidemiology and Risk Factors in Non-infectious Uveitis: A Systematic Review. Front Med (Lausanne) 2021; 8:695904. [PMID: 34568364 PMCID: PMC8461013 DOI: 10.3389/fmed.2021.695904] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/17/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose: Non-infectious uveitis is a leading cause of vision loss in the developed world. The purpose of this systematic review is to investigate the epidemiology and risk factors of non-infectious uveitis over the last 50 years. Methods: A systematic literature search of Pubmed/MEDLINE database was performed in the 50-year period from January 1971 to January 2021, according to the PRISMA guidelines. Studies that assessed the epidemiology and risk factors for non-infectious uveitis were included. Results: Few epidemiologic studies focus specifically on non-infectious uveitis. In the Unites States, the estimated prevalence of non-infectious uveitis is 121/100,000. The incidence and prevalence varies considerably worldwide. Females and the working age group (20–50 years) appear to be the most affected. Smoking and vitamin D deficiency are the biggest risk factors for non-infectious uveitis, while pregnancy appears to be protective. Additional risk factors include presence of other autoimmune diseases (thyroid disease, diabetes, celiac), pre-eclampsia/eclampsia, psychological stress, and certain medications (bisphosphonates, immune checkpoint inhibitors, female hormone therapy, and etanercept). Discussion: Our systematic review summarizes the incidence and prevalence of non-infectious uveitis and associated modifiable and non-modifiable risk factors.
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Affiliation(s)
- Katherine A Joltikov
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Ann-Marie Lobo-Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, United States
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7
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Association between Optic Neuritis and Inflammatory Bowel Disease: A Population-Based Study. J Clin Med 2021; 10:jcm10040688. [PMID: 33578895 PMCID: PMC7916645 DOI: 10.3390/jcm10040688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 01/13/2023] Open
Abstract
Extraintestinal manifestations are common in patients with inflammatory bowel disease (IBD), and optic neuritis (ON) is a rare but severe one. This study aimed to evaluate possible factors associated with ON in patients with IBD. Adult patients with IBD who were not with concomitant ON on the index date identified from the Taiwan National Health Insurance Research Database (NHIRD) from the years 2000 to 2013 were included. A four-fold matched group was selected using age, sex and year of index date for comparison. All the patients were followed up until the development of ON or the end of the study period. Data of included patients were extracted and analyzed statistically. The mean follow-up time for all patients was 7.13 ± 5.21 years. At the study period conclusion, eight (0.18%) and five (0.003%) patients with and without IBD, respectively, had developed ON (p = 0.001). Adjusted HRs showed that patients with IBD aged between 30 and 39 years, with comorbidities including neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), systemic lupus erythematosus (SLE) and with a higher Charlson Comorbidity Index, had a significantly higher risk of developing ON (all p < 0.005). Among the eight IBD patients who developed ON, only one patient was diagnosed with Crohn’s disease, the male gender was slightly dominant, and two (25%) patients received antitumor necrosis factor α (anti-TNF α) treatment for IBD. Patients with IBD have a higher risk of developing ON compared to patients without IBD. ON occurs more frequently in IBD patients aged between 30 and 39 years, with comorbidities including NMO, ADEM and SLE. Other factors besides anti-TNF α treatment for IBD are more likely associated with the development of ON.
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8
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Kilgore DA, Behrens AW, Siddiqui MZ, Chancellor JR, Phillips PH, Uwaydat SH, Vonlanthen MG, Gonzalez-Krellwitz L, Sallam AB. Inflammatory choroiditis and papillitis from Crohn's disease in a child. J AAPOS 2021; 25:37-40. [PMID: 33127473 DOI: 10.1016/j.jaapos.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
A 5-year-old boy had subacute painless visual loss in his left eye with disk edema, macular edema, and choroidal thickening. He was subsequently diagnosed with inflammatory papillitis and choroiditis from Crohn's disease. The disk and macular edema responded minimally to antivascular endothelial growth factor injections but significantly to intravitreal corticosteroids.
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Affiliation(s)
- David A Kilgore
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Alice W Behrens
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mohammad Z Siddiqui
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John R Chancellor
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Paul H Phillips
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Sami H Uwaydat
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Ahmed B Sallam
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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9
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Hanzel J, Ma C, Casteele NV, Khanna R, Jairath V, Feagan BG. Vedolizumab and Extraintestinal Manifestations in Inflammatory Bowel Disease. Drugs 2021; 81:333-347. [PMID: 33400241 DOI: 10.1007/s40265-020-01460-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In Crohn's disease and ulcerative colitis, inflammation is not limited to the digestive tract. Extraintestinal manifestations (EIMs), which affect up to 50% of patients, can substantially impair quality of life. EIMs may parallel luminal disease activity or have an independent course. They most commonly involve the musculoskeletal system (e.g., peripheral or axial arthritis) and skin (e.g., erythema nodosum and pyoderma gangrenosum). Less commonly, the hepatobiliary tract (e.g., primary sclerosing cholangitis [PSC]) and the eye (e.g., episcleritis, scleritis, and uveitis) are involved. Although the pathophysiology of EIMs is poorly understood, they are likely either manifestations of a primary systemic immune disease with variable expression amongst organs, or secondary phenomena to bowel inflammation. Additional pathophysiologic mechanisms may include aberrant lymphocyte homing mediated by ectopic expression of gut-specific chemokines and adhesion molecules, cross-reactivity between microbial and self-antigens, autoantibodies against epitopes shared by the intestine and extraintestinal tissues, elevated serum concentrations of cytokines, and alterations in innate immunity. Many EIMs independent of intestinal disease activity can be successfully treated with tumor necrosis factor (TNF) antagonists. The efficacy of vedolizumab-a monoclonal antibody targeting the α4β7 integrin-for the treatment of EIMs is uncertain, but data are emerging from post hoc analyses of randomized controlled trials, prospective and retrospective cohort studies, and case series. Vedolizumab may be effective in treating EIMs related to luminal disease activity (e.g., type 1 peripheral arthritis and erythema nodosum) but has not shown biochemical improvement in PSC. Its postulated role in the development of de novo EIMs is heavily confounded by the high proportion of patients previously exposed to TNF antagonists; new EIMs could result from TNF antagonist treatment cessation rather than being caused by vedolizumab. A common limitation of clinical studies is the lack of multidisciplinary involvement in the diagnosis and monitoring of EIMs, which may lead to misdiagnosis and overreporting. Future studies should rigorously measure EIMs in parallel with objective measures of luminal disease activity to provide more robust data on the relative efficacy of new drugs, especially as increasing numbers of gut-selective compounds enter clinical development.
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Affiliation(s)
- Jurij Hanzel
- Department of Gastroenterology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,, Hullenbergweg 278-308, 1101 BV, Amsterdam, The Netherlands
| | - Christopher Ma
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, 6D61 Teaching Research Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Niels Vande Casteele
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,Department of Medicine, University of California San Diego, 9500 Gilman Drive #0956, La Jolla, CA, 92093, USA
| | - Reena Khanna
- Division of Gastroenterology, University of Western Ontario, 1151 Richmond Street, London, N6A 2K7, ON, Canada
| | - Vipul Jairath
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,Division of Gastroenterology, University of Western Ontario, 1151 Richmond Street, London, N6A 2K7, ON, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - Brian G Feagan
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada. .,Division of Gastroenterology, University of Western Ontario, 1151 Richmond Street, London, N6A 2K7, ON, Canada. .,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada. .,Department of Medicine, University of Western Ontario, London, ON, Canada.
