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Singh M, Deokar K, Sinha BP, Doshi J, Katoch C. Infective pulmonary diseases and the eye: a narrative review. Monaldi Arch Chest Dis 2024. [PMID: 39259221 DOI: 10.4081/monaldi.2024.2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/17/2024] [Indexed: 09/12/2024] Open
Abstract
Several infectious pulmonary diseases affect the eye. An understanding of the association between infectious pulmonary and ocular diseases is pivotal to their successful management. We aimed to review the infections affecting both the lungs and the eye. The electronic database PubMed and the search engine Google Scholar were searched for relevant articles. Ocular tuberculosis (TB), usually not associated with clinical evidence of pulmonary TB, can affect almost all the ocular structures. Confirmation of the diagnosis of ocular TB requires demonstration of Mycobacterium tuberculosis in ocular fluids/tissues. Among the drugs used to treat TB, ethambutol, isoniazid, and linezolid may cause toxic optic neuropathy. Elderly, those with renal disease, diabetes mellitus, malnourished, alcoholics, and those who will receive ethambutol at doses greater than 15 mg/kg/day and for prolonged periods are at high risk of developing toxic optic neuropathy. These individuals should be referred to an ophthalmologist before initiating ATT for a baseline ophthalmic evaluation. Linezolid may also cause toxic retinal neuropathy. Rifampicin may cause yellowish-orange discoloration of tears and contact lenses. Adenovirus, coronavirus, influenza virus, respiratory syncytial virus, and rhinovirus exhibit both pulmonary and ocular tropism. Pneumocystis jirovecii choroiditis is rare and mainly seen when aerosolized pentamidine is used for pneumocystis pneumonia prophylaxis. Further research is needed to develop non-interventional strategies to diagnose ocular TB. Biomarkers for early detection of toxic optic neuropathy are a need of the hour. Genetic factors and mechanisms behind the development of ethambutol, isoniazid, and linezolid-induced toxic optic neuropathy need further study.
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Affiliation(s)
- Mamta Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Rajkot.
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot.
| | - Bibhuti Prassan Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna.
| | - Jinish Doshi
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot.
| | - Cds Katoch
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot.
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2
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Lee SM, Jung JH, Lee J, Choi EY, Shin JY, Kim M. Clinical Features, Long-Term Outcomes, and Prognostic Factors of Eales' Disease in Korean Patients. Ocul Immunol Inflamm 2024; 32:621-627. [PMID: 36897992 DOI: 10.1080/09273948.2023.2183870] [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: 08/12/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE We studied Korean patients with Eales' disease to document clinical features, long-term outcomes, and explore its association with TB, given South Korea's high TB burden. METHODS We retrospectively reviewed medical records of Eales' disease patients for clinical characteristics, long-term outcomes, and its association with TB. RESULTS Among 106 eyes, the average age of diagnosis was 39.28 years, with 82.7% male and 58.7% having unilateral involvement. Patients who underwent vitrectomy showed greater long-term improvement in visual acuity (P = .047), while those with glaucoma filtration surgery showed less improvement (P = .008). Having glaucoma through disease progression was associated with poor visual outcomes (odds ratio=15.556, P < .02). 27 out of 39 patients (69.23%) who underwent IGRA screening tested positive for TB. CONCLUSIONS In Korean patients with Eales' disease, we observed male predominance, unilateral presentation, older age of onset, and a link with TB. Timely diagnosis and management should be considered to maintain good vision in patients with Eales' disease.
