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Musa M, Bale BI, Suleman A, Aluyi-Osa G, Chukwuyem E, D’Esposito F, Gagliano C, Longo A, Russo A, Zeppieri M. Possible viral agents to consider in the differential diagnosis of blepharoconjunctivitis. World J Virol 2024; 13:97867. [DOI: 10.5501/wjv.v13.i4.97867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Blepharoconjunctivitis poses a diagnostic challenge due to its diverse etiology, including viral infections. Blepharoconjunctivits can be acute or chronic, self-limiting, or needing medical therapy.
AIM To review possible viral agents crucial for accurate differential diagnosis in cases of blepharoconjunctivitis.
METHODS The PubMed database was searched for records relating to viral blepharoconjunctivitis. The search string generated was “("virally"[All Fields] OR "virals"[All Fields] OR "virology"[MeSH Terms] OR "virology"[All Fields] OR "viral"[All Fields]) AND "Blepharoconjunctivitis"[All Fields]".
RESULTS A total of 24 publications were generated from the search string. Reference lists from each relevant article were also searched for more information and included in this review. Viral etiologies such as adenovirus, herpes simplex virus (HSV), varicella-zoster virus (VZV), and Epstein-Barr virus (EBV) are frequently implicated. Adenoviral infections manifest with follicular conjunctivitis and preauricular lymphadenopathy, often presenting as epidemic keratoconjunctivitis. HSV and VZV infections can result in herpetic keratitis and may exhibit characteristic dendritic corneal ulcers. EBV, although less common, can cause unilateral or bilateral follicular conjunctivitis, particularly in immunocompromised individuals. Other potential viral agents, such as enteroviruses and molluscum contagiosum virus, should also be considered, especially in pediatric cases.
CONCLUSION Prompt recognition of these viral etiologies is essential for appropriate management and prevention of complications. Thus, a thorough understanding of the clinical presentation, epidemiology, and diagnostic modalities is crucial for accurate identification and management of viral blepharoconjunctivitis.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre Ltd, Benin 300105, Nigeria
- Department of Ophthalmology, Centre for Sight Africa Ltd, Nkpor 434212, Nigeria
| | | | - Ayuba Suleman
- Department of Ophthalmology, Africa Eye Laser Centre Ltd, Benin 300105, Nigeria
| | - Gladness Aluyi-Osa
- Department of Ophthalmology, Africa Eye Laser Centre Ltd, Benin 300105, Nigeria
| | - Ekele Chukwuyem
- Department of Ophthalmology, Centre for Sight Africa Ltd, Nkpor 434212, Nigeria
| | - Fabiana D’Esposito
- Imperial College Ophthalmic Research Group Unit, Imperial College, London NW1 5QH, United Kingdom
- GENOFTA srl, Via A. Balsamo, 93, Naples 80065, Italy
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna "Kore", Catania 94100, Italy
- Eye Clinic, Catania University San Marco Hospital, Catania 95121, Italy
| | - Antonio Longo
- Department of Ophthalmology, University Hospital of Catania, Catania 95123, Italy
| | - Andrea Russo
- Department of Ophthalmology, University Hospital of Catania, Catania 95123, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Roston S, Minkus CL, Armbrust KR. Incident Ocular Inflammation After COVID-19 Infection in a US Veteran Population. Ocul Immunol Inflamm 2024; 32:1937-1944. [PMID: 38194622 DOI: 10.1080/09273948.2023.2296035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To investigate whether COVID-19 infection is a risk factor for incident ocular inflammatory disease. DESIGN Retrospective case-crossover study. METHODS The US Veterans Health Administration Corporate Data Warehouse was used to identify patients with positive COVID-19 testing and incident ocular inflammatory disease between March 2020 and May 2022. The timing of incident ocular inflammation and COVID-19 testing was assessed for each participant to determine whether positive COVID-19 testing occurred 0-60 days prior to incident ocular inflammation diagnosis (risk period) or 15-75 days after incident ocular inflammation diagnosis (control period). The main outcome measure was the odds of positive COVID-19 testing in the risk period versus control period. RESULTS Of the 1006 patients with incident ocular inflammation and a positive COVID-19 test in the study period, the age mean ± standard deviation was 62.6 ± 9.8 years and 840 (83%) were male. The odds of COVID-19 exposure was higher in the risk than control period (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.04-2.36; P = 0.03). Ocular inflammation was more likely to be bilateral in the risk period (OR, 3.97; 95% CI, 1.01-23.01; P = 0.03). Other ocular features and demographic characteristics were similar in the risk and control periods. Most cases of ocular inflammation were quiescent at the most recent eye examination. CONCLUSIONS Incident ocular inflammation is associated with COVID-19 infection, but the increased risk is small, and the ocular inflammation is typically acute.
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Affiliation(s)
- Sydney Roston
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Caroline L Minkus
- Department of Ophthalmology, Park Nicollet Eye Care, St Louis Park, Minnesota, USA
| | - Karen R Armbrust
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
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Mahendradas P, Patil A, Kawali A, Rathinam SR. Systemic and Ophthalmic Manifestations of Chikungunya Fever. Ocul Immunol Inflamm 2024; 32:1796-1803. [PMID: 37773977 DOI: 10.1080/09273948.2023.2260464] [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: 02/07/2023] [Revised: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Chikungunya is a re-emerging viral infection across the globe. The purpose of this article is to review the systemic and ophthalmic manifestations associated with chikungunya fever. METHOD A review of literature was conducted using online databases. RESULTS In this report, we have reviewed the presently available literature on uveitis caused by chikungunya and highlighted the current knowledge of its clinical manifestations, imaging features, laboratory diagnostics, and the available therapeutic modalities from the systemic and ophthalmic standpoint. CONCLUSIONS Ocular involvement in chikungunya infection may occur at the time of systemic manifestations or it may occur as a delayed presentation many weeks after the fever. Treatment relies on a supportive therapy for systemic illness. Treatment of ocular manifestation depends on the type of manifestations and usually includes a combination of topical and oral steroids.
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Affiliation(s)
| | - Aditya Patil
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
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Rangel CM, Restrepo-Arango M, Mejía-Salgado G, Gómez-Rocha MA, Gómez Velasco M, García MF, Moreno JJ. Acute Retinal Necrosis: Experience in a Reference Center in Santander - Colombia. Ocul Immunol Inflamm 2024; 32:1342-1350. [PMID: 37582226 DOI: 10.1080/09273948.2023.2244076] [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: 05/08/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is crucial for optimal visual outcomes. OBJECTIVE We present an ARN case series showcasing treatment experience and results. METHODOLOGY Patients diagnosed with ARN based on SUN Working Group 2021 criteria were included; all underwent comprehensive eye exams, PCR analysis, and imaging. RESULTS Eight patients were studied; PCR confirmed ARN in six. Induction treatment, either oral valacyclovir (5/8) or intravenous acyclovir (3/8), lasted 10-14 days. Maintenance included oral valacyclovir (6/8), oral valganciclovir (2/8) for six months, along with intravitreal ganciclovir. Visual outcomes were similar for oral and intravenous therapies; poor baseline acuity and macular involvement tend to result in a worse final acuity. CONCLUSIONS Swift treatment is vital to ARN management. Our findings emphasize effective treatment strategies' role in visual prognosis. ABBREVIATIONS ACV: Acyclovir; BCVA: Best Corrected Visual Acuity; CMV: Cytomegalovirus; EBV: Epstein Barr Virus; FTA-ABS: Fluorescent treponemal antibody absorption test; HSV 1-2: Herpes simplex virus 1-2; HIV: Human Immunodeficiency Virus; IV-ACV: Intravenous- Acyclovir; PCR: Polymerase Chain Reaction;Tg: Toxoplasma gondii; VZV: Varicella Zoster Virus; VCV: Valacyclovir; VDRL: Venereal disease research laboratory test.
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MESH Headings
- Humans
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/virology
- Retinal Necrosis Syndrome, Acute/drug therapy
- Antiviral Agents/therapeutic use
- Male
- Female
- Valacyclovir/therapeutic use
- Visual Acuity/physiology
- Colombia
- Acyclovir/therapeutic use
- Acyclovir/analogs & derivatives
- Middle Aged
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/virology
- Eye Infections, Viral/drug therapy
- Adult
- Polymerase Chain Reaction
- Ganciclovir/therapeutic use
- Ganciclovir/analogs & derivatives
- DNA, Viral/analysis
- DNA, Viral/genetics
- Administration, Oral
- Valganciclovir/therapeutic use
- Retrospective Studies
- Intravitreal Injections
- Tomography, Optical Coherence
- Fluorescein Angiography
- Young Adult
- Aged
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Affiliation(s)
- Carlos Mario Rangel
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | | | - Germán Mejía-Salgado
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - María Alejandra Gómez-Rocha
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Maira Gómez Velasco
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - María Fernanda García
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Juan José Moreno
- Fundación Oftalmológica de Santander Carlos Ardila Lule (FOSCAL), Floridablanca, Santander, Colombia
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Kalogeropoulos D, Afshar F, Kalogeropoulos C, Vartholomatos G, Lotery AJ. Diagnostic and therapeutic challenges in acute retinal necrosis; an update. Eye (Lond) 2024; 38:1816-1826. [PMID: 38519714 PMCID: PMC11226642 DOI: 10.1038/s41433-024-03028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
Acute retinal necrosis (ARN) is a rare but severe ophthalmic pathology defined by panuveitis, retinal necrosis, and high rates of retinal detachment. ARN may lead to poor visual outcomes even if promptly diagnosed and treated. ARN may present with a wide spectrum of clinical findings compatible with panuveitis including anterior uveitis, scleritis, vitritis, necrotizing retinitis, occlusive vasculitis, and optic disc edema. The American Uveitis Society introduced clinical criteria in 1994 for the diagnosis of ARN, while more recent criteria have been proposed by the Standardization of Uveitis Nomenclature (SUN) Working Group and the Japanese ARN Study Group. Multimodal imaging is a valuable tool in evaluating patients with ARN, particularly in unusual cases, while utilizing retinal imaging and applying AI algorithms in these areas of clinical research could be highly beneficial. Over the last few years, significant progress has been made in achieving timely diagnosis and treatment. The precise identification of the viral cause in suspected ARN cases has been greatly enhanced by the advancements in PCR techniques and flow cytometry used for intraocular fluids. systemic (intravenous or oral) antivirals with adjunctive intravitreal antiviral therapy are recommended as first-line therapy to reduce disease severity, the risk of vision loss, and retinal detachment incidence. Although aciclovir was the first existing antiviral agent, at present many clinicians prefer high-dose valaciclovir orally or intravenous aciclovir combined with intravitreal foscarnet. Despite significant progress in diagnosing and treating ARN, further research is needed to improve visual outcomes in this challenging clinical condition.