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10
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Sengul Samanci N, Poturoglu S, Samanci C, Ustabasioglu FE, Koldas M, Duman AE, Ormeci AC. The Relationship between Ocular Vascular Changes and the Levels of Malondialdehyde and Vascular Endothelial Growth Factor in Patients with Inflammatory Bowel Disease. Ocul Immunol Inflamm 2020; 29:1459-1463. [PMID: 32255700 DOI: 10.1080/09273948.2020.1740281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: We evaluated ocular hemodynamic changes, malondialdehyde(MDA) and vascular endothelial growth factor (VEGF) levels in patients with IBD.Methods: We used ocular color Doppler ultrasonography to analyze 56 eyes with Crohn's disease (CD), 62 eyes with ulcerative colitis (UC), 68 eyes of healthy volunteers. We measured peak systolic velocity (PSV),end-diastolic velocity (EDV),and the resistivity index (RI) of ophthalmic artery (OA) and central retinal artery (CRA). MDA and VEGF levels were measured in the plasma samples.Results: MDA levels were significantly higher in both UC and CD patients, whereas VEGF levels were only higher in the CD group (p = .003,p < .001,p = .01).The PSV and EDV of the OA were significantly lower in CD patients (p = .017,p = .001). The EDV of the CRA was significantly lower in CD patients than UC patients and controls (p = .014,p < .001).Conclusions: CD patients exhibited decreased blood flow in both the OA and CRA. Ocular vascular flow was only affected in CD patients. We found that ocular ischemia may occur in CD patients even in the absence of any clinical finding.
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Affiliation(s)
- Nilay Sengul Samanci
- Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sule Poturoglu
- Department of Gastroenterology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cesur Samanci
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Macit Koldas
- Biochemistry Department, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Ali Erkan Duman
- Department of Gastroenterology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aslı Ciftcibası Ormeci
- Department of Gastroenterology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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The retinal foveal avascular zone as a systemic biomarker to evaluate inflammatory bowel disease control. Int J Retina Vitreous 2019; 5:16. [PMID: 31406581 PMCID: PMC6683555 DOI: 10.1186/s40942-019-0168-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) is a systemic inflammatory disease and is classified as Crohn's disease (CD) or ulcerative colitis (UC) depending on the extent of gastrointestinal tract involvement. IBD can be associated with extraintestinal findings, such as fever, weight loss, arthralgia, and mucocutaneous lesions, as well as hepatic, renal and ophthalmological involvement. Clinical parameters and colonoscopy are used to establish the criteria for controlled or non-controlled disease and subsequent definition of treatment. Our objective in the present study was to compare the area of the foveal avascular zone (FAZ) in patients with a diagnosis of IBD during remission and active disease. Methods 144 eyes of 72 patients with IBD were evaluated via a complete ophthalmological exam. Fundus photography and optical coherence tomography/angiography (OCT/OCTA) were performed with a Topcon Triton. The macula and posterior pole were evaluated by binocular indirect ophthalmoscopy and fundus biomicroscopy. The area of the FAZ was determined via manual delimitation of superficial retinal vascular layers from OCTA with image6.net software. To establish disease activity, we considered the Mayo Score, fecal calprotectin levels, colonoscopy results and clinical parameters. All retinal parameters were evaluated in a blinded manner. Means were compared between groups using the Mann-Whitney test. Results The participants had a mean age of 42.26 years and included 28 males (38.88%) and 44 females (61.11%). Among the participants, 37 had a diagnosis of CD (51.38%), and 35 had a diagnosis of UC (48.61%). Twenty-five patients (34.72%) had active disease, and 47 (65.27%) were in remission. The area of the FAZ did not differ significantly between the CD and UC groups (p = 0.91 for the right eye and p = 0.76 for the left eye) but did differ significantly between the remission and active disease groups (p = 0.01 for the right eye and p = 0.02 for the left eye). Discussion Our study is the first to evaluate the area of the FAZ in patients with IBD via swept-source OCTA. The area of the FAZ did not differ significantly in either eye between the CD and UC groups. However, patients classified as having active disease according to clinical parameters and colonoscopy presented a significant decrease in the area of the FAZ compared with patients in remission. The area of the FAZ is an ophthalmological parameter that can be obtained non-invasively and is increased in ischemic diseases such as diabetic retinopathy. The FAZ may decrease due to vascular engorgement or increased systemic inflammation. This parameter can be used to help determine whether a patient is in remission or active IBD, thus potentially reducing the need for invasive exams during disease follow-up.
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Warren LR, Clarke JM, Arora S, Barahona M, Arebi N, Darzi A. Transitions of care across hospital settings in patients with inflammatory bowel disease. World J Gastroenterol 2019; 25:2122-2132. [PMID: 31114138 PMCID: PMC6506584 DOI: 10.3748/wjg.v25.i17.2122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/05/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.
AIM To determine the type and location of hospital services accessed by IBD patients in England.
METHODS This was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider’. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.
RESULTS 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD ‘home provider’ was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.
CONCLUSION Transitions of care between secondary care settings are common for patients with IBD. Effective systems of data-sharing and care integration are essential to providing safe and effective care for patients. Geographic and age-related patterns of care transitions identified in this study may be used to guide interventions aimed at improving continuity of care.
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Affiliation(s)
- Leigh R Warren
- Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Jonathan M Clarke
- Centre for Health Policy, Imperial College London Centre for Mathematics of Precision Healthcare, Imperial College London, London SW7 2BX, United Kingdom
- Department of Biostatistics, Harvard University, Boston, MA 02115, United States
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Sonal Arora
- Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Mauricio Barahona
- Centre for Health Policy, Imperial College London Centre for Mathematics of Precision Healthcare, Imperial College London, London SW7 2BX, United Kingdom
- Department of Mathematics, Imperial College London, London SW7 2BX, United Kingdom
| | - Naila Arebi
- Department of Gastroenterology, St. Marks Academic Institute, Harrow HA1 3UJ, United Kingdom
| | - Ara Darzi
- Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
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Imam L, Haboubi HN. G-Eye: ocular manifestations of gastrointestinal disease. Frontline Gastroenterol 2019; 11:162-167. [PMID: 32133116 PMCID: PMC7043099 DOI: 10.1136/flgastro-2018-101083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/14/2019] [Accepted: 01/22/2019] [Indexed: 02/04/2023] Open
Abstract
Extraintestinal manifestations of gastrointestinal disease can form an important aspect of the diagnosis, monitoring and management in these diseases. Ocular manifestations in particular are often disregarded and can, albeit rarely, present as an emergency.