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Affiliation(s)
- Seung Min Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Jung
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junwon Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 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
| | - Joo Youn Shin
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yonginsi, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Bae K, Alcantara CA, Kim J, Tsui C, Venketaraman V. A Review of Eales' Disease and Mycobacterium tuberculosis. BIOLOGY 2024; 13:460. [PMID: 38927340 PMCID: PMC11200918 DOI: 10.3390/biology13060460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Eales' Disease is an idiopathic peripheral retinal vasculopathy first described by British ophthalmologist Henry Eales in 1880. Most prevalent in healthy young males, Eales' Disease often presents with symptoms of sudden blurry or decreased vision and floaters. Although no clear, standardized stage of the disease exists, it progresses through three overlapping phases-peripheral periphlebitis, ischemic capillary ischemia, and retinal neovascularization. The etiology of Eales' Disease is unknown and appears to be multifactorial, but post-TB hypersensitivity to tuberculoprotein and M. tuberculosis DNA is the most potential cause in the etiology of Eales' Disease. With a thorough examination of the clinical presentation and diagnosis of Eales' Disease-incorporating the latest clinical findings related to the condition-the investigation for Eales' Disease extends to explore recent potential connections with other ocular conditions or possible cofactors, such as glaucoma, uncontrolled diabetes, drug abuse, or inherited medical conditions. Moreover, focusing on critical insights into the treatment of Eales' Disease across its various stages of progression, the overarching goal of the paper is to refine and suggest possible future diagnostic and therapeutic strategies. Widening our understanding of pathophysiology and utilizing various treatment options for individual patients holds immense potential for advancing ocular medicine and optimizing patient care for people with this disease with unknown pathophysiology.
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Affiliation(s)
| | | | | | | | - Vishwanath Venketaraman
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
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Biswas J, Jadhav S, Eswaran BV. Evolution of research in diagnosis and management of uveitis over four decades in India. Indian J Ophthalmol 2024; 72:809-815. [PMID: 38454865 PMCID: PMC11232861 DOI: 10.4103/ijo.ijo_1577_23] [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: 06/16/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 03/09/2024] Open
Abstract
Uveitis and its complications are more common in the developing world, in which the condition occurs in up to 714 per 100,000 in the population and accounts for up to 25% of all blindness. In India, the ophthalmic sub speciality of uveitis greatly evolved in the last four decades. In the early decades most of the studies were epidemiological studies. In recent years, more research has been published due to tremendous advancements in clinical diagnosis, laboratory investigations and ancillary test and treatment modalities. In this review article, we did a medline search with key words 'uveitis' and 'India', and selectively incorporated articles showing the evolution of this sub-speciality in India.
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Affiliation(s)
- Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sourabh Jadhav
- Department of Vitreo Retina, Shri Bhagvan Mahavir, Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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5
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He M, Yang L, Jia S, Yang J, Wen X, Fan J, Jia R, Fan X. Does vitreous haemorrhage and calcification lead to increased risk of enucleation in advanced retinoblastoma? Acta Ophthalmol 2024; 102:e296-e301. [PMID: 37431955 DOI: 10.1111/aos.15735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To explore whether varying degrees of vitreous haemorrhage (VH) and calcification act as risk factors for enucleation in patients with advanced retinoblastoma (RB). METHODS Advanced RB was defined by the international classification of RB (Philadelphia version). Basic information for retinoblastoma patients diagnosed as groups D and E in our hospital between January 2017 and June 2022 was reviewed by logistics regression models. Additionally, a correlation analysis was performed, excluding variables with a VIF (variance inflation factor) >10 from the multivariate analysis. RESULTS A total of 223 eyes diagnosed with RB were included in assessing VH and calcification; of these, 101 (45.3%) eyes experienced VH, and 182 (76.2%) eyes were found to have calcification within the tumour through computed tomography (CT) or B-scan ultrasonography. Ninety-two eyes (41.3%) were enucleated, of which 67 (72.8%) had VH and 68 (73.9%) calcification, both of which were significantly relevant to enucleation (p < 0.001*). Other clinical risk factors, such as corneal edema, anterior chamber haemorrhage, high intraocular pressure during treatment and iris neovascularization, correlated significantly with enucleation (p < 0.001*). Multivariate analysis included IIRC (intraocular international retinoblastoma classification), VH, calcification and high intraocular pressure during treatment as independent risk factors for enucleation. CONCLUSIONS Despite identifying different potential risk factors for RB, there remains significant controversy concerning which patients require enucleation, and the degree of VH varies. Such eyes need to be evaluated carefully, and management with appropriate adjuvant therapy may improve the outcome of these patients.