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Affiliation(s)
| | - Farid Afshar
- Southampton Eye Unit, University Hospital Southampton, Southampton, UK
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Andrew John Lotery
- Southampton Eye Unit, University Hospital Southampton, Southampton, UK.
- Faculty of Medicine, University of Southampton, Southampton, UK.
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Zur Bonsen L, Rübsam A, Knecht V, Pleyer U. [Vasculitis of the retina : Clinical aspects, diagnostics, management and treatment]. DIE OPHTHALMOLOGIE 2024; 121:509-524. [PMID: 38806792 DOI: 10.1007/s00347-024-02050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/30/2024]
Abstract
Inflammatory changes in the retinal vessels can be attributed to a wide range of etiologies. These include infections, intraocular and systemic autoimmune processes, general diseases and iatrogenic factors. As the endothelium of the retinal capillaries forms the inner blood-retinal barrier, a disruption of this structure is directly associated with consequences for the fluid electrolyte balance of the retina. Clinical sequelae can include leakage of the retinal vessels and macular edema, which are often functionally threatening and significantly reduce the quality of life of patients. As the eye can be affected as an "index organ", a work-up of the patient by the ophthalmologist is of great importance. In the age of "precision medicine", efforts are being made to gain new insights into the pathogenetic mechanisms of vasculitis through "omics" in order to develop innovative treatment concepts.
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Affiliation(s)
- Lynn Zur Bonsen
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Anne Rübsam
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Vitus Knecht
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Uwe Pleyer
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland.
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Leong E, Cifuentes-González C, Hu Y W J, Perumal Samy R, Khairallah M, Rojas-Carabali W, Putera I, de-la-Torre A, Agrawal R. Clinical Insights: Antimicrobial Therapy for Infectious Uveitis. Ocul Immunol Inflamm 2024:1-21. [PMID: 38759216 DOI: 10.1080/09273948.2024.2345848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
Infectious uveitis is a major global cause of vision impairment. Despite the eye's immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection's etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis.
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Affiliation(s)
- Evangeline Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeremy Hu Y W
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ramar Perumal Samy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alejandra de-la-Torre
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Ong KTI, Kwon T, Jang H, Kim M, Lee CS, Byeon SH, Kim SS, Yeo J, Choi EY. Multitask Deep Learning for Joint Detection of Necrotizing Viral and Noninfectious Retinitis From Common Blood and Serology Test Data. Invest Ophthalmol Vis Sci 2024; 65:5. [PMID: 38306107 PMCID: PMC10851173 DOI: 10.1167/iovs.65.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose Necrotizing viral retinitis is a serious eye infection that requires immediate treatment to prevent permanent vision loss. Uncertain clinical suspicion can result in delayed diagnosis, inappropriate administration of corticosteroids, or repeated intraocular sampling. To quickly and accurately distinguish between viral and noninfectious retinitis, we aimed to develop deep learning (DL) models solely using noninvasive blood test data. Methods This cross-sectional study trained DL models using common blood and serology test data from 3080 patients (noninfectious uveitis of the posterior segment [NIU-PS] = 2858, acute retinal necrosis [ARN] = 66, cytomegalovirus [CMV], retinitis = 156). Following the development of separate base DL models for ARN and CMV retinitis, multitask learning (MTL) was employed to enable simultaneous discrimination. Advanced MTL models incorporating adversarial training were used to enhance DL feature extraction from the small, imbalanced data. We evaluated model performance, disease-specific important features, and the causal relationship between DL features and detection results. Results The presented models all achieved excellent detection performances, with the adversarial MTL model achieving the highest receiver operating characteristic curves (0.932 for ARN and 0.982 for CMV retinitis). Significant features for ARN detection included varicella-zoster virus (VZV) immunoglobulin M (IgM), herpes simplex virus immunoglobulin G, and neutrophil count, while for CMV retinitis, they encompassed VZV IgM, CMV IgM, and lymphocyte count. The adversarial MTL model exhibited substantial changes in detection outcomes when the key features were contaminated, indicating stronger causality between DL features and detection results. Conclusions The adversarial MTL model, using blood test data, may serve as a reliable adjunct for the expedited diagnosis of ARN, CMV retinitis, and NIU-PS simultaneously in real clinical settings.
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Affiliation(s)
- Kai Tzu-iunn Ong
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Taeyoon Kwon
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Harok Jang
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Yeo
- Department of Artificial Intelligence, Yonsei University College of Computing, Seoul, Republic of Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Yang Q, Zhang T, Wu Y, Liang Q, Zhao W, Liu R, Jin X. Progress in the Application of Microneedles in Eye Disorders and the Proposal of the Upgraded Microneedle with Spinule. Pharm Res 2024; 41:203-222. [PMID: 38337104 DOI: 10.1007/s11095-024-03658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE In the local administration methods for treating eye diseases, the application of microneedles has great potential due to the shortcomings of low efficacy and significant side effects of local administration preparations. This article provides ideas for the research on the application of ophthalmic microneedle in the treatment of eye diseases. RESULTS This article analyzes the physiological structures of the eyes, ocular diseases and its existing ocular preparations in sequence. Finally, this article reviews the development and trends of ocular microneedles in recent years, and summarizes and discusses the drugs of ocular microneedles as well as the future directions of development. At the same time, according to the inspiration of previous work, the concept of "microneedle with spinule" is proposed for the first time, and its advantages and limitations are discussed in the article. CONCLUSIONS At present, the application of ocular microneedles still faces multiple challenges. The aspects of auxiliary devices, appearance, the properties of the matrix materials, and preparation technology of ophthalmic microneedle are crucial for their application in the treatment of eye diseases.
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Affiliation(s)
- Qiannan Yang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Tingting Zhang
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yujie Wu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qianyue Liang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Wanqi Zhao
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Rui Liu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China.
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Xin Jin
- Military Medicine Section, Logistics University of People's Armed Police Force, 1 Huizhihuan Road, Tianjin, 300309, Dongli District, China.
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Ahmad F, Deshmukh N, Webel A, Johnson S, Suleiman A, Mohan RR, Fraunfelder F, Singh PK. Viral infections and pathogenesis of glaucoma: a comprehensive review. Clin Microbiol Rev 2023; 36:e0005723. [PMID: 37966199 PMCID: PMC10870729 DOI: 10.1128/cmr.00057-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, caused by the gradual degeneration of retinal ganglion cells and their axons. While glaucoma is primarily considered a genetic and age-related disease, some inflammatory conditions, such as uveitis and viral-induced anterior segment inflammation, cause secondary or uveitic glaucoma. Viruses are predominant ocular pathogens and can impose both acute and chronic pathological insults to the human eye. Many viruses, including herpes simplex virus, varicella-zoster virus, cytomegalovirus, rubella virus, dengue virus, chikungunya virus, Ebola virus, and, more recently, Zika virus (ZIKV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have been associated with sequela of either primary or secondary glaucoma. Epidemiological and clinical studies suggest the association between these viruses and subsequent glaucoma development. Despite this, the ocular manifestation and sequela of viral infections are not well understood. In fact, the association of viruses with glaucoma is considered relatively uncommon in part due to underreporting and/or lack of long-term follow-up studies. In recent years, literature on the pathological spectrum of emerging viral infections, such as ZIKV and SARS-CoV-2, has strengthened this proposition and renewed research activity in this area. Clinical studies from endemic regions as well as laboratory and preclinical investigations demonstrate a strong link between an infectious trigger and development of glaucomatous pathology. In this article, we review the current understanding of the field with a particular focus on viruses and their association with the pathogenesis of glaucoma.
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Affiliation(s)
- Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nikhil Deshmukh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aaron Webel
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandra Johnson
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ayman Suleiman
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Rajiv R. Mohan
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Frederick Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
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Curi ALL, de-la-Torre A, Schlaen A, Mahendradas P, Biswas J. Pediatric Posterior Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1944-1954. [PMID: 38096404 DOI: 10.1080/09273948.2023.2284990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS Review of the literature. RESULTS The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
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Affiliation(s)
- André Luiz Land Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Disease - INI/Fiocruz, Rio de Janeiro, Brazil
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Derqui-Pilar, Argentina
| | | | - Jyortimay Biswas
- Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India
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12
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Wang H, Qian Z, Cui L, Liu B, Zou J, Wang L, Tao Y, Zhang L, Jin L. False negative result of polymerase chain reaction in very early stages of acute retinal necrosis. J Ophthalmic Inflamm Infect 2023; 13:49. [PMID: 37940794 PMCID: PMC10632314 DOI: 10.1186/s12348-023-00366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/16/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Viral nucleic acid testing of intraocular fluid using polymerase chain reaction (PCR) is a major laboratory examination in the diagnosis of acute retinal necrosis (ARN). Importantly, false negative PCR results may occur in several special situations. We reported a case of ARN with a negative PCR result in the aqueous humour in the very early stages of disease. CASE PRESENTATION A female patient presented to the ophthalmologist with complaints of blurred vision and redness in her left eye. Her medical history included ARN in her right eye 10 years prior. Although the result of the aqueous viral analysis by PCR in her left eye was negative the first time (one day after the appearance of ocular symptoms), ARN in her left eye was presumed based on the clinical signs. With timely antiviral and anti-inflammatory treatments, the retinal lesions diminished. The viral load of herpes simplex virus (HSV) turned positive (7.25 × 103 copies/mL) one week later, increased to 2.49 × 105 copies/mL after three weeks, and finally turned negative about five weeks after the onset of disease. The initial HSV-IgG level in the aqueous humour was 0.01 U/mL and increased to 222.64 U/mL in the final sampling. CONCLUSIONS The results of PCR analysis can be negative in the very early stages of ARN. Diagnosis of ARN should be made based on the clinical features, and antiviral treatments should not be delayed. Repeated PCR analysis of the aqueous humour is necessary to confirm the diagnosis and monitor the disease process.