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Affiliation(s)
- Lema Imam
- Department of Medicine, Glangwili General Hospital, Carmarthen, UK
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Lee DH, Han JY, Park JJ, Cheon JH, Kim M. Ophthalmologic Manifestation of Inflammatory Bowel Disease: A Review. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:269-275. [DOI: 10.4166/kjg.2019.73.5.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Dong Hyun Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Yong Han
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Jun Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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High frequency of secondary, but not primary ocular manifestations of inflammatory bowel disease in patients treated at a tertiary care center. Eur J Gastroenterol Hepatol 2018; 30:1502-1506. [PMID: 30148806 DOI: 10.1097/meg.0000000000001248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Ocular manifestations of inflammatory bowel disease (IBD) are relevant complications of IBD. Only a few prospective studies are available on the characteristics of these manifestations. The aim of this study was to characterize the frequency of eye disease in patients with IBD, including primary and secondary ocular manifestations of IBD, and to identify patients who may need specialized ophthalmologic care. PATIENTS AND METHODS In a prospective observational study, patients with IBD were examined for ocular symptoms in comparison with control participants without IBD. All patients with IBD underwent a thorough ophthalmologic examination (including slit-lamp, tonometry, tear breakup time, Schirmer's test, and coherence tomography). The results were analyzed with respect to sociodemographic and disease-related characteristics. RESULTS A total of 61 patients (33 women, 39 Crohn's disease, 22 ulcerative colitis, age 43.3±12.9 years, disease duration 12.4±9.3 years) were included. Ophthalmologic symptoms were reported by 53 patients (86.9%, most frequently deterioration of vision 42.6%, foreign body sensation 36.1%) compared with 60.6% in healthy controls (P=0.001). A clinically relevant, previously undetected ophthalmologic diagnosis was identified in 56 patients (91.8% - dry eye syndrome 75.4%, cataract 67.2%, blepharitis 45.9%, fundus hypertonicus 14.8%, other 16.4%). CONCLUSION Although primary ocular manifestations of IBD are rare in intensively treated patients, the high frequency of unrecognized secondary manifestations should give reason to refer especially patients with longstanding or complicated IBD to an eye specialist - irrespective of ocular symptoms.
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NAKAYAMA LF, BERGAMO VC, CONTI MLD, BUENO L, MORAES NSBD, AMBROGINI JR O. FREQUENCY OF OPHTHALMOLOGICAL POSTERIOR SEGMENT FINDINGS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:188-191. [DOI: 10.1590/s0004-2803.201800000-34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
ABSTRACT BACKGROUND: Inflammatory bowel disease is a systemic inflammatory disease classified as Crohn disease or ulcerative colitis. It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement. Among ophthalmological findings, posterior segment findings are present in less than 1% of patients with inflammatory bowel disease, however, these findings could bring definitive visual impairment. OBJECTIVE: Our study objective was to evaluate ocular posterior segment findings is patients with inflammatory bowel disease, through retinal mapping, color fundus retinography, optical coherence tomography (OCT) and OCT angiography, and compare our results to literature. METHODS: We evaluated eighty patients with inflammatory bowel disease through complete ophthalmological examination and posterior segment assessment. Color fundus retinography, OCT and OCT angiography was performed with Topcon Triton (Topcon ® , Tokyo, Japan). Macula and posterior pole were evaluated with binocular indirect ophthalmoscopy and fundus biomicroscopy. RESULTS: Participants mean age was 44.16 years (18.08-68.58), 28 (35%) male patients and 52 (65%) female patients. Thirty-five (44%) with diagnosis of Crohn disease, 41 (52%) patients with diagnosis of ulcerative colitis and 3 (4%) had non-conclusive Crohn disease or ulcerative colitis classification. We found abnormal exams in 21 (26.25%) patients. CONCLUSION: Our study found similar prevalence of ophthalmological posterior segment commitment compared to previous literature prevalence. The findings were predominantly unrelated to inflammatory bowel disease, rather than primarily related to it. The most prevalent, and non-previous reported, finding was increased arteriolar tortuosity, probably occurs due to systemic vascular impairment in inflammatory bowel disease.
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Troncoso LL, Biancardi AL, de Moraes Jr HV, Zaltman C. Ophthalmic manifestations in patients with inflammatory bowel disease: A review. World J Gastroenterol 2017; 23:5836-5848. [PMID: 28932076 PMCID: PMC5583569 DOI: 10.3748/wjg.v23.i32.5836] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/29/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.
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Affiliation(s)
- Leandro Lopes Troncoso
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Ana Luiza Biancardi
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | | | - Cyrla Zaltman
- Department of Internal Medicine, Gastroenterology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
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Lee HJ, Song HJ, Jeong JH, Kim HU, Boo SJ, Na SY. Ophthalmologic manifestations in patients with inflammatory bowel disease. Intest Res 2017; 15:380-387. [PMID: 28670235 PMCID: PMC5478763 DOI: 10.5217/ir.2017.15.3.380] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/03/2016] [Accepted: 11/22/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/AIMS Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), has been reported to have various ophthalmologic manifestations. The aim of this study was to evaluate the prevalence of ophthalmologic manifestations associated with IBD in Korea. METHODS Sixty-one patients were examined between May 2013 and October 2014. We performed complete ophthalmologic examinations. RESULTS Findings included 36 patients with CD and 25 with UC. The mean age of the patients was 34±16 years and disease duration was 45.3±23.9 months. Ophthalmologic manifestations were positive in 44 cases. Primary complication was diagnosed in 5 cases, as follows; iritis in 2 cases, episcleritis in one case, iritis with optic neuritis in 1 case, and serous retinal detachment in 1 case, without secondary complications. The most common coincidental complication was dry eye syndrome (DES), in 35 patients (57.4%). The prevalence of DES in the control group was 21.3%. The proportion of DES in patients with IBD was significantly higher than in the control group (P=0.002). CONCLUSIONS Ophthalmologic manifestations were high (72.1%) in IBD patients. Clinically significant primary ocular inflammation occurred in 8.2% of patients. The most common complication was DES. There was a higher rate of DES in patients with IBD compared to the control group. Evaluation of the eye should be a routine component in patients with IBD.
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Affiliation(s)
- Hye Jin Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jin Ho Jeong
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Ong SS, Walter SD, Chen X, Vora GK, Daluvoy M, Proia AD, Mruthyunjaya P. Ocular Surface Epithelial Atypia Mimicking Squamous Neoplasia in Association With Ulcerative Colitis. Cornea 2017; 36:502-505. [DOI: 10.1097/ico.0000000000001144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Alexandre B, Vandermeeren Y, Dewit O, Moreels T, de Boer N, Dhar A, Ziady C, Shitrit ABG, Steinwurz F, Jojic N, Costantino G, Bihin B, Rahier JF, Katsanos KH. Optic Neuritis Associated or Not with TNF Antagonists in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:541-8. [PMID: 26759360 PMCID: PMC4957451 DOI: 10.1093/ecco-jcc/jjw003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Acute optic neuritis [ON] is an inflammatory condition affecting the optic nerve. Clinicians should suspect optic neuritis in cases of painful and rapidly progressive loss of central visual field. This condition may be associated with a multitude of diseases, and mostly with multiple sclerosis [MS] where it may present as an initial symptom. The literature reports that optic neuritis and MS occur in patients with inflammatory bowel disease [IBD] before and after the era of anti-tumour necrosis factor-α [TNFα] drugs. At the present moment, there is little consensus for managing this complication, currently treated with corticosteroids and discontinuation of the causative agents. METHODS We collected cases through a retrospective multicentre European Crohn's and Colitis Organisation CONFER [COllaborative Network For Exceptionally Rare case reports] project. We also performed a comprehensive retrospective search of the available literature on this topic. RESULTS We report herein 12 new cases of ON, including 10 under anti-TNF therapy, collected through the CONFER project. We also compare characteristics of ON associated or not with anti-TNFα agents. CONCLUSIONS The exceptional and current observation of distant family history of MS in 17% of our patients who developed ON, despite the small number and the lack of a control arm, might be an important signal that should be taken into account in our therapeutic strategies in the future.