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Affiliation(s)
- Mengjia He
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ludi Yang
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shichong Jia
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Tianjin Eye Institute, Tianjin, China
| | - Jie Yang
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xuyang Wen
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jiayan Fan
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Nakamura K, Akiyama H, Tokui S, Saito K, Nitta K. A CASE OF EALES DISEASE OBSERVED BY WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retin Cases Brief Rep 2024; 18:116-119. [PMID: 36026697 DOI: 10.1097/icb.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to report a 30-year-old woman with Eales disease, showing bilateral proliferative tissue. The retinal vessels were evaluated using widefield optical coherence tomography angiography (widefield OCTA), which has a wider angle of view compared with conventional instruments. METHODS This is a case report. RESULTS Widefield OCTA showed an extensive nonperfusion area and A-V shunt in both eyes and a vascular structure in the left eye that appeared to be retinal neovascularization. Ultra-widefield fluorescein angiography revealed no filling delay in the early phase, a vast nonperfusion area from the midperiphery to the ora serrata in bilateral eyes, and retinal neovascularization in the left eye. Based on the results of ultra-widefield angiography, OCTA examination, and systemic examination, a diagnosis of Eales disease was finally made after all the differential diseases had been excluded. CONCLUSION In a patient with Eales disease, the peripheral nonperfusion area and retinal neovascularization that were consistent with the ultra-widefield angiography findings were noninvasively confirmed by widefield OCTA. Widefield OCTA is useful in the detection of peripheral changes of the fundus.
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Affiliation(s)
- Kosuke Nakamura
- Department of Ophthalmology, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Gonzalez Martinez OG, Villegas VM, Oliver AL, Santos C. Adjuvant Intravitreal Bevacizumab for Retinal Neovascularization in Eales' Disease Associated With Latent Mycobacterium Tuberculosis. Cureus 2023; 15:e41003. [PMID: 37503481 PMCID: PMC10371457 DOI: 10.7759/cureus.41003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
We report a case of bilateral Eales' disease managed with intravitreal bevacizumab. A 32-year-old woman with a history of bacillus Calmette-Guerin vaccine, administered when she was 10 years old, presented with a five-day history of a scotoma in the temporal field of her right eye. A dilated fundus exam and fluorescein angiography showed bilateral retinal peripheral capillary non-perfusion, retinal neovascularization in the right eye, and deep intraretinal hemorrhages in the left eye. Her laboratory workup resulted in a positive QuantiFERON-TB Gold test (Cellestis Ltd, Carnegie, Victoria, Australia). Chest computed tomography showed a calcified granuloma in her right lung. Angiographic-guided pan-retinal photocoagulation was performed, and intravitreal injections of bevacizumab (1.25 mg/0.05 mL) were administered in both eyes over the course of three months. The intraretinal hemorrhages resolved after three months of therapy. Three months following treatment, the patient showed normal fundus findings without any evidence of recurrence and a visual acuity of 20/20 in both eyes. Intravitreal bevacizumab in combination with angiography-guided pan-retinal photocoagulation may be efficacious in select patients with Eales' disease.
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Affiliation(s)
| | - Victor M Villegas
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Armando L Oliver
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Carmen Santos
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
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Cocaine Abuse as an Immunological Trigger in a Case Diagnosed with Eales Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010169. [PMID: 36676793 PMCID: PMC9865688 DOI: 10.3390/medicina59010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023]
Abstract
Background: Eales disease is a clinical syndrome affecting the mid-peripheral retina with an idiopathic occlusive vasculitis and possible subsequent retinal neovascularization. The disease can develop into visually threatening complications. Case Presentation: We report the case of a 40-year-old Caucasian male with a history of cocaine abuse who presented with blurred vision in the left eye (LE). Fundus examination showed vitreous hemorrhages, peripheral sheathing of venous blood vessels, areas of retinal neovascularization in the LE, and peripheral occlusive phlebitis in the right eye. The full serologic panel was negative except for the heterozygous mutation of factor V Leiden. Clinical and biochemical parameters suggested a diagnosis of Eales disease. Therapy with dexamethasone, 1 mg per kg per day, tapered down slowly over 4 months, and peripheral laser photocoagulation allowed a regression of clinical signs and symptoms. Conclusion: This case shows an uncommon presentation of Eales disease associated with cocaine abuse. Both cocaine abuse and a thrombophilic pattern, as cofactors, might have sensitized the retinal microcirculation on the pathogenetic route to this retinal pathology. Furthermore, in view of this hypothesis, a thorough ocular and general medical history investigating drug abuse and coagulation disorders is recommended for ophthalmologists in such cases.