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Affiliation(s)
- Haibo Wang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian Medical University, Zhongshan District, No. 110, Tianjin Road, Dalian, 116033, China
| | - Zhuyun Qian
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Lin Cui
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian Medical University, Zhongshan District, No. 110, Tianjin Road, Dalian, 116033, China
| | - Beichen Liu
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian Medical University, Zhongshan District, No. 110, Tianjin Road, Dalian, 116033, China
| | - Jixin Zou
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian Medical University, Zhongshan District, No. 110, Tianjin Road, Dalian, 116033, China
| | - Lu Wang
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lijun Zhang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian Medical University, Zhongshan District, No. 110, Tianjin Road, Dalian, 116033, China.
| | - Lei Jin
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian Medical University, Zhongshan District, No. 110, Tianjin Road, Dalian, 116033, China.
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, USA.
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13
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Annamalai R, Mahesh A, Biswas J. Clinical association and visual morbidity in uveitis with systemic diseases: An analysis from a tertiary ophthalmic center. Oman J Ophthalmol 2023; 16:472-477. [PMID: 38059097 PMCID: PMC10697255 DOI: 10.4103/ojo.ojo_250_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/10/2023] [Accepted: 09/03/2023] [Indexed: 12/08/2023] Open
Abstract
AIM The aim of this study was to identify the incidence, etiology, most common presentations, complications, and the causes of visual loss in posterior uveitis (PU). MATERIALS AND METHODS A retrospective study was conducted on a cohort of 125 patients with PU with a minimum follow-up of 6 months. Ocular evaluation consisted of slit-lamp examination, indirect ophthalmoscopy, tonometry, and refraction. Ancillary ophthalmic investigations such as fundus fluorescein angiography, optical coherence tomography, and B-scan ultrasonography were done. Laboratory tests were performed on blood on all patients and in aqueous humor samples obtained by anterior chamber paracentesis in cases of diagnostic dilemmas. All the data were analyzed using SPSS program. RESULTS PU occurred in 61%. Infections were noted in 34% and autoimmune diseases in 27%. The most frequent presentation was choroiditis. The most common etiologies were tubercular uveitis in 50%, Toxoplasma retinochoroiditis in 23%, and autoimmune category of serpiginous choroiditis in 56% of patients. Complications occurred in 27% and were most commonly cystoid macular edema and macular scarring. Polymerase chain reaction (PCR), nested PCR, and real-time PCR on ocular fluids were required for diagnosis in 30%. A combination of laboratory investigations on blood and aqueous humor samples were confirmation in 88%. CONCLUSION PU and its sequelae are known to be sight threatening and are associated with systemic diseases. They have diverse etiologies and presentations. Identification of etiology is important as management is diametrically opposite in infections and autoimmune diseases.
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Affiliation(s)
- Radha Annamalai
- Department of Ophthalmology and Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Abhinav Mahesh
- Department of Ophthalmology and Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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14
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Servillo A, Berni A, Marchese A, Bodaghi B, Khairallah M, Read RW, Miserocchi E. Posterior Herpetic Uveitis: A Comprehensive Review. Ocul Immunol Inflamm 2023; 31:1461-1472. [PMID: 37364039 DOI: 10.1080/09273948.2023.2221338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE To report and illustrate the main clinical presentations of posterior herpetic uveitis. METHODS Narrative review. RESULTS The ocular manifestations of posterior herpetic uveitis include different clinical presentations. Herpes simplex and varicella zoster can cause acute retinal necrosis, progressive outer retinal necrosis, and non-necrotizing herpetic retinopathies. Cytomegalovirus has been associated with fulminant retinitis with confluent areas of retinal necrosis and retinal hemorrhages, indolent/granular retinitis, and frosted branch angiitis. These diverse clinical presentations are often associated with specific risk factors and different immunological profiles of the host. CONCLUSIONS Herpetic viruses can cause posterior uveitis, presenting various clinical findings. Specific ocular manifestations and the immunological status of the host can help to differentiate the various herpetic entities before laboratory tests confirm the diagnosis.
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Affiliation(s)
- Andrea Servillo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Berni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Russell W Read
- Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Elisabetta Miserocchi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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15
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Fabozzi L, Testi I, De Benito-Llopis L, Pavesio C. Cytomegalovirus anterior uveitis and occlusive retinal vasculitis without retinitis in a patient on immunomodulatory therapy. J Ophthalmic Inflamm Infect 2023; 13:34. [PMID: 37540447 PMCID: PMC10403449 DOI: 10.1186/s12348-023-00356-z] [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: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To describe unusual clinical features and therapeutic management of a case of cytomegalovirus (CMV) ocular disease in a patient on immunomodulatory therapy. SETTING/VENUE Moorfields Eye Hospital NHS Foundation Trust, London, UK. METHODS Medical history, clinical findings, investigation results, and multimodal imaging were retrospectively collected. RESULTS A 61-year-old, South-East Asian man, developed CMV-related endotheliitis and occlusive retinal vasculitis, diagnosed by wide-angle fluorescein angiography. No retinitis was present on the fundus examination. Suspicion of CMV etiology was based on anterior segment findings, especially the presence of coin-shaped endothelial lesions. The diagnosis was confirmed by aqueous polymerase chain reaction (PCR) analysis which was positive for CMV DNA. The combined use of topical and systemic valganciclovir resulted in significant improvement of the picture. CONCLUSIONS CMV can manifest in the eye as occlusive retinal vasculitis without the presence of typical retinitis.
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Affiliation(s)
- Lorenzo Fabozzi
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Ilaria Testi
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
- Rheumatology Department, Great Ormond Street Hospital for Children, London, UK
| | - Laura De Benito-Llopis
- Department of External Diseases, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK.
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16
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Corbitt K, Nowatzky J. Inflammatory eye disease for rheumatologists. Curr Opin Rheumatol 2023; 35:201-212. [PMID: 36943695 PMCID: PMC10461883 DOI: 10.1097/bor.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review provides a framework for understanding inflammatory eye disease diagnosis, differential diagnosis, and management for rheumatologists. Uveitis, scleritis, episcleritis, peripheral ulcerative keratitis, and orbital inflammation are all discussed. The goal is to facilitate the development of approaches to inflammatory eye diseases that will help rheumatologists co-manage these patients with eye care providers specializing in ocular inflammation. RECENT FINDINGS In recent years, studies have aimed to advance biologic treatments and define standard-of-care therapy. Inflammatory eye diseases are highly heterogeneous and often rare, which poses significant challenges to their research and the interpretation of existing data. To date, glucocorticoids, mycophenolate, methotrexate, and TNF inhibitors remain the mainstay of treatment options for many of these diseases. SUMMARY Patients with inflammatory eye diseases require multidisciplinary care for best outcomes, frequently including rheumatologists. Understanding the differentials, diagnostics, and treatment are essential to preserving vision in these patients. The diverse nature of the disease processes within this field requires focusing on specific disease phenotypes and endotypes in research and clinical practice.
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Affiliation(s)
- Kelly Corbitt
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
| | - Johannes Nowatzky
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology, NYU Langone Behçet’s Disease Program, NYU Ocular Rheumatology Program
- New York University Grossman School of Medicine, Department of Pathology
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17
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Caldrer S, Deotto N, Pertile G, Bellisola G, Guidi MC. Infrared analysis in the aqueous humor of patients with uveitis: Preliminary results. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 243:112715. [PMID: 37126864 DOI: 10.1016/j.jphotobiol.2023.112715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
Inflammatory processes affecting the uvea result in a temporary o permanent blurred vision and represent an important cause of visual impairment worldwide. It is often hard to make a precise diagnosis which is dependent on the clinical expertise, diagnostic tests, laboratory investigations in blood and sometimes in the aqueous humor (AH). With the aim of obtaining proof of principle Fourier Transformed Infrared (FT-IR) absorbance spectroscopy was applied to study the molecular composition of 72 AH samples collected in 26 patients with uveitis and in 44 controls. The unsupervised exploration of the internal structure of the dataset by principal component analysis reduced hundreds IR variables to those most representative allowing to obtain the predictive model that distinguished the AH spectra of patients with uveitis from controls. The same result was obtained by unsupervised agglomerative cluster analysis. After labeling the spectra with some clinical information it was observed that most severe uveitis with active processes were grouped separately from chronic and relapsing uveitis and controls. The consistence of prediction models is discussed in the light of supporting etiological diagnosis by machine learning processes. In conclusion, proof of principle has been obtained that the IR spectral pattern of AH may reflect particular uveal diseases.
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Affiliation(s)
- Sara Caldrer
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Via Don A. Sempreboni, 5, Negrar di Valpolicella (Verona) 37024, Italy.
| | - Niccolò Deotto
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, Negrar di Valpolicella (Verona) 37024, Italy.
| | - Grazia Pertile
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, Negrar di Valpolicella (Verona) 37024, Italy.
| | - Giuseppe Bellisola
- INFN - Laboratori Nazionali di Frascati, Via E. Fermi, 54, Frascati (Rome) 00044, Italy.