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Affiliation(s)
- Benjamin Alexandre
- Department of Internal Medicine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, Gosselies, Belgium,*Corresponding author. Benjamin Alexandre, MD, Department of Internal Medecine and Hepato-gastroenterology Unit, Notre-Dame de Grâce Hospital, 212 Chaussée de Nivelles, 6041 Gosselies, Belgium. Tel: +32 71 37 91 27;
| | - Yves Vandermeeren
- Department of Neurology, Université Catholique de Louvain, Yvoir, Belgium
| | - Olivier Dewit
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Tom Moreels
- Department of Gastroenterology, Université Catholique de Louvain, St-Luc Hospital, Brussels, Belgium
| | - Nanne de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anjan Dhar
- Darlington Memorial and Bishop Auckland Hospitals, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Chris Ziady
- Department of Gastroenterology, Kloof Hospital, Pretoria, South Africa
| | | | - Flavio Steinwurz
- Department of Gastroenterology, Hospital Israelita Albert Einstein, Sao Paolo, Brazil
| | - Njegica Jojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | - Giuseppe Costantino
- Department of Internal Medicine and Medical Therapy University of Messina, Messina, Italy
| | - Benoit Bihin
- Scientific Support Unit, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-François Rahier
- Department of Gastroenterology, Université Catholique de Louvain, Yvoir, Belgium
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Tréchot F, Angioi K, Latarche C, Conroy G, Beaujeux P, Andrianjafy C, Portier M, Batta B, Conart JB, Cloché V, Peyrin-Biroulet L. Keratoconus in Inflammatory Bowel Disease Patients: A Cross-sectional Study. J Crohns Colitis 2015; 9:1108-12. [PMID: 26351387 DOI: 10.1093/ecco-jcc/jjv151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/21/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Increasing evidence suggests that keratoconus may have an inflammatory component. The possible association of keratoconus with inflammatory bowel disease (IBD) has yet to be determined. The aim of this study was to determine the prevalence of keratoconus and suspect keratoconus in patients with IBD. METHODS All consecutive adult IBD patients seen in the Department of Gastroenterology, Nancy, University Hospital, France, between March 2014 and June 2014 were included. Pregnant women, rigid lens wearers, patients with a family history of keratoconus and patients with a history of refractive surgery were excluded. A control group of healthy subjects was included. All included patients underwent a corneal topography (OPD-Scan III, Nidek) to detect keratoconus or suspect keratoconus. Rabinowitz videokeratographic indices were the basis of corneal topography interpretation. RESULTS Two hundred and one IBD patients were included, 150 with Crohn's disease and 51 with ulcerative colitis. Mean age was 38.7 years and 121 were women. Mean disease duration was 10.8 years. Two IBD patients were diagnosed with keratoconus (1%) and 38 with suspect keratoconus (18.9%). Overall prevalence of keratoconus and suspect keratoconus was 19.9% (95% confidence interval [CI] 17.5-22.0). None of the 100 healthy subjects had keratoconus, while three were diagnosed with suspect keratoconus (p = 0.0002 versus IBD patients). Only smoking was identified as a risk factor (p = 0.029), especially in Crohn's disease. CONCLUSION Inflammatory bowel disease patients may carry an increased risk of keratoconus and suspect keratoconus, smoking further increasing this risk. This supports the hypothesis of an inflammatory origin of keratoconus.
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Affiliation(s)
- Fanny Tréchot
- Department of Ophthalmology, Nancy, University Hospital, University of Lorraine, France
| | - Karine Angioi
- Department of Ophthalmology, Nancy, University Hospital, University of Lorraine, France
| | - Clothilde Latarche
- Inserm CIC-EC and Department of Epidemiology and Clinical Evaluation, Nancy, University Hospital, University of Lorraine, France
| | - Guillaume Conroy
- Inserm U 954 and Department of Gastroenterology, Nancy, University Hospital, University of Lorraine, France
| | - Pauline Beaujeux
- Department of Ophthalmology, Nancy, University Hospital, University of Lorraine, France
| | - Charlotte Andrianjafy
- Inserm U 954 and Department of Gastroenterology, Nancy, University Hospital, University of Lorraine, France
| | - Mathilde Portier
- Inserm U 954 and Department of Gastroenterology, Nancy, University Hospital, University of Lorraine, France
| | - Benjamine Batta
- Department of Ophthalmology, Nancy, University Hospital, University of Lorraine, France
| | - Jean-Baptiste Conart
- Department of Ophthalmology, Nancy, University Hospital, University of Lorraine, France
| | - Véronique Cloché
- Department of Ophthalmology, Nancy, University Hospital, University of Lorraine, France
| | - Laurent Peyrin-Biroulet
- Inserm U 954 and Department of Gastroenterology, Nancy, University Hospital, University of Lorraine, France
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Ben Abdelghani K, Slouma M, Ben Jalel W, Zakraoui L. Retinal vasculitis: a novel paradoxical effect of anti-TNFα? BMJ Case Rep 2014; 2014:bcr-2014-204909. [PMID: 25143312 DOI: 10.1136/bcr-2014-204909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Retinal vasculitis (RV) is extremely rare in spondyloarthritis associated with Crohn's disease. Infliximab, a chimeric monoclonal antibody to tumour necrosis factor (TNF) α, is efficient in spondyloarthritis, Crohn's disease and RV. We present the case of a 41-year-old man with a known history of spondyloarthritis associated with Crohn's disease. He was under treatment with infliximab. Four days after his 12th infusion of infliximab, he presented with sudden blurred vision. Although his disease was in remission, ophthalmological examination revealed bilateral peripheral retinal occlusive vasculitis. The patient responded positively to the treatment by laser photocoagulation and peribulbar corticosteroid injection. Infliximab was not stopped. There was improvement in his eye disease. To the best of our knowledge, this is the first case of new onset of RV occurring under infliximab in a patient with Crohn's related spondyloarthritis. This case illustrates the possibility of a paradoxical effect of this kind of therapy.
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Affiliation(s)
| | - Maroua Slouma
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunisia
| | - Wady Ben Jalel
- Department of Ophthalmology, Hospital of internal security forces, La Marsa, Tunisia
| | - Leith Zakraoui
- Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunisia
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Anemia and retinal function in a mouse model of acute colitis. ACTA ACUST UNITED AC 2014; 21:301-8. [PMID: 25156814 DOI: 10.1016/j.pathophys.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 01/29/2023]
Abstract
Individuals with inflammatory bowel diseases (IBD) have an elevated risk of ocular inflammation. Both the anterior and posterior eye can be affected by IBD, although posterior eye dysfunction is more likely to go undetected. Little investigative attention has been directed toward the mechanisms of ocular dysfunction with IBD; however, given the prevalence of anemia in IBD and the effects of anemia on the retina, we examined the association between retinal function (electroretinography, ERG) and the anemia induced by experimental IBD, and we tested for a potential retinal benefit of acutely attenuating anemia (via red blood cell (RBC) infusion). Colitis was induced in mice in a model involving drinking water ingestion of dextran sodium sulfate (DSS), with untreated drinking water administered to controls. A subset of the DSS mice was infused with RBCs to attenuate the severity of the anemia induced by DSS. ERG signals (a-waves, b-waves, and oscillatory potential amplitudes and implicit times) were compared between the three groups of mice to evaluate retinal function. ERG amplitudes were significantly decreased in DSS mice compared to controls, with the amplitudes demonstrating a positive correlation with hematocrit, that is, the lowest ERG amplitudes were found with the most severe cases of anemia. An acute infusion of RBCs into DSS mice provided an improvement in the oscillatory potential implicit times, but no significant improvements in other ERG parameters. Despite the association between anemia and ERG signals in DSS-induced colitis, acute RBC infusion may only partially attenuate the associated retinal dysfunction.