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Nebbioso M, Franzone F, Lambiase A, Bonfiglio V, Limoli PG, Artico M, Taurone S, Vingolo EM, Greco A, Polimeni A. Oxidative Stress Implication in Retinal Diseases-A Review. Antioxidants (Basel) 2022; 11:antiox11091790. [PMID: 36139862 PMCID: PMC9495599 DOI: 10.3390/antiox11091790] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Oxidative stress (OS) refers to an imbalance between free radicals (FRs), namely highly reactive molecules normally generated in our body by several pathways, and intrinsic antioxidant capacity. When FR levels overwhelm intrinsic antioxidant defenses, OS occurs, inducing a series of downstream chemical reactions. Both reactive oxygen species (ROS) and reactive nitrogen species (RNS) are produced by numerous chemical reactions that take place in tissues and organs and are then eliminated by antioxidant molecules. In particular, the scientific literature focuses more on ROS participation in the pathogenesis of diseases than on the role played by RNS. By its very nature, the eye is highly exposed to ultraviolet radiation (UVR), which is directly responsible for increased OS. In this review, we aimed to focus on the retinal damage caused by ROS/RNS and the related retinal pathologies. A deeper understanding of the role of oxidative and nitrosative stress in retinal damage is needed in order to develop targeted therapeutic interventions to slow these pathologies.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p.le A. Moro 5, 00185 Rome, Italy
- Correspondence:
| | | | - Alessandro Lambiase
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p.le A. Moro 5, 00185 Rome, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | | | - Marco Artico
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p.le A. Moro 5, 00185 Rome, Italy
| | | | - Enzo Maria Vingolo
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p.le A. Moro 5, 00185 Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p.le A. Moro 5, 00185 Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome 5, p.le A. Moro 5, 00185 Rome, Italy
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Ng CC, Ng J, McDonald HR, Cunningham ET. Bartonella henselae-associated recurrent, bilateral segmental periphlebitis. Am J Ophthalmol Case Rep 2022; 26:101475. [PMID: 35321248 PMCID: PMC8935419 DOI: 10.1016/j.ajoc.2022.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe a patient with atypical Bartonella henselae (B. henselae)-associated ocular inflammation that manifested with recurrent, bilateral segmental periphlebitis. Observations A 32-year-old White man presented with multiple paracentral scotomata in each eye. Examination revealed mild vitreous cell, segmental sheathing of the retinal veins, and inflammation of the paravenous retina in each eye. Multimodal imaging, including optical coherence tomography as well as widefield fundus autofluorescence, fluorescein angiography, and indocyanine green angiography, was consistent with bilateral, segmental retinal periphlebitis with paravenous inflammation and retinochoroidal scarring. Serology showed elevated B. henselae antibody titers, but was otherwise unrevealing, and the patient was diagnosed with presumed B. henselae-associated ocular inflammation. Treatment with systemic doxycycline (100 mg PO BID) for four weeks improved the patient's symptoms and posterior uveitis. However, after an asymptomatic period of nearly one year, his bilateral pericentral scotomata recurred and posterior segment examination confirmed new foci of retinal periphlebitis in each eye. Re-treatment with doxycycline (100 mg PO BID) for four weeks again yielded improvement, but one month after completing his antibiotic course, his visual symptoms recurred, and we observed additional areas of periphlebitis and paravenous retinitis with associated branch retinal vein occlusions in each eye. This time a dual antibiotic regimen of doxycycline (100 mg PO BID) and rifampin (300 mg PO BID) was administered for three months, with improvement. Over the next eight years, the patient experienced no further disease relapse, and the previous sites of retinal periphlebitis eventually developed perivenous fibrosis with paravenous retinochoroidal scarring. Conclusion Rarely, patients with B. henselae-associated ocular inflammation develop segmental retinal periphlebitis with or without retinal vein occlusion. This form of ocular bartonellosis can recur, requiring multiple courses of antimicrobial therapy.