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18
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Jayadev C, Sanjay S, Handa A, Agrawal S. Human immunodeficiency virus retinopathy with presumed cytomegalovirus retinitis with macular oedema in a diabetic. BMJ Case Rep 2023; 16:e252710. [PMID: 37024150 PMCID: PMC10083806 DOI: 10.1136/bcr-2022-252710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
A man in his early 50s on regular follow-up for a stable non-proliferative diabetic retinopathy (NPDR) presented with decreased vision, worsening of retinal pathology and macular oedema in both eyes. His corrected distance visual acuity (CDVA) was 6/9 in the right eye and 6/15 in the left eye and fundus examination showed multiple intraretinal haemorrhages in all quadrants. His systemic workup revealed a severe thrombocytopaenia, which prompted a further detailed systemic evaluation revealing him to be positive for HIV with retinopathy complicating the pre-existing NPDR. Given the significant inflammation and macular oedema, a cocktail of intravitreal bevacizumab, ganciclovir and dexamethasone was administered. The retinopathy and macular oedema resolved and the CDVA improved to 6/6 in both eyes over a 6-month follow-up period. Any sudden worsening of fundus findings in a patient with diabetes necessitates immediate and detailed ocular and systemic evaluation, especially when the immune status is unknown.
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Affiliation(s)
- Chaitra Jayadev
- Vitreoretina Department, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Srinivasan Sanjay
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ashit Handa
- Vitreoretina Department, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sameeksha Agrawal
- Vitreoretina Department, Narayana Nethralaya, Bengaluru, Karnataka, India
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19
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Thomas J, Nguyen NV, Fashina T, Huang Y, Yeh S, Conrady CD. An update on immunological and molecular tests and their impact in infectious uveitis. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1132131. [PMID: 38983089 PMCID: PMC11182284 DOI: 10.3389/fopht.2023.1132131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/06/2023] [Indexed: 07/11/2024]
Abstract
Early diagnosis of infectious uveitis can lead to prompt initiation of treatment to minimize vision-threatening sequelae. As various infectious etiologies of uveitis share similar clinical features, advancements in polymerase chain reaction (PCR) and metagenomic next-generation sequencing (MDS) have shown significant promise in improving diagnostic capabilities. Various techniques of PCR, including real-time, multiplex, comprehensive, and broad-range, have increased the armamentarium for infectious uveitis diagnosis. Additionally, metagenomic deep sequencing technology has provided a methodology to identify causative pathogens as well as novel etiologies of uveitis. This review discusses the diagnostic tools available for infectious uveitis and highlights the advantages and disadvantages of the techniques.
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Affiliation(s)
- Joanne Thomas
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Nam V. Nguyen
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tolulope Fashina
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ye Huang
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
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20
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Venkatesh R, Reddy NG, Mishra P, Gupta A, Mahendradas P, Yadav NK. Unilateral Acute Idiopathic Maculopathy following Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV-2) Infection. Ocul Immunol Inflamm 2023; 31:445-448. [PMID: 35113743 DOI: 10.1080/09273948.2022.2028287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To report a case of unilateral acute idiopathic maculopathy (UAIM) following SARS-CoV-2 virus infection. CASE DESCRIPTION A 44-year-old male patient, infected with SARS-CoV-2 virus previously, presented to the retina department with complaints of sudden blurring of vision in right eye. His presenting visual acuity in right eye was 20/30, N8. Fundus showed an irregular area of yellowish-white subretinal lesion at the macula involving the fovea with reddish-brown pigment clumps. Retinal imaging findings were consistent with the diagnosis of UAIM. No treatment was given. RESULTS The imaging findings showed improvement at day 7 post-presentation with improvement in vision to 20/20, N6. At final visit (5-week post presentation), visual acuity was maintained at 20/20, N6 and there was no recurrence of findings. EXPERT OPINION Unilateral acute idiopathic maculopathy might be associated with SARS-CoV-2 virus infection. CONCLUSION Infection with SARS-CoV-2 virus might be associated with UAIM. Such an association has not yet been described in the literature.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bangalore, India
| | | | - Pranjal Mishra
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bangalore, India
| | - Aditi Gupta
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bangalore, India
| | | | - Naresh Kumar Yadav
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bangalore, India
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21
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Agarwal A, Pichi F, Invernizzi A, Grewal DS, Singh RB, Upadhyay A. Stepwise approach for fundus imaging in the diagnosis and management of posterior uveitis. Surv Ophthalmol 2023; 68:446-480. [PMID: 36724831 DOI: 10.1016/j.survophthal.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
An array of retinochoroid imaging modalities aid in comprehensive evaluation of the immunopathological changes in the retina and choroid, forming the core component for the diagnosis and management of inflammatory disorders such as uveitis. The recent technological breakthroughs have led to the development of imaging platforms that can evaluate the layers of retina and choroid and the structural and functional alteration in these tissues. Ophthalmologists heavily rely on imaging modalities such as dye-based angiographies (fluorescein angiography and indocyanine green angiography), optical coherence tomography, fundus autofluorescence, as well as dye-less angiography such as optical coherence tomography angiograph,y for establishing a precise diagnosis and understanding the pathophysiology of the diseases. Furthermore, these tools are now being deployed with a 'multimodal' approach for swift and accurate diagnosis. In this comprehensive review, we outline the imaging platforms used for evaluation of posterior uveitis and discuss the organized, algorithmic approach for the assessment of the disorders. Additionally, we provide an insight into disease-specific characteristic pathological changes and the established strategies to rule out disorders with overlapping features on imaging.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, New South Wales, Australia
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Awaneesh Upadhyay
- Department of Ophthalmology, EyeQ Super-specialty Hospitals, Noida, Uttar Pradesh, India
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22
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Adaptive Optics of Kyrieleis Plaques in Varicella Zoster Virus-Associated Posterior Uveitis: A Multimodal Imaging Analysis. J Clin Med 2023; 12:jcm12030884. [PMID: 36769532 PMCID: PMC9917841 DOI: 10.3390/jcm12030884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/25/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Kyrieleis plaques (KP) represent a peculiar type of vasculitis affecting retinal arterial branches in a beaded segmental pattern that can be found in several posterior inflammatory ocular conditions. The nature and precise location of KP is unclear. Adaptive Optics (AO) provides an in vivo visualization of retinal vasculature on a microscopic level, thus permitting a more detailed characterization of KP as compared to traditional imaging techniques. This study aims to report AO imaging of KP in Varicella Zoster virus (VZV)-associated posterior uveitis and to correlate the findings with traditional imaging techniques. Three patients diagnosed with VZV posterior uveitis underwent adaptive optics (AO) imaging and traditional multimodal imaging techniques, including fundus photography, fluorescein angiography, indocyanine green angiography and optical coherence tomography. In all subjects, AO imaging revealed segmental hyporeflectivity confined to the vessel wall, with no evidence of arterial wall disruption or extravascular involvement. In our series, AO findings support the view that KP are localized within the inner arterial wall, possibly at the endothelial level.
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Qian Z, Zhang Y, Wang L, Li Z, Wang H, Kang H, Feng J, Hu X, Tao Y. Application of metagenomic next-generation sequencing in suspected intraocular infections. Eur J Ophthalmol 2023; 33:391-397. [PMID: 35712966 DOI: 10.1177/11206721221107311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the efficacy of metagenomic next-generation sequencing (mNGS) and to explore its value in the diagnosis of intraocular infection. METHODS A retrospective case-series study of patients with suspected intraocular infection was performed. Intraocular fluid samples were collected from all the patients and sent for mNGS. Detailed clinical data, the results of mNGS and other laboratory examinations, the sequencing data of mNGS, and the final diagnosis were recorded. RESULTS Fifteen eyes of 15 patients were included in the study. Eight samples were identified as positive for different kinds of pathogens by mNGS, which were all confirmed by other laboratory examinations or effective diagnostic treatment. The mNGS results were negative in seven samples. The final diagnosis was still intraocular infection in four of the seven negative results. Of these, one patient was diagnosed with fungal endophthalmitis according to the clinical characteristics and good treatment response to the anti-fungal therapy, one patient underwent vitrectomy and the bacterial culture of the vitreous sample was positive for Brucella melitensis, and two patients were diagnosed with ocular tuberculosis according to the positive T-SPOT test and effective anti-tuberculous treatments. CONCLUSIONS mNGS could be helpful in determining pathogens in cases of suspected intraocular infection. The mNGS protocols should be optimized for the detection of intracellular bacterial and fungal pathogens.
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Affiliation(s)
- Zhuyun Qian
- Beijing GIANTMED medical diagnostics Lab, Beijing, China
| | - Yankun Zhang
- Department of Ophthalmology, Hebei Chest Hospital, Hebei, China
| | - Lu Wang
- Beijing GIANTMED medical diagnostics Lab, Beijing, China
| | - Ziqiang Li
- Beijing GIANTMED medical diagnostics Lab, Beijing, China
| | - Hui Wang
- Department of Ophthalmology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hao Kang
- Department of Ophthalmology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Feng
- Department of Ophthalmology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Hu
- Department of Ophthalmology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yong Tao
- Department of Ophthalmology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Belanger NL, Barbero R, Barclay R, Lepene B, Sobrin L, Bispo PJM. Improved Detection of Herpesviruses from Diluted Vitreous Specimens Using Hydrogel Particles. Diagnostics (Basel) 2022; 12:3016. [PMID: 36553022 PMCID: PMC9777164 DOI: 10.3390/diagnostics12123016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/10/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Infectious uveitis is a sight-threatening infection commonly caused by herpesviruses. Vitreous humor is often collected for molecular confirmation of the causative agent during vitrectomy and mixed in large volumes of buffered saline, diluting the pathogen load. Here, we explore affinity-capture hydrogel particles (Nanotrap®) to concentrate low abundant herpesviruses from diluted vitreous. Simulated samples were prepared using porcine vitreous spiked with HSV-1, HSV-2, VZV and CMV at 105 copies/mL. Pure undiluted samples were used to test capturing capability of three custom Nanotrap particles (red, white and blue) in a vitreous matrix. We found that all particles demonstrated affinity to the herpesviruses, with the Red Particles having both good capture capability and ease of handling for all herpesviruses. To mimic diluted vitrectomy specimens, simulated-infected vitreous were then serially diluted in 7 mL TE buffer. Diluted samples were subjected to an enrichment protocol using the Nanotrap Red particles. Sensitivity of pathogen detection by qPCR in diluted vitreous increased anywhere between 2.3 to 26.5 times compared to non-enriched specimens. This resulted in a 10-fold increase in the limit of detection for HSV-1, HSV-2 and VZV. These data demonstrated that Nanotrap particles can capture and concentrate HSV-1, HSV-2, VZV and CMV in a vitreous matrix.