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Katsanos A, Asproudis I, Katsanos KH, Dastiridou AI, Aspiotis M, Tsianos EV. Orbital and optic nerve complications of inflammatory bowel disease. J Crohns Colitis 2013; 7:683-93. [PMID: 23083697 DOI: 10.1016/j.crohns.2012.09.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/11/2012] [Accepted: 09/27/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Extraintestinal manifestations of inflammatory bowel disease (IBD) can involve the orbit and the optic nerve. Although these manifestations are rare, they can be particularly serious as they can lead to permanent loss of vision. The aim of the review is to present the existing literature on IBD-related optic nerve and orbital complications. METHODS A literature search identified the publications reporting on incidence, clinical features and management of IBD patients with optic nerve and orbital manifestations. RESULTS Posterior scleritis and orbital inflammatory disease (orbital pseudotumor) are the most commonly encountered entities affecting the structures of the orbit. On the other hand, the optic nerve of IBD patients can be affected by conditions such as optic (demyelinating) neuritis ("retrobulbar" neuritis), or ischaemic optic neuropathy. Other neuro-ophthalmic manifestations that can be encountered in patients with IBD are related to increased intracranial pressure or toxicity secondary to anti tumour necrosis factor (anti-TNF) agents. CONCLUSIONS IBD-related optic nerve and orbital complications are rare but potentially vision-threatening. Heightened awareness and close cooperation between gastroenterologists and ophthalmologists are warranted.
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Affiliation(s)
- Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
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Abstract
BACKGROUND Ocular disease is known widely to occur in a subset of patients experiencing inflammatory bowel diseases. Although this extraintestinal manifestation has been recognized for a number of years, the pathogenetic mechanisms responsible for this distant organ inflammatory response are unknown. METHODS In the current study, we used a T-cell transfer model of chronic colitis in mice in which we quantified colonic inflammation, ocular function (electroretinography), ocular blood flow (intravital microscopy of the retina), intraocular pressure, and retinal hypoxia. RESULTS Ocular function in colitic mice was significantly impaired, with decreases in retinal b-wave amplitudes and oscillatory potentials. Moreover, retinal a waves and oscillatory potentials were delayed. Retinal blood flow was significantly reduced in the colitic mice, and this decrease in perfusion coupled with significant decreases in hematocrit would decrease oxygen delivery to the eye. Accordingly, mice with severe colitis showed increased levels of immunostaining for the hypoxia-dependent probe pimonidazole. Finally, intraocular pressures were found to be reduced in the colitic mice. CONCLUSIONS Ocular disease occurs in a mouse model of chronic colitis, with retinal dysfunction seeming to be related to insufficient perfusion and oxygen delivery.
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Cloché V, Buisson A, Tréchot F, Batta B, Locatelli A, Favel C, Premy S, Collet-Fenetrier B, Fréling E, Lopez A, Massoure MP, Humbert AL, Hansmannel F, Guéant JL, Bigard MA, Peyrin-Biroulet L, Angioi K. Ocular symptoms are not predictive of ophthalmologic inflammation in inflammatory bowel disease. Dig Liver Dis 2013. [PMID: 23200464 DOI: 10.1016/j.dld.2012.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ocular manifestations are frequent in patients with inflammatory bowel disease. AIM To evaluate for the first time the value of ocular symptoms in predicting ophthalmologic inflammation in inflammatory bowel disease. METHODS All consecutive inflammatory bowel disease patients seen in the Department of Gastroenterology (Nancy, University Hospital, France) between April 2009 and July 2011 were interviewed for this cross-sectional study using a pre-established questionnaire. If the patient had at least one ocular symptom, he systematically underwent an ophthalmologic examination (visual acuity, Break-Up Time test, Schirmer Test, slit-lamp exam with fundus examination). RESULTS This cross-sectional survey was completed by 305 patients: 169 were women (55.2%), 228 had Crohn's disease (74.5%). Ninety-eight patients (32%) reported at least one ocular symptom: ocular irritation (56.8%), red eye (40.5%), blurred vision (37.8%), progressive visual loss (34.4%), ocular pain (31.1%), myodesopsia (23.3%), eyelid secretion (12.2%), dry eye (9.5%), watering (6.8%), diplopia (5.4%), metamorphopsia (4%), and sudden visual loss (4%). Following ophthalmologic examination (n=74), 41.9% patients had evidence of dry eye (n=31), 14.9% blepharitis (n=11) and 1.4% scleritis (n=1). No uveitis was reported. CONCLUSION Ocular symptoms are frequent in inflammatory bowel disease, but are non-specific and rarely associated with ocular inflammation. Systematic ocular symptoms assessment is of poor value for diagnosing ocular inflammation in inflammatory bowel disease.
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Affiliation(s)
- Véronique Cloché
- Department of Ophthalmology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
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Denniston AK, Gayed M, Carruthers D, Gordon C, Murray PI. Rheumatic Disease. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00080-1] [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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Liu MP, Hwang FS, Dunn J, Stark WJ, Bower KS. Hypopyon Uveitis Following LASIK in a Patient With Ulcerative Colitis. J Refract Surg 2012; 28:589-91. [DOI: 10.3928/1081597x-20120722-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/12/2012] [Indexed: 11/20/2022]
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Nonischemic central retinal vein occlusion in an adolescent patient with ulcerative colitis. Case Rep Ophthalmol Med 2012; 2011:963583. [PMID: 22606483 PMCID: PMC3350116 DOI: 10.1155/2011/963583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/30/2011] [Indexed: 01/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) can present with extraintestinal manifestations occasionally involving the eye. Retinal vein occlusions are rarely seen and have never been reported in the pediatric population though vascular thrombosis can be associated with IBD. Here, we present a case of what we believe is the youngest reported patient with nonischemic central retinal vein occlusion (CRVO).
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Barabino AV, Gandullia P, Calvi A, Vignola S, Arrigo S, Marco RD. Sudden blindness in a child with Crohn’s disease. World J Gastroenterol 2011; 17:4344-6. [PMID: 22090792 PMCID: PMC3214711 DOI: 10.3748/wjg.v17.i38.4344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/27/2011] [Accepted: 05/04/2011] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is often associated with extraintestinal manifestations (EIMs) such as optic neuritis (ON), although this has been described in only a few adult patients so far, all of whom were affected with Crohn’s disease (CD). Furthermore, ON and demyelinating diseases have been demonstrated to be more frequent in IBD patients than in control populations. In our current case report, we describe a child with active CD who developed sudden blindness due to bilateral ON that was not related to any known cause, and that promptly responded to a high dose of steroids. Investigations and a clinical follow-up have so far ruled out the development of demyelinating diseases in this patient. To our knowledge, this is the first report of ON in a pediatric patient with CD. Possible explanations for this case include an episodic EIM of an active bowel disease, an associated autoimmune disorder such as a recurrent isolated ON, the first manifestation of multiple sclerosis, or another demyelinating disease that could appear in a later follow-up.