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Affiliation(s)
- Caleb C. Ng
- Retina Consultants of Orange County, Fullerton, CA, USA
- West Coast Retina Medical Group, San Francisco, CA, USA
| | - Joshua Ng
- West Coast Retina Medical Group, San Francisco, CA, USA
| | - H. Richard McDonald
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Emmett T. Cunningham
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
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Murillo López S, Medina Medina S, Murillo López F. Eales' disease: epidemiology, diagnostic and therapeutic concepts. Int J Retina Vitreous 2022; 8:3. [PMID: 34983678 PMCID: PMC8728940 DOI: 10.1186/s40942-021-00354-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 12/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background To describe the epidemiological traits, clinical characteristics, diagnostic procedures, therapeutic interventions and evolution in a large series of patients with diagnosis of Eales’ disease. Methods A clinical retrospective review of patients with Eales’ disease, evaluated and treated between April 2009 and April 2018, with a 1-year minimum follow-up. Thirty patients (59 eyes), were included. Age, sex, laboratory results (CBC, glycemia, protein electrophoresis, ACE levels) immunological profile and a Quantiferon-TB Gold Plus test were recorded. The patients were divided into groups according to their evolution, medical or surgical treatment, and visual outcomes. Results Seventeen male patients and 13 female patients were included, and their ages ranged from 14 to 35 years. The Quantiferon-TB Gold Plus test was positive in 25 patients. Twenty-eight patients had unilateral vitreous hemorrhage, 10 of whom presented with vasculitis and non-perfusion areas in the contralateral eye, 9 presented contralateral peripheral neovascularization and 9 had contralateral fibrovascular proliferation. The remaining 2 patients presented with a rhegmatogenous retinal detachment. In 6 patients, conservative treatment with intravitreal anti-VEGF injections and photocoagulation was performed after the hemorrhage cleared. Twenty-two patients, required vitrectomy, with good visual outcomes. Macular edema was found in 16 eyes, which responded to periocular and/or systemic corticosteroid therapy, except for 9 eyes that required intravitreal bevacizumab, with complete resolution in 7 eyes and partial resolution in 2 eyes. Conclusions Eales’ disease is a pathology of significant prevalence in our country. The distribution according to sex, tends to be equivalent. The etiology, even when it is not specifically determined, according to laboratory tests, confirms the probable immunologic response in the presence of Mycobacterium tuberculosis antigens. This is still a diagnosis of exclusion, and therefore, it is advisable to perform a complete laboratory work-up in each case. Timely application of laser and other medical treatments, help to avoid progression to more advanced stages and their complications. The surgical treatment of vitrectomy for vitreous hemorrhage, and/or tractional vitreous detachment yields good primary anatomical and functional outcomes. Secondary macular edema responds to periocular and intravitreal corticosteroids, and in refractory cases, the use of anti-VEGF therapy leads to an effective resolution.
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Affiliation(s)
- Sergio Murillo López
- Clínica del Ojo, Jaime Mendoza St. # H- 22. Torre Grazia 1st. Floor, La Paz, Bolivia
| | - Silvia Medina Medina
- Clínica del Ojo, Jaime Mendoza St. # H- 22. Torre Grazia 1st. Floor, La Paz, Bolivia.