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Affiliation(s)
- Nicole L. Belanger
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
- Infectious Disease Institute, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
- Infectious Disease Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Paulo J. M. Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
- Infectious Disease Institute, Harvard Medical School, Boston, MA 02115, USA
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25
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Petrillo F, Petrillo A, Sasso FP, Schettino A, Maione A, Galdiero M. Viral Infection and Antiviral Treatments in Ocular Pathologies. Microorganisms 2022; 10:2224. [PMID: 36363815 PMCID: PMC9694090 DOI: 10.3390/microorganisms10112224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 08/27/2023] Open
Abstract
Ocular viral infections are common and widespread globally. These infectious diseases are a major cause of acute red eyes and vision loss. The eye and its nearby tissues can be infected by several viral agents, causing infections with a short course and limited ocular implications or a long clinical progression and serious consequences for the function and structure of the ocular region. Several surveillance studies underline the increased emergence of drug resistance among pathogenic viral strains, limiting treatment options for these infections. Currently, in the event of resistant infections, topical or systemic corticosteroids are useful in the management of associated immune reactions in the eye, which contribute to ocular dysfunction. Many cases of viral eye infections are misdiagnosed as being of bacterial origin. In these cases, therapy begins late and is not targeted at the actual cause of the infection, often leading to severe ocular compromises, such as corneal infiltrates, conjunctival scarring, and reduced visual acuity. The present study aims at a better understanding of the viral pathogens that cause eye infections, along with the treatment options available.
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Affiliation(s)
- Francesco Petrillo
- Azienda Ospedaliera Universitaria-Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | | | | | - Antonietta Schettino
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Angela Maione
- Department of Biology, University of Naples Federico II, 80126 Naples, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Koretz ZA, Apostolopoulou A, Chen E, Beale O, Veldkamp P, Viehman JA, Sahel JA, Chhablani J, Dansingani KK, Errera MH, Bonhomme GR. Clinical Features and Multimodal Imaging in Atypical Posterior Uveitis Secondary to Bartonella Henselae Infection. Ocul Immunol Inflamm 2022; 30:2047-2054. [PMID: 34402723 DOI: 10.1080/09273948.2021.1961812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To characterize an unusual presentation of infectious posterior uveitis using multimodal imaging, and discuss the clinical decision-making involved in diagnosis and treatment. METHODS Wide-field fundus photography, swept-source optical coherence tomography (OCT), swept-source OCT angiography, fluorescein angiography, and indocyanine green angiography. RESULTS This patient presented with cyclical fevers and blurry vision. Fundus examination revealed bilateral optic disc edema, macular intraretinal white spots and many scattered yellow-white chorioretinal lesions. Multimodal imaging characteristics suggested that many of these lesions represent choroidal granulomas. Extensive systemic workup was only notable for borderline elevated Bartonella henselae IgG titers (1:128), however convalescent IgG titers were elevated at 38 days (1:512) supporting the diagnosis of Bartonella chorioretinitis. CONCLUSION Ocular manifestations of Bartonella henselae infection are varied and may include choroidal granulomas. Multimodal imaging characteristics may help identify etiologies of infectious uveitis. Convalescent titers are important when evaluating patients with suspected Bartonellosis, especially patients with atypical presentations.
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Affiliation(s)
- Zachary A Koretz
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anna Apostolopoulou
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edwin Chen
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Oliver Beale
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter Veldkamp
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John Alex Viehman
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle R Bonhomme
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Gueudry J, Bodaghi B. Advances in the microbiological diagnosis of herpetic retinitis. FRONTIERS IN OPHTHALMOLOGY 2022; 2:990240. [PMID: 38983563 PMCID: PMC11182275 DOI: 10.3389/fopht.2022.990240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/24/2022] [Indexed: 07/11/2024]
Abstract
Viral retinitis associated with herpesvirus is one of the most severe forms of uveitis and is a potentially sight-threatening ophthalmologic disease. The prognosis is poor and a rapid and aggressive management is necessary to improve the visual and sometimes vital prognosis of these patients. The treatments used are not without side effects, while many differential diagnoses exist, such as toxoplasmic retinochoroiditis, syphilitic retinitis, endogenous endophthalmitis and intraocular lymphoma. Causatives viruses are herpes simplex virus, varicella-zoster virus, and cytomegalovirus, which require rapid detection in ocular fluid, mainly aqueous humor. However, only a small amount of intraocular fluid is available for analysis. Advances in microbiological diagnostic techniques therefore were key factors in improving the management of these diseases. Historically, the diagnosis was based on immunological tests but more recently advances in molecular biology, in particular polymerase chain reaction, have played a crucial role to obtain a reliable and rapid diagnosis of viral retinitis associated with herpesvirus, as discussed in this review.
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Affiliation(s)
- Julie Gueudry
- Department of Ophthalmology - Charles Nicolle University Hospital, CHU Charles Nicolle, Rouen, France
| | - Bahram Bodaghi
- Department of Ophthalmology, DHU ViewRestore, Sorbonne Université, Pitié Salpêtrière Hospital, Paris, France
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28
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Peiretti E, Demarinis G, Casu C, Scano A, Orrù G. Oral-ocular trans infection of Epstein Barr virus. A possible new way of transmission by wearing masks in the SARS-CoV-2 era. Am J Ophthalmol Case Rep 2022; 27:101626. [PMID: 35761878 PMCID: PMC9217628 DOI: 10.1016/j.ajoc.2022.101626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/26/2022] [Accepted: 06/15/2022] [Indexed: 10/28/2022] Open
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Are Viral Infections Key Inducers of Autoimmune Diseases? Focus on Epstein–Barr Virus. Viruses 2022; 14:v14091900. [PMID: 36146707 PMCID: PMC9506567 DOI: 10.3390/v14091900] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 12/26/2022] Open
Abstract
It is generally accepted that certain viral infections can trigger the development of autoimmune diseases. However, the exact mechanisms by which these viruses induce autoimmunity are still not understood. In this review, we first describe hypothetical mechanisms by which viruses induce some representative autoimmune diseases. Then, we focus on Epstein–Barr virus (EBV) and discuss its role in the pathogenesis of rheumatoid arthritis (RA). The discussion is mainly based on our own previous findings that (A) EBV DNA and its products EBV-encoded small RNA (EBER) and latent membrane protein 1 (LMP1) are present in the synovial lesions of RA, (B) mRNA expression of the signaling lymphocytic activation molecule-associated protein (SAP)/SH2D1A gene that plays a critical role in cellular immune responses to EBV is reduced in the peripheral T cells of patients with RA, and (C) EBV infection of mice reconstituted with human immune system components (humanized mice) induced erosive arthritis that is pathologically similar to RA. Additionally, environmental factors may contribute to EBV reactivation as follows: Porphyromonas gingivalis peptidylarginine deiminase (PAD), an enzyme required for citrullination, engenders antigens leading to the production of citrullinated peptides both in the gingiva and synovium. Anti-citrullinated peptides autoantibody is an important marker for diagnosis and disease activity of RA. These findings, as well as various results obtained by other researchers, strongly suggest that EBV is directly involved in the pathogenesis of RA, a typical autoimmune disease.
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30
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Thomas J, Kim L, Albini T, Yeh S. Triamcinolone acetonide injectable suspension for suprachoroidal use in the treatment of macular edema associated with uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2022; 17:165-173. [PMID: 36060305 PMCID: PMC9438525 DOI: 10.1080/17469899.2022.2114456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
Introduction Macular edema due to noninfectious uveitis is a sight-threatening complication that is routinely treated with corticosteroids. Triamcinolone acetonide injectable suspension for suprachoroidal use (Xipere™) is an alternative treatment option for patients with non-infectious uveitis associated macular edema. Areas covered This review describes the recently FDA approved triamcinolone acetonide injectable suspension that can be injected into the suprachoroidal space. This physiological space is between the sclera and choroid. This allows for therapeutic targeting of the retina and choroid. This review highlights published clinical trials for this novel drug preparation. Expert opinion Suprachoroidal administration of triamcinolone acetonide has shown improvement in vision and inflammation in studies with non-infectious uveitis associated macular edema. This unique delivery method suggests the potential to decrease side effects of anterior segment exposure such as glaucoma and cataract, but head-to-head trials are needed for further study of safety and efficacy. Additionally, there are promising prospective studies underway for utilization of the suprachoroidal space for other diseases including macular degeneration, diabetic macular edema, and ocular tumors.