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Pham M, Chow CC, Badawi D, Tu EY. Use of infliximab in the treatment of peripheral ulcerative keratitis in Crohn disease. Am J Ophthalmol 2011; 152:183-188.e2. [PMID: 21652024 DOI: 10.1016/j.ajo.2011.01.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 01/28/2011] [Accepted: 01/29/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the effectiveness of infliximab in the treatment of peripheral ulcerative keratitis (PUK) associated with Crohn disease. DESIGN Retrospective, interventional case series. METHODS SETTING Institutional, academic referral setting. patient or study population: Six eyes of 3 patients with PUK associated with Crohn disease that failed or were intolerant to traditional immunosuppression such as oral prednisone and cyclophosphamide. INTERVENTION OR OBSERVATION PROCEDURE(S): Infliximab intravenous infusion 5 mg/kg every 2 to 8 weeks. MAIN OUTCOME MEASURE(S) Subjective outcome such as pain improvement and objective outcomes such as visual acuity, signs of inflammation, and progression of corneal thinning. RESULTS Symptom of pain improved in all patients. Visual acuity remained stable in 4 of 6 eyes, improved in 1 of 6 eyes, and worsened in 1 of 6 eyes (secondary to stromal scar). Rapid resolution of inflammation and arrest of further thinning were observed in all 6 eyes. Similar effects were observed on recurrence treated with repeat dosing of infliximab in 5 of 6 eyes. CONCLUSIONS Infliximab produced a rapid, dramatic, repeatable suppression of corneal inflammation, pain, and keratolysis in PUK associated with Crohn disease. Although the effect of long-term therapy with these agents is unknown, infliximab should be considered in patients with Crohn-associated PUK not amenable to traditional therapy. Larger prospective studies are needed to determine the efficacy of infliximab in this aggressive disease entity.
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Angioi K, Kaminsky P, Peyrin-Biroulet L. Infliximab for severe peripheral ulcerative keratopathy revealing Crohn's disease. Inflamm Bowel Dis 2011; 17:866-7. [PMID: 20848541 DOI: 10.1002/ibd.21358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Malik A, Zakri RH, Sheikh Z, Shalchi Z, Zia R, Schultz DJ. Concurrent macular oedema and optic neuritis in Crohn's disease with varied response to steroids. BMJ Case Rep 2010; 2010:bcr10.2009.2394. [PMID: 22479295 DOI: 10.1136/bcr.10.2009.2394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A patient with a 10-year history of Crohn's disease presented to our ophthalmology service with symptoms of acute anterior uveitis. Previous episodes had been treated successfully with topical steroids.However, on this occasion after treatment with topical steroids, the patient developed macular oedema with concurrent optic neuritis in the affected eye.Furthermore, optic neuritis persisted despite oral steroid treatment contrary to expectations based on current literature. After 6 months of treatment, optic disc oedema had markedly improved but was replaced by sectoral disc pallor.
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Affiliation(s)
- Adeela Malik
- William Harvey Hospital, Department of Ophthalmology, Kennington Road, Willesborough, Ashford, TN24 0LZ, UK
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Larsen S, Bendtzen K, Nielsen OH. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management. Ann Med 2010; 42:97-114. [PMID: 20166813 DOI: 10.3109/07853890903559724] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract Extraintestinal manifestations occur rather frequently in inflammatory bowel disease (IBD), e.g. ulcerative colitis (UC) and Crohn's disease (CD). The present paper provides an overview of the epidemiology, clinical characteristics, diagnostic process, and management of rheumatic, metabolic, dermatologic (mucocutaneous), ophthalmologic, hepatobiliary, hematologic, thromboembolic, urinary tract, pulmonary, and pancreatic extraintestinal manifestations related to IBD. Articles were identified through search of the PubMed and Embase databases, the Cochrane Library, and the web sites of the European Agency for the Evaluation of Medicinal Products (EMEA) and the US Food and Drug Administration (FDA) (cut-off date October 2009). The search terms 'Crohn's disease', 'inflammatory bowel disease', or 'ulcerative colitis' were combined with the terms 'adalimumab', 'anemia', 'arthritis', 'bronchiectasis', 'bronchitis', 'cutaneous manifestations', 'erythema nodosum', 'extraintestinal manifestations', 'hyperhomocysteinemia', 'infliximab', 'iridocyclitis', 'lung disease', 'ocular manifestations', 'osteomalacia', 'pancreatitis', 'primary sclerosing cholangitis', 'renal stones', 'sulfasalazine', 'thromboembolism', and 'treatment'. The search was performed on English-language reviews, practical guidelines, letters, and editorials. Articles were selected based on their relevance, and additional papers were retrieved from their reference lists. Since some of the diseases discussed are uncommon, valid evidence of treatment was difficult to obtain, and epidemiologic data on the rarer forms of extraintestinal manifestations are scarce. However, updates on the pathophysiology and treatment regimens are given for each of these disorders. This paper offers a current review of original research papers and randomized clinical trials, if any, within the field and makes an attempt to point out practical guidelines for the diagnosis and treatment of various extraintestinal manifestations related to IBD.
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Affiliation(s)
- Signe Larsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Denmark
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Repair of Necrotizing Scleritis in Ulcerative Colitis With Processed Pericardium and a Prokera Amniotic Membrane Graft. Eye Contact Lens 2010; 36:60-1. [DOI: 10.1097/icl.0b013e3181c6deb0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Katsanos KH, Saougos V, Kosmidou M, Doukas M, Kamina S, Asproudis I, Tsianos EV. Sjogren's syndrome in a patient with ulcerative colitis and primary sclerosing cholangitis: Case report and review of the literature. J Crohns Colitis 2009; 3:200-3. [PMID: 21172271 DOI: 10.1016/j.crohns.2009.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 03/23/2009] [Accepted: 03/23/2009] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease has been reported to co-exist with other autoimmune diseases. Sjogren's syndrome is an autoimmune disorder characterized by xerostomy and/or xerophthalmy. Sjogren's syndrome occurring in IBD has been very rarely reported. A 45-year old woman diagnosed ten years ago with ulcerative pancolitis and primary sclerosing cholangitis was referred to our outpatient IBD clinic because of xerostomy but not for xerophthalmy for the previous three months. The patient had been under azathioprine maintenance treatment (2 mg/kg) and achieved long-term disease remission for the past 4 years. Patient clinical examination and laboratory tests were unremarkable. Salivary gland biopsy and complete ophthalmologic investigation were performed and the patient was diagnosed with Sjogren's syndrome. Understanding sicca manifestations in IBD is difficult since the pathogenesis of this intestinal disorder is not yet clear. Of these complex autoimmune phenomena which occur along with IBD it is quite difficult to categorize concomitant Sjogren's syndrome as primary or secondary and literature is conflicting. The possibility of Sjogren's syndrome should always be considered and properly investigated in patients diagnosed with inflammatory bowel disease who develop a constellation of constitutional sicca symptoms.