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Affiliation(s)
| | - Lucas Kim
- Truhlsen Eye Institute, Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE
| | - Thomas Albini
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Steven Yeh
- Truhlsen Eye Institute, Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE
- Emory Eye Center, Department of Ophthalmology, Atlanta, GA
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31
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Li Z, Guo C, Nie D, Lin D, Cui T, Zhu Y, Chen C, Zhao L, Zhang X, Dongye M, Wang D, Xu F, Jin C, Zhang P, Han Y, Yan P, Lin H. Automated detection of retinal exudates and drusen in ultra-widefield fundus images based on deep learning. Eye (Lond) 2022; 36:1681-1686. [PMID: 34345030 PMCID: PMC9307785 DOI: 10.1038/s41433-021-01715-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/14/2021] [Accepted: 07/22/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Retinal exudates and/or drusen (RED) can be signs of many fundus diseases that can lead to irreversible vision loss. Early detection and treatment of these diseases are critical for improving vision prognosis. However, manual RED screening on a large scale is time-consuming and labour-intensive. Here, we aim to develop and assess a deep learning system for automated detection of RED using ultra-widefield fundus (UWF) images. METHODS A total of 26,409 UWF images from 14,994 subjects were used to develop and evaluate the deep learning system. The Zhongshan Ophthalmic Center (ZOC) dataset was selected to compare the performance of the system to that of retina specialists in RED detection. The saliency map visualization technique was used to understand which areas in the UWF image had the most influence on our deep learning system when detecting RED. RESULTS The system for RED detection achieved areas under the receiver operating characteristic curve of 0.994 (95% confidence interval [CI]: 0.991-0.996), 0.972 (95% CI: 0.957-0.984), and 0.988 (95% CI: 0.983-0.992) in three independent datasets. The performance of the system in the ZOC dataset was comparable to that of an experienced retina specialist. Regions of RED were highlighted by saliency maps in UWF images. CONCLUSIONS Our deep learning system is reliable in the automated detection of RED in UWF images. As a screening tool, our system may promote the early diagnosis and management of RED-related fundus diseases.
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Affiliation(s)
- Zhongwen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Danyao Nie
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tingxin Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xulin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Meimei Dongye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ping Zhang
- Xudong Ophthalmic Hospital, Inner Mongolia, China
| | - Yu Han
- EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Pisong Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China.
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Zhang J, Wu J, Lu D, To CH, Lam TC, Lin B. Retinal Proteomic Analysis in a Mouse Model of Endotoxin-Induced Uveitis Using Data-Independent Acquisition-Based Mass Spectrometry. Int J Mol Sci 2022; 23:ijms23126464. [PMID: 35742911 PMCID: PMC9223489 DOI: 10.3390/ijms23126464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Uveitis is a group of sight-threatening ocular inflammatory diseases, potentially leading to permanent vision loss in patients. However, it remains largely unknown how uveitis causes retinal malfunction and vision loss. Endotoxin-induced uveitis (EIU) in rodents is a good animal model to study uveitis and associated acute retinal inflammation. To understand the pathogenic mechanism of uveitis and screen potential targets for treatment, we analyzed the retinal proteomic profile of the EIU mouse model using a data-independent acquisition-based mass spectrometry (SWATH-MS). After systemic LPS administration, we observed activation of microglial cells accompanied with the elevation of pro-inflammatory mediators and visual function declines. In total, we observed 79 upregulated and 90 downregulated differentially expressed proteins (DEPs). Among the DEPs, we found that histone family members (histone H1, H2A, H2B) and blood proteins including haptoglobin (HP), hemopexin (HPX), and fibrinogen gamma chain (FGG) were dramatically increased in EIU groups relative to those in control groups. We identified phototransduction and synaptic vesicle cycle as the top two significant KEGG pathways. Moreover, canonical pathway analysis on DEPs using Ingenuity Pathway Analysis revealed top three most significant enriched pathways related to acute phase response signaling, synaptogenesis signaling, and eif2 signaling. We further confirmed upregulation of several DEPs associated with the acute phase response signaling including HP, HPX, and FGG in LPS-treated retinas by qPCR and Western blot. In summary, this study serves as the first report to detect retinal proteome changes in the EIU model. The study provides several potential candidates for exploring the mechanism and novel therapeutic targets for uveitis and other retinal inflammatory diseases.
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Affiliation(s)
- Jing Zhang
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (J.Z.); (J.W.); (D.L.); (C.-H.T.)
| | - Jiangmei Wu
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (J.Z.); (J.W.); (D.L.); (C.-H.T.)
| | - Daqian Lu
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (J.Z.); (J.W.); (D.L.); (C.-H.T.)
| | - Chi-Ho To
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (J.Z.); (J.W.); (D.L.); (C.-H.T.)
- Centre for Eye and Vision Research (CEVR), Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Thomas Chuen Lam
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (J.Z.); (J.W.); (D.L.); (C.-H.T.)
- Centre for Eye and Vision Research (CEVR), Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong SAR, China
- Correspondence: (T.C.L.); (B.L.)
| | - Bin Lin
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (J.Z.); (J.W.); (D.L.); (C.-H.T.)
- Centre for Eye and Vision Research (CEVR), Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong SAR, China
- Correspondence: (T.C.L.); (B.L.)
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Agarwal A, Invernizzi A. The Role of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Differential Diagnosis of Posterior Uveitis. Ocul Immunol Inflamm 2022; 30:682-689. [PMID: 35593586 DOI: 10.1080/09273948.2022.2071743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The purpose of this study is to review role of OCT and OCTA in differential diagnosis of certain posterior uveitic entities. METHODS Narrative review. RESULTS In this review, we have comprehensively summarized the utility of OCT and OCTA in helping the clinician diagnose common but challenging inflammatory conditions including ocular toxoplasmosis, viral retinitis, and vitreoretinal lymphoma, among others. OCT and OCTA can also be used to assess the choriocapillaris involvement in conditions such as multiple evanescent white dot syndrome, and choroidal granulomas in tubercular and sarcoid uveitis. CONCLUSIONS Fundus imaging with OCT and OCTA has assumed a significant role in establishing the diagnosis in uveitis apart from microbiological and other laboratory analysis. Advantages such as rapidity and non-invasiveness make these imaging modalities very useful and convenient.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan, Milan, Italy.,The Discipline of Clinical Ophthalmology and Eye Health, Save Sight Institute, Sydney Eye Hospital, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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Arenas-Canchuja F, Campos-Dávila B, Valderrama-Albino V. A case of non-necrotising herpetic retinitis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:295-299. [PMID: 35526954 DOI: 10.1016/j.oftale.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/15/2020] [Indexed: 06/14/2023]
Abstract
In developed countries, the main etiology of posterior uveitis is of infectious origin, Herpes is the most common viral agent as it has a wide spectral of ocular manifestations. These manifestations could depend on the patient's immunologic state, ranging from a mild focal form of non-necrotizing herpetic renitis (NNHR) to a severe form of Acute retinal necrosis (ARN). We present a case of NNHR by VHS 2 and the different differential diagnostics previous to its diagnosis: atypical ocular toxoplasmosis, ocular tuberculosis and ARN. During its evolution, it presented a drastic drop in the visual acuity despite of the antiviral treatment, and with systemic corticoids and the injury's clinical improvement. This event led to reevaluate the suspected entities, establishing the NNHR as a definitive diagnostic by exclusion that constituted a challenging diagnostic.
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Affiliation(s)
- F Arenas-Canchuja
- Instituto Nacional de Oftalmología Dr. Francisco Contreras Campos, Lima, Peru.
| | - B Campos-Dávila
- Departamento de Atención Especializada en Úvea, Instituto Nacional de Oftalmología Dr. Francisco Contreras Campos, Lima, Peru
| | - V Valderrama-Albino
- Departamento de Atención Especializada en Úvea, Instituto Nacional de Oftalmología Dr. Francisco Contreras Campos, Lima, Peru
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35
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A Comprehensive Update on Retinal Vasculitis: Etiologies, Manifestations and Treatments. J Clin Med 2022; 11:jcm11092525. [PMID: 35566655 PMCID: PMC9101900 DOI: 10.3390/jcm11092525] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/18/2022] Open
Abstract
Retinal vasculitis is characterized by inflammatory involvement of retinal arterioles, venules and/or capillaries and can be associated with a myriad of systemic and ophthalmic diseases. In this review, we have comprehensively discussed the etiologies, clinical manifestations, and presentations of retinal vasculitis. We have also included newer advances in imaging in retinal vasculitis such as OCTA and widefield imaging.
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36
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Lains I, Eliott D. Challenges and Updates on the Management of Acute Retinal Necrosis. Int Ophthalmol Clin 2022; 62:173-196. [PMID: 35325918 DOI: 10.1097/iio.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Ocular Manifestations of Chikungunya Infection: A Systematic Review. Pathogens 2022; 11:pathogens11040412. [PMID: 35456087 PMCID: PMC9028588 DOI: 10.3390/pathogens11040412] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 02/04/2023] Open
Abstract
The Chikungunya virus (CHIKV) can cause long lasting symptoms and manifestations. However, there is little information on which ocular ones are most frequent following infection. We performed a systematic review (registered in the International Prospective Register of Systematic Reviews; no CRD42020171928) to establish the most frequent ocular manifestations of CHIKV infection and their associations with gender and age. Articles published until September 2020 were selected from PubMed, Scielo, Cochrane and Scopus databases. Only studies with CHIKV-infected patients and eye alterations were included. Reviews, descriptive studies, or those not investigating the human ocular manifestations of CHIKV, those with patients with other diseases and infections, abstracts and studies without relevant data were excluded. Twenty-five studies were selected for inclusion. Their risk of bias was evaluated by a modified Newcastle-Ottawa scale. The most frequent ocular symptoms of CHIKV infection included ocular pain, inflammation and reduced visual acuity, whilst conjunctivitis and optic neuritis were the most common manifestations of the disease. These occurred mostly in individuals of 42 ± 9.5 years of age and woman. The few available reports on CHIKV-induced eye manifestations highlight the need for further research in the field to gather more substantial evidence linking CHIKV infection, the eye and age/gender. Nonetheless, the data emphasizes that ocular alterations are meaningful occurrences of CHIKV infection which can substantially affect quality of life.
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38
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Forrester JV, Mölzer C, Kuffova L. Immune Privilege Furnishes a Niche for Latent Infection. FRONTIERS IN OPHTHALMOLOGY 2022; 2:869046. [PMID: 38983514 PMCID: PMC11182092 DOI: 10.3389/fopht.2022.869046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 07/11/2024]
Abstract
The microenvironment of the CNS (eye and brain) is fertile ground for infection if the barriers are breached. The result of pathogen invasion is often devastating destruction of tissues. In the eye, inflammation is broadly classified either as "infectious" (i.e. caused by infection) or "non-infectious". However, increasingly, forms of intraocular inflammation (IOI), which clinically appear to be "non-infectious" turn out to be initiated by infectious agents, suggesting that pathogens have been retained in latent or persistent form within ocular tissues and have reactivated to cause overt disease. A similar pathogenesis applies to latent infections in the brain. Not all CNS tissues provide an equally protective niche while different pathogens escape detection using different strategies. This review summarises how immune privilege (IP) in the CNS may be permissive for latent infection and allow the eye and the brain to act as a reservoir of pathogens which often remain undetected for the lifetime of the host but in states of immune deficiency may be activated to cause sight- and life-threatening inflammation.
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Affiliation(s)
- John V Forrester
- Ocular Immunology Group, Section of Infection and Immunity, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Christine Mölzer
- Ocular Immunology Group, Section of Infection and Immunity, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Lucia Kuffova
- Ocular Immunology Group, Section of Infection and Immunity, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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Agarwal A, Jindal AK, Anjani G, Suri D, Freund KB, Gupta V. SELF-INFLICTED LASER-INDUCED MACULOPATHY MASQUERADING AS POSTERIOR UVEITIS IN A PATIENT WITH SUSPECTED IgG4-RELATED DISEASE. Retin Cases Brief Rep 2022; 16:226-232. [PMID: 31725490 DOI: 10.1097/icb.0000000000000935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical presentation and imaging features in a case of bilateral self-inflicted handheld laser-induced maculopathy which masqueraded as progressive posterior uveitis in a patient with suspected IgG4-related disease. METHODS Case report with clinical history, fundus photographs, fluorescein angiography, indocyanine green angiography, and swept-source optical coherence tomography. RESULTS A young Asian Indian man presented with sudden progressive bilateral visual loss over the past 1 week. He was being treated with oral corticosteroids for multiple subcutaneous skin lesions believed to be due to IgG4-related disease. Findings included bilateral central areas of outer retinal disruption with eccentric linear and serpentine lesions showing hypoautofluorescence. Hyperreflective bands extending from the retinal pigment epithelium and interdigitation zone to the outer plexiform layer were present on swept-source optical coherence tomography. After careful history and evaluation of multimodal imaging, posterior uveitis was excluded, and a diagnosis of handheld laser-induced maculopathy was established. CONCLUSION Pattern recognition is important in establishing a diagnosis of self-inflicted handheld laser-induced maculopathy which can masquerade as posterior uveitis. Increasing availability of powerful Class IIIb laser devices in both developed and developing countries will likely increase the incidence of this entity.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; and
| | - Gummadi Anjani
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; and
| | - Deepti Suri
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; and
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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40
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Gregory-Evans K. A review of diseases of the retina for neurologists. HANDBOOK OF CLINICAL NEUROLOGY 2021; 178:1-11. [PMID: 33832671 DOI: 10.1016/b978-0-12-821377-3.00001-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Diseases of the retina are common and numerous, with causes ranging over inherited, inflammatory, vascular, infectious, neoplastic, traumatic, toxic, and idiopathic etiologies. A key issue in the diagnosis of retinal disease is the duration of symptoms, which can be acute, chronic, or acute presentations of chronic disease. Clinical examination with direct ophthalmoscopy or, even better, biomicroscopy with a slit lamp and condensing lens, is a key component of diagnosis, which can be enhanced through investigational methods such as fluorescein angiography, optical coherence tomography, or electroretinography. Consideration of the history, visual acuity and visual field, and fundoscopic findings is usually sufficient to determine whether patients need referral on an emergency, urgent, or routine basis. Emphasis is given to vascular disease, age-related macular degeneration, diabetic retinopathy, genetic eye disease, and retinal detachment.
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Affiliation(s)
- Kevin Gregory-Evans
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
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Fernández Alcalde C, Granados Fernández M, Nieves Moreno M, Calvo Rey C, Falces Romero I, Noval Martín S. COVID-19 ocular findings in children: a case series. World J Pediatr 2021; 17:329-334. [PMID: 33619650 PMCID: PMC7899207 DOI: 10.1007/s12519-021-00418-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Celia Fernández Alcalde
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España.
| | - Maria Granados Fernández
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España
| | - Maria Nieves Moreno
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España
| | - Cristina Calvo Rey
- Paediatric and Infectious Diseases Department, Hospital Universitario La Paz and Fundación Idipaz, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Iker Falces Romero
- Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Susana Noval Martín
- Department of Ophthalmology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, 28046, Madrid, Madrid, España
- Universidad Autónoma de Madrid, Madrid, Spain
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42
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Singh S, Sawant OB, Mian SI, Kumar A. Povidone-Iodine Attenuates Viral Replication in Ocular Cells: Implications for Ocular Transmission of RNA Viruses. Biomolecules 2021; 11:753. [PMID: 34069869 PMCID: PMC8157382 DOI: 10.3390/biom11050753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 01/02/2023] Open
Abstract
Several RNA viruses, including SARS-CoV-2, can infect or use the eye as an entry portal to cause ocular or systemic diseases. Povidone-Iodine (PVP-I) is routinely used during ocular surgeries and eye banking as a cost-effective disinfectant due to its broad-spectrum antimicrobial activity, including against viruses. However, whether PVP-I can exert antiviral activities in virus-infected cells remains elusive. In this study, using Zika (ZIKV) and Chikungunya (CHIKV) virus infection of human corneal and retinal pigment epithelial cells, we report antiviral mechanisms of PVP-I. Our data showed that PVP-I, even at the lowest concentration (0.01%), drastically reduced viral replication in corneal and retinal cells without causing cellular toxicity. Antiviral effects of PVP-I against ZIKV and CHIKV were mediated by direct viral inactivation, thus attenuating the ability of the virus to infect host cells. Moreover, one-minute PVP-I exposure of infected ocular cells drastically reduced viral replication and the production of infectious progeny virions. Furthermore, viral-induced (CHIKV) expression of inflammatory genes (TNF-α, IL-6, IL-8, and IL1β) were markedly reduced in PVP-I treated corneal epithelial cells. Together, our results demonstrate potent antiviral effects of PVP-I against ZIKV and CHIKV infection of ocular cells. Thus, a low dose of PVP-I can be used during tissue harvesting for corneal transplants to prevent potential transmission of RNA viruses via infected cells.
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Affiliation(s)
- Sneha Singh
- Department of Ophthalmology, Visual and Anatomical Sciences, Kresge Eye Institute, School of Medicine, Wayne State University, Detroit, MI 48201, USA;
| | - Onkar B. Sawant
- Center for Vision and Eye Banking Research, Eversight, Cleveland, OH 44103, USA;
| | - Shahzad I. Mian
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Kresge Eye Institute, School of Medicine, Wayne State University, Detroit, MI 48201, USA;
- Department of Biochemistry, Microbiology, and Immunology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
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43
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Kang H, Wei Y, Liu M, Yu D, Tao Y. Flow cytometric analysis of T lymphocytes and cytokines in aqueous humor of patients with varicella zoster virus-mediated acute retinal necrosis. BMC Ophthalmol 2021; 21:193. [PMID: 33933004 PMCID: PMC8088617 DOI: 10.1186/s12886-021-01951-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The purpose of this study is to investigate the aqueous humor (AH) T lymphocyte subsets and cytokines of acute retinal necrosis (ARN) to elucidate the immunologic inflammatory features of this disorder. METHODS Three patients with ARN infected with varicella zoster virus (VZV) who underwent multiple intravitreal injections of ganciclovir were enrolled in this study. The control group consisted of four non-infectious patients with acute anterior uveitis (AAU). Flow cytometric analysis was performed on the lymphocyte subsets from the AH and peripheral blood (PB) samples during the active phase of intraocular inflammation. Five inflammatory cytokines were measured in each AH sample and various clinical characteristics were also assessed. RESULTS VZV deoxyribonucleic acid (DNA) was detected by real-time polymerase chain reaction (PCR) in AH from all the ARN patients, who showed higher CD8+ T lymphocytes population in AH than the AAU patients (p = 0.006). CD4/CD8 ratios of T lymphocytes and the percentage of CD8 + CD25+ T lymphocytes in AH were significantly lower in ARN than in AAU (p = 0.006; p = 0.012). In the ARN patients, the percentages of CD4+ and CD8+ T lymphocytes in AH were higher than those found in PB. The percentage of CD4 + CD25+ T lymphocytes in AH was significantly higher than the proportion in PB in the AAU patients (p = 0.001). Immunoregulatory cytokine Interleukin-10 in AH was significantly elevated in the ARN patients in comparison with the case of the AAU patients (p = 0.036). In ARN, the copy number of VZV DNA in AH positively correlated with the percentage of CD8+ T lymphocytes in AH and negatively correlated with the CD4/CD8 ratio in AH during the course of disease treatment (p = 0.009, r = 0.92; p = 0.039, r = - 0.834). CONCLUSION The ARN patients caused by VZV had different intraocular T lymphocyte subsets and cytokines profile than those of the non-infectious patients. High percentages of CD8+ T lymphocytes and low CD4/CD8 T cell ratios may be a potential biomarker for diagnosis of viral-infectious uveitis. T lymphocytes examination at the inflammatory sites has the potential to become a useful research tool for differentiating viral and non-viral uveitis.