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Affiliation(s)
- Konstantinos H Katsanos
- 1st Department of Internal Medicine and Hepato-Gastroenterology Unit, Medical School, University of Ioannina, 451 10, Ioannina, Greece
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Case of lacrimal gland inflammation associated with ulcerative colitis. Int Ophthalmol 2009; 30:109-11. [PMID: 19169863 DOI: 10.1007/s10792-009-9296-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 01/05/2009] [Indexed: 01/13/2023]
Abstract
We report a case of lacrimal gland pseudotumor as the presenting sign of ulcerative colitis. A 25-year-old woman presented with a right upper eyelid swelling and pain. Intravenous administration of prednisolone was initiated on suspicion of lacrimal gland inflammation (pseudotumor). Although the treatment markedly reduced her ocular symptoms, she developed lower abdominal cramping and diarrhea with the 5 mg/day of oral prednisolone. Sigmoid colonoscopy and colon biopsy led to make a diagnosis of ulcerative colitis. Ulcerative colitis improved significantly with increased dose of steroid and additive mesalazine therapy. Ulcerative colitis should be included in the differential diagnosis of lacrimal gland pseudotumor.
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Felekis T, Katsanos K, Kitsanou M, Trakos N, Theopistos V, Christodoulou D, Asproudis I, Tsianos EV. Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: a prospective single-center study. Inflamm Bowel Dis 2009; 15:29-34. [PMID: 18626979 DOI: 10.1002/ibd.20584] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The frequency and spectrum of ophthalmologic manifestations in patients with inflammatory bowel disease (IBD) has been reported to vary among studies; however, rare and silent manifestations have not been extensively studied. METHODS This was a prospective study of 60 patients diagnosed with IBD who underwent full ophthalmologic examination, including visual acuity, slit lamp examination of the anterior segments, intraocular pressure, and fundus examination accompanied by color photography. Thirty-seven (61,7%) patients were diagnosed with ulcerative colitis (UC) and 23 (38,3%) with Crohn's disease (CD). Data from 276 control individuals were used for the determination of the prevalence of dry eye in our area. RESULTS Ophthalmologic manifestations were diagnosed in 26 (43%) patients (14 UC, 12 CD; 12 males and 14 females). Conjunctivitis was diagnosed in 1 patient (CD), episcleritis in 2 patients (UC), and iridocyclitis in 3 (CD). Fundus examination showed 1 patient (CD) with unilateral choroiditis, 1 (UC) with retinal vasculitis, and 1 (CD) with optic neuritis. Retinal pigment epithelium disturbances (RPED) were present in 3 patients (1 CD, 2 UC) and 2 had serous retinal detachment. In total, 13/60 patients (22%) had dry eye compared with the 11% prevalence in controls. Eight patients developed glucocorticosteroid-induced cataracts, 2 of them treated surgically. CONCLUSIONS This study demonstrated the prevalence of the spectrum of ophthalmologic manifestations in the IBD population, including some rare and silent findings that may merit consideration and early intervention.
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Affiliation(s)
- Taxiarchis Felekis
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
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Cheng S, Vu P. Recurrent orbital myositis with radiological feature mimicking thyroid eye disease in a patient with Crohn's disease. Orbit 2009; 28:368-370. [PMID: 19929661 DOI: 10.3109/01676830903104751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Orbital myositis is an extremely rare extra-intestinal manifestation of Crohn's disease. Herein we describe a patient with self-limiting episodes of episcleritis and uveitis prior to the diagnosis of Crohn's disease, and subsequent development of recurrent orbital myositis with radiological features mimicking thyroid eye disease.
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Affiliation(s)
- Sean Cheng
- Department of Ophthalmology, Mater Children's Hospital, South Brisbane QLD 4101, Australia
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Ishihara K, Tsujikawa A, Yodoi Y, Kameda T, Yoshimura N. Choroidal neovascularization in a patient with ulcerative colitis. Jpn J Ophthalmol 2008; 52:515-518. [DOI: 10.1007/s10384-008-0587-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 07/22/2008] [Indexed: 01/06/2023]
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Post-cataract surgery cystoid macular edema from choriocapillaris submacular leakage in a patient with crohn disease: a case report. Retin Cases Brief Rep 2008; 2:241-4. [PMID: 25390099 DOI: 10.1097/icb.0b013e318162b046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe an unusual case of cystoid macular edema after cataract surgery in a patient with Crohn disease. METHODS A confocal scanning laser ophthalmoscopic study was performed on one eye before and after systemic corticosteroid treatment. Both fluorescein and indocyanine green angiograms were used to visualize vascular leakage. RESULTS Both fluorescein and indocyanine green angiograms indicated early-phase leakage in the macular region. The early-phase indocyanine green leakage was from choroidal vasculature and suggested choriocapillaris vasculitis. In the later phases, the fluorescein angiogram showed the typical petaloid pattern of cystoid macular edema. After 1 month of treatment, the abnormal indocyanine green leakage disappeared with a concomitant increase in visual acuity. CONCLUSIONS We report possible choriocapillaritis associated with Crohn disease based on dynamic angiography that revealed indocyanine green leakage in combination with early-phase fluorescein leakage. To our knowledge, this is the first description of choriocapillaris vasculitis associated with Crohn disease.
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Day MJ, Mould JRB, Carter WJ. An immunohistochemical investigation of canine idiopathic granulomatous scleritis. Vet Ophthalmol 2008; 11:11-7. [DOI: 10.1111/j.1463-5224.2007.00592.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Diagnostic and Therapeutic Challenges. Retina 2007; 27:1305-10. [DOI: 10.1097/iae.0b013e318156db4d] [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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Yilmaz S, Aydemir E, Maden A, Unsal B. The prevalence of ocular involvement in patients with inflammatory bowel disease. Int J Colorectal Dis 2007; 22:1027-30. [PMID: 17262200 DOI: 10.1007/s00384-007-0275-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2007] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this prospective randomized clinical study was to evaluate the prevalence of ocular involvement in patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS We prospectively evaluated 116 patients who went to the gastroenterology clinic with endoscopically proven IBD between December 2001 and February 2005. All patients were examined for evidence of ocular manifestations of IBD. Twenty patients had Crohn's disease and 96 had ulcerative colitis. The examination consisted of slit-lamp examinations, tonometry, visual acuity, and indirect ophthalmoscopy. RESULTS The mean age of the 116 patients with IBD who were enrolled was 40.6 +/- 14.4 years (range 16 to 75). Twelve of 20 patients (60%) with Crohn's disease and 22 of 96 patients (22.92%) with ulcerative colitis had ocular involvement. The most common ocular findings were conjunctivitis (8.62%) and blepharitis (6.9%) followed by uveitis (5.17%), cataract (5.17%), and episcleritis (3.45%). Extraintestinal complications were seen in 12 (35.3%) of 34 patients with ocular involvement and in 16 (19.5%) of 82 patients without ocular involvement. CONCLUSION Because the ocular complaints of IBD patients are often nonspecific, it may be helpful to performed eye examinations as a routine component in the follow-up of these patients. It is well-known that early diagnosis and treatment of ocular involvement may prevent serious ocular complications that could be associated with significant visual morbidity. In addition, clinicians should be aware that some ocular diseases, such as uveitis and scleritis, might precede a diagnosis of ulcerative colitis or Crohn's disease.
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Affiliation(s)
- Safiye Yilmaz
- Department of the Ophthalmology, Izmir Atatürk Training and Research Hospital, Mustafa Kemal Cad. No. 36/4, Izmir, Bornova 35040, Turkey.