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Affiliation(s)
- Hao Kang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yunbo Wei
- Laboratory of Immunology for Environment and Health, Shandong Analysis and Test Center, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong, China
| | - Ming Liu
- Beijing GiantMed Diagnostics Co., LTD, Beijing, China
| | - Di Yu
- Laboratory of Immunology for Environment and Health, Shandong Analysis and Test Center, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong, China
- Department of Immunology and Infectious Disease, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Sadik MT, Aksu Ceylan N, Cebeci Z, Kir N, Oray M, Tugal-Tutkun I. Patterns of cytomegalovirus retinitis at a tertiary referral center in Turkey. Int Ophthalmol 2021; 41:2981-2992. [PMID: 33885967 DOI: 10.1007/s10792-021-01857-3] [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: 02/14/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze predisposing conditions in Turkish patients with CMV retinitis and to compare HIV-positive and HIV-negative patients. METHODS We reviewed medical charts and ocular images of 41 patients with CMV retinitis diagnosed between 1996 and 2019. RESULTS Eleven patients (27%) had HIV infection and 30 were immunocompromised from diverse causes. Initial visual acuity, type, zone, and extent of CMV retinitis, and response to anti-CMV treatment were not significantly different between the two groups. Vitreous haze and panretinal occlusive vasculopathy were the presenting features only in non-HIV patients, seen in 34% and 16% of eyes, respectively. Although not statistically significant, recurrent CMV retinitis was more common in non-HIV patients (17.4% vs. 4.3%/eye-year) and immune recovery uveitis was more common in HIV patients (43% vs. 26%/eye-year). Visual outcomes were similar. Final visual acuity of 1 logMAR or worse was significantly associated with the recurrence of CMV retinitis (odds ratio 9.67; p = 0.01) and also with the occurrence of immune recovery uveitis (odds ratio 4.31; p = 0.058). CONCLUSIONS Diverse immunocompromising conditions are more commonly associated with CMV retinitis than HIV infection in Turkish patients. Intraocular inflammation was more commonly associated with active retinitis in non-HIV patients and immune recovery uveitis was more common in HIV patients.
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Affiliation(s)
- Muhammed Talha Sadik
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Nihan Aksu Ceylan
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Zafer Cebeci
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Nur Kir
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Merih Oray
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey.
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45
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Venkatesh A, Patel R, Goyal S, Rajaratnam T, Sharma A, Hossain P. Ocular manifestations of emerging viral diseases. Eye (Lond) 2021; 35:1117-1139. [PMID: 33514902 PMCID: PMC7844788 DOI: 10.1038/s41433-020-01376-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. In recent times, the most prominent outbreaks have constituted RNA viruses, spreading via droplets (COVID-19 and Influenza A H1N1), directly between humans (Ebola and Marburg), via arthropod vectors (Dengue, Zika, West Nile, Chikungunya, Crimean Congo) and zoonotically (Lassa fever, Nipah, Rift Valley fever, Hantaviruses). However, specific approved antiviral therapies and vaccine availability are scarce, and public health measures remain critical. Patients can present with a spectrum of ocular manifestations. Emerging infectious diseases should therefore be considered in the differential diagnosis of ocular inflammatory conditions in patients inhabiting or returning from endemic territories, and more general vigilance is advisable in the context of a global pandemic. Eye specialists are in a position to facilitate swift diagnosis, improve clinical outcomes, and contribute to wider public health efforts during outbreaks. This article reviews those emerging viral diseases associated with reports of ocular manifestations and summarizes details pertinent to practicing eye specialists.
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Affiliation(s)
- Ashwin Venkatesh
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ravi Patel
- grid.439257.e0000 0000 8726 5837Moorfields Eye Hospital, London, UK
| | - Simran Goyal
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Timothy Rajaratnam
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anant Sharma
- grid.439257.e0000 0000 8726 5837Moorfields Eye Hospital, London, UK
| | - Parwez Hossain
- grid.430506.4Eye Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK ,grid.5491.90000 0004 1936 9297Clinical Experimental Sciences, Faculty of Medicine, Univeristy of Southampton, Southampton, UK
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46
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Wu CY, Knight D, Freeman W. White Macula After Pars Plana Vitrectomy in a 71-Year-Old Woman. JAMA Ophthalmol 2021; 139:478-479. [PMID: 33538786 DOI: 10.1001/jamaophthalmol.2020.4616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chris Y Wu
- Shiley Eye Institute, University of California at San Diego, La Jolla
| | - Darren Knight
- Shiley Eye Institute, University of California at San Diego, La Jolla
| | - William Freeman
- Shiley Eye Institute, University of California at San Diego, La Jolla
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47
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Bai YC, Wang CY, Lin CL, Lai JN, Wei JCC. Association Between Air Pollution and the Risk of Uveitis: A Nationwide, Population-Based Cohort Study. Front Immunol 2021; 12:613893. [PMID: 33815370 PMCID: PMC8013994 DOI: 10.3389/fimmu.2021.613893] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
Previous studies have revealed an association between ocular surface disorders and air pollution, few studies have focused on the risk of uveitis. We aimed to investigate whether air pollution increases the risk of uveitis. We used the Taiwan Longitudinal Health Insurance Database (LHID) and the Taiwan Air Quality Monitoring Database (TAQMD) to conduct a retrospective cohort study. Air pollutant concentrations, including those of carbon dioxide (CO2), were grouped into four levels according to quartiles. The outcome was the incidence of uveitis, as defined in the International Classification of Diseases, Ninth Revision. We used univariable and multivariable Cox proportional hazard regression models to calculate the adjusted hazard ratios (aHRs) and determine the potential risk factors of uveitis. Overall, 175,489 subjects were linked to their nearby air quality monitoring stations. We found that for carbon monoxide, the aHRs of uveitis risk for the Q3 and Q4 levels were 1.41 (95% confidence interval (CI) = 1.23–1.61) and 2.19 (95% CI = 1.93–2.47), respectively, in comparison with those for the Q1 level. For nitric oxide, the aHRs for the Q3 and Q4 levels were 1.46 (95% CI = 1.27–1.67) and 2.05 (95% CI = 1.81–2.32), respectively. For nitrogen oxide (NOx), the aHRs for the Q2, Q3, and Q4 levels were 1.27 (95% CI = 1.11–1.44), 1.34 (95% CI = 1.16–1.53), and 1.85 (95% CI = 1.63–2.09), respectively. For total hydrocarbon (THC), the aHRs for the Q2, Q3, and Q4 levels were 1.42 (95% CI = 1.15–1.75), 3.80 (95% CI = 3.16–4.57), and 5.02 (95% CI = 4.19–6.02), respectively. For methane (CH4), the aHRs for the Q3 and Q4 levels were 1.94 (95% CI = 1.60–2.34) and 7.14 (95% CI = 6.01–8.48), respectively. In conclusion, air pollution was significantly associated with incidental uveitis, especially at high THC and CH4 levels. Furthermore, the uveitis risk appeared to increase with increasing NOx and THC levels.
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Affiliation(s)
- Yi-Chiao Bai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Cheng-You Wang
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Institute of Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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48
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Senter G, do Nascimento HM, Belfort Junior R. Response to "Comment On: Acute Retinal Necrosis: Is the Current Valacyclovir Regimen Adequate?". Ocul Immunol Inflamm 2021; 30:1290. [PMID: 33646073 DOI: 10.1080/09273948.2020.1860235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute Retinal Necrosis (ARN) is a potentially devastating form of Uveitis. Antivirals are the mainstay treatment for this syndrome. In this letter, we question the current oral Valacyclovir dosage, based on the experience we had with a recent unresponsive ARN case.
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Affiliation(s)
- Gabrielle Senter
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Rubens Belfort Junior
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
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Arenas-Canchuja F, Campos-Dávila B, Valderrama-Albino V. A case of non-necrotising herpetic retinitis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 97:S0365-6691(21)00033-2. [PMID: 33612363 DOI: 10.1016/j.oftal.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
In developed countries, the main origin of posterior uveitis is an infection. Herpes is the most common viral agent, as it has a wide spectrum of ocular manifestations. These manifestations may depend on the immunological state of the patient, and range from a mild focal form of non - necrotising herpetic retinitis (NNHR) to a severe form of acute retinal necrosis (ARN). A case of NNHR due to Herpes simplex virus type 2 (HSV-2) is reported, along with the different differential diagnostics prior to its diagnosis: atypical ocular toxoplasmosis, ocular tuberculosis, and ARN. During its course, despite the antiviral treatment, systemic corticoids and the clinical improvement of the injury, there was a drastic drop in the visual acuity. This event led to the re-evaluation of the suspected entities, establishing the NNHR as a definitive diagnostic by exclusion, which was a diagnostic challenge.
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Affiliation(s)
- F Arenas-Canchuja
- Instituto Nacional de Oftalmología Dr. Francisco Contreras Campos, Lima, Perú.
| | - B Campos-Dávila
- Departamento de Atención Especializada en Úvea, Instituto Nacional de Oftalmología Dr. Francisco Contreras Campos, Lima, Perú
| | - V Valderrama-Albino
- Departamento de Atención Especializada en Úvea, Instituto Nacional de Oftalmología Dr. Francisco Contreras Campos, Lima, Perú
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McKay KM, Lim LL, Van Gelder RN. Rational laboratory testing in uveitis: A Bayesian analysis. Surv Ophthalmol 2021; 66:802-825. [PMID: 33577878 DOI: 10.1016/j.survophthal.2021.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 01/07/2023]
Abstract
Uveitis encompasses a heterogeneous group of clinical entities with the common feature of intraocular inflammation. In addition to patient history and examination, a focused set of laboratory investigations is frequently necessary to establish a specific diagnosis. There is limited consensus among uveitis specialists regarding appropriate laboratory evaluation for many distinct patient presentations. The appropriateness of a laboratory test for a given case of uveitis will depend on patient-specific as well as epidemiologic factors. Bayesian analysis is a widely used framework for the interpretation of laboratory testing, but is seldom adhered to in clinical practice. Bayes theorem states that the predictive value of a particular laboratory test depends on the sensitivity and specificity of that test, as well as the prevalence of disease in the population being tested. In this review we will summarize the performance of commonly-utilized laboratory tests for uveitis, as well as the prevalence of uveitic diagnoses in different geographic practice settings. We will propose a logical framework for effective laboratory testing in uveitic disease through rigorous application of Bayesian analysis. Finally, we will demonstrate that while many highly sensitive laboratory tests offer an effective means to rule out associated systemic disease, limited test specificity and low pretest probability often preclude the diagnosis of systemic disease association with any high degree of certainty, even in the face of positive testing.
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Affiliation(s)
- K Matthew McKay
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Russell N Van Gelder
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA; Department of Biological Structure, University of Washington, Seattle, Washington, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
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