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Fuentes-Páez G, Martínez-Osorio H, Herreras JM, Calonge M. Subretinal fibrosis and uveitis syndrome associated with ulcerative colitis. Int J Colorectal Dis 2007; 22:333-4. [PMID: 16721489 DOI: 10.1007/s00384-006-0137-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS We report a case of subretinal fibrosis and panuveitis syndrome as an extraintestinal manifestation of ulcerative colitis. MATERIALS AND METHODS We present an interventional case report of a 40-year-old female patient with inactive ulcerative colitis referred to our center for refractory uveitis in her right eye. RESULTS/FINDINGS She was diagnosed with subretinal fibrosis and uveitis syndrome after work-up ruled out tuberculosis, bartonellosis, Lyme disease, and sarcoidosis. Right eye multifocal choroiditis and panuveitis syndrome with subretinal fibrosis was diagnosed, and posterior pole subretinal fibrosis caused a 90% loss of visual efficiency. She had concurrent dermatological manifestations but no gastrointestinal symptoms. One year of immunosuppressive therapy with methotrexate (7.5 mg/week) controlled ocular inflammation. Two colitis episodes, with no visual involvement, were recorded during follow-up. Her final, right-eye, best-corrected visual acuity remained stable at 0.160 due to scarring sequela after 7 years of follow-up. INTERPRETATION/CONCLUSION Subretinal fibrosis and uveitis syndrome can occur as a sight-threatening extraintestinal manifestation of ulcerative colitis.
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Affiliation(s)
- Graciana Fuentes-Páez
- Ocular Immunology and Uveitis Unit, Institute of Ophthalmobiology (IOBA), Facultad de Medicina, University of Valladolid, Calle Ramón y Cajal 7, Valladolid, 47005, Spain
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Leibovitch I, Ooi C, Huilgol SC, Reid C, James CL, Selva D. Pyodermatitis-pyostomatitis vegetans of the eyelids case report and review of the literature. Ophthalmology 2005; 112:1809-13. [PMID: 16095701 DOI: 10.1016/j.ophtha.2005.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 04/19/2005] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To present the first reported case of eyelid involvement in pyodermatitis-pyostomatitis vegetans (PDPSV) leading to the diagnosis of ulcerative colitis, and to review the literature. DESIGN Interventional case report. METHODS A 29-year-old man presented with a 4-week history of severe bilateral upper and lower eyelid margin ulceration and pustules unresponsive to topical and systemic broad-spectrum antibiotic treatment. Further questioning revealed the existence of skin and oral lesions. MAIN OUTCOME MEASURES Clinical course, histological findings, and response to treatment. RESULTS The histological and immunofluorescence studies were suggestive of PDPSV. Colonoscopy showed significant chronic active ulcerative colitis. Treatment with systemic steroids and sulfasalazine resulted in complete resolution of eyelid, oral, and skin lesions. However, stopping the steroids resulted in recurrence of eyelid and oral lesions and required recommencement of treatment. CONCLUSION It is important to be familiar with this pustular skin condition, as correct diagnosis may lead to the diagnosis of inflammatory bowel disease. Although periocular involvement is probably rare, the combined typical skin and oral lesions and the characteristic histological and immunofluorescence tests should suggest the correct diagnosis.
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Affiliation(s)
- Igal Leibovitch
- Oculoplastic & Orbital Division, Department of Ophthalmology & Visual Sciences, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
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Leibovitch I, Galanopoulos A, Selva D. Suppurative granulomatous myositis of an extra-ocular muscle in Crohn's disease. Am J Gastroenterol 2005; 100:2136-7. [PMID: 16128967 DOI: 10.1111/j.1572-0241.2005.50395_10.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Krohne TU, Inhetvin-Hutter C, Holz FG. Einseitige Visusminderung in Gegenwart retinaler Hämorrhagien bei einer 35-jährigen Patientin. Ophthalmologe 2005; 102:622-4. [PMID: 15959772 DOI: 10.1007/s00347-004-1068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW The ophthalmologist has direct visual access to inflamed vessels when examining the retina, and "vasculitis" in ophthalmology has so far mainly referred to retinal vasculitis. In the past few years the means to explore vasculitis in the ocular sphere have improved. Indocyanine green angiography now enables the analysis of choroidal inflammatory vasculopathy as well as vasculitis of the sclera (scleritis) and episclera (episcleritis) in addition to retinal vasculitis. Because vasculitis detected by the ophthalmologist can be the presenting sign of a systemic disease and has to be approached in a multidisciplinary fashion, the emerging term "ocular vasculitis," instead of retinal vasculitis, should be used in the future. The term covers vasculitis affecting all structures of the eye and the periocular tissues as detailed in this article. The ocular findings have to be integrated within the established and accepted classification of systemic vasculitis, which is divided into primary vasculitides, where the vessel itself is the target of the inflammatory reaction, and secondary vasculitides, caused by other inflammatory processes. This review will deal with recently published articles on ocular vasculitis, including its clinical aspects, its link with systemic diseases, and its investigation and management. The discussion will be conducted within the framework of the new classification put forward here. RECENT FINDINGS Novel imaging techniques such as indocyanine green angiography have made it possible to explore inflammation of choroidal vessels and of scleral vasculitis in addition to retinal vasculitis, contributing to the global concept of ocular vasculitis. It has been shown, in particular, that the choriocapillaris, a vascular structure adjacent to the retina, can be the site of a primary inflammatory vasculopathy unrecognized so far. Most of the recent articles cited, however, deal not so much with new findings but with the integration of ocular pathologic changes into the systemic diseases they are part of. New knowledge about disease mechanisms and novel therapeutic modalities with biologic agents cited in this review are coming from other fields but have contributed to progress in the management of ocular vasculitis. SUMMARY New investigational techniques of vasculitis in ocular structures other than the retina have contributed to the development of the global concept of ocular vasculitis. This review shows the importance of promoting a comprehensive and global classification of ocular vasculitis compatible with the concepts accepted for systemic vasculitis to contribute to its multidisciplinary approach.
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Affiliation(s)
- Carl P Herbort
- Inflammatory Eye Diseases, La Source Eye Centre, and University of Lausanne, Lausanne, Switzerland.
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Diaz-Valle D, Benitez del Castillo JM, Fernandez Aceñero MJ, Pascual Allen D, Moriche Carretero M. Bilateral lid margin ulcers as the initial manifestation of Crohn disease. Am J Ophthalmol 2004; 138:292-4. [PMID: 15289143 DOI: 10.1016/j.ajo.2004.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2004] [Indexed: 01/13/2023]
Abstract
PURPOSE To report an unusual bilateral ulcerative lid involvement as the presenting manifestation of a severe Crohn disease. DESIGN Observational case report. METHOD Description of an otherwise healthy woman who initially presented with bilateral ulcerative lid involvement before the discovery of an extensive ulcerative intestinal inflammatory disease. RESULTS A 32-year-old woman presented with bilateral ulcerative blepharitis. She also complained of aphthous oral lesions and diarrheic episodes for the previous 3 days. Impression cytology of the lid ulcers showed conjunctival cells, together with the presence of lymphocytes and macrophages. Colonoscopy and colonic biopsy were characteristic of Crohn disease. The treatment with systemic corticosteroids healed bowel, oral, and lid margin ulcerative lesions. CONCLUSION The simultaneous appearance of ulcerative lesions in the intestinal mucosa and in the mucocutaneous lid margin and the comparable features encountered in the cytologic studies indicate that ulcerative lid margin disease could be an ocular manifestations of Crohn disease.
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Affiliation(s)
- David Diaz-Valle
- Department of Ophthalmology, Hospital General de Mostoles, Madrid, Spain.
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