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Alfayyadh MA, Alabdulhadi HA, Almubarak MH. Advanced Eales' Disease With Neovascular Glaucoma at First Presentation. Cureus 2021; 13:e18302. [PMID: 34722077 PMCID: PMC8548357 DOI: 10.7759/cureus.18302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 11/05/2022] Open
Abstract
Eales' disease is an idiopathic vasculitis that affects the peripheral retina. It is characterized by recurrent vitreous hemorrhage as a complication of retinal neovascularization. It is more prevalent in India and affects young males. Here, we present a patient with neovascular glaucoma as a rare first presentation of Eales' disease. This is a 24-year-old Indian male, who complained of a sudden decrease in vision in the left eye over less than 24 hours, along with frontal headache and eye pain for the last three weeks. Ocular examination revealed peripheral retinal ischemia in the right eye, very high intraocular pressure, rubeosis iridis, vitreous hemorrhage and extensive retinal ischemia in the left eye, vascular sheathing and neovascularization in both eyes. The purified protein derivative skin test was positive. The patient was managed with anti-glaucoma, intravitreal anti-vascular endothelial growth factor and laser photocoagulation. Systemic steroids and anti-tuberculous therapy were also initiated. Neovascular glaucoma is an infrequent complication of Eales' disease. However, the lack of early detection of the disease in the early stages might lead to such serious complications.
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13
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Shah A, Giridhar S, Patnaik G, Mhatre R, Das D, Janani MK, Mahadevan A, Biswas J. Histopathological, immunohistochemical and molecular biologic study of an enucleated specimen of a case of Eales' disease. J Ophthalmic Inflamm Infect 2021; 11:29. [PMID: 34467418 PMCID: PMC8408300 DOI: 10.1186/s12348-021-00259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022] Open
Abstract
Eales' disease is a retinal vasculitis characterized by retinal inflammation, ischemia, and neovascularization. Exact pathogenesis of this disease is yet to be found out. We present a 29-year-old male, diagnosed with Eales' disease in both eyes with persistent intraocular inflammation. Enucleation of the pthisical right eye was subjected for histopathological examination immunohistochemistry and molecular biologic study for mycobacterial tuberculosis DNA. Our study showed that Eales disease is probably a T cell mediated disease which is triggered by mycobacterial TB DNA. Further studies are needed to confirm our findings.
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Affiliation(s)
- Amravi Shah
- Uvea Department, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Tamilnadu, 600006, Chennai, India
| | - Sneha Giridhar
- Shri BhagwanMahavir Vitreoretinal Services Sankara Nethralaya, 18 College Road, Tamilnadu, Chennai, India
| | - Gazal Patnaik
- Uvea Department, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Tamilnadu, 600006, Chennai, India
| | - Radhika Mhatre
- Department of Neuropathology, NIMHANS, Bengaluru, Karnataka, India
| | - Dipankar Das
- Department of Uvea, Sri SankaradevaNethralaya, Guwahati, Assam, India
| | - M K Janani
- Sankara Nethralaya Referral Laboratory, Tamil Nadu, Chennai, India
| | - Anita Mahadevan
- Department of Neuropathology, NIMHANS, Bengaluru, Karnataka, India
| | - Jyotirmay Biswas
- Uvea Department, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Tamilnadu, 600006, Chennai, India.
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Eales' Disease: When the Rare Sounds Frequent. Case Rep Ophthalmol Med 2021; 2021:1056659. [PMID: 34422421 PMCID: PMC8371666 DOI: 10.1155/2021/1056659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
Eales' disease is a peripheral occlusive retinal phlebitis, with an unclear pathogenesis. The classic association with hypersensitivity to Mycobacterium tuberculosis protein infers that immunologic disturbance may be involved. Here, we described three cases of Eales' disease. All patients are Caucasian men aged 27-58 years and presented with vitreous hemorrhage and/or peripheral venous vasculitis. Tuberculin skin sensitive test (Mantoux screening test) and interferon-gamma release assay (IGRA) were positive in all patients. Therapeutic approach included antituberculosis therapy and systemic steroids, associated or not to immunosuppressive therapy, and retinal scatter photocoagulation in all cases. Antivascular endothelial grow factor (VEGF) intravitreal injections were also required in two cases. Since various retinal diseases can resemble this presentation, Eales' disease is considered a diagnosis of exclusion. Early diagnosis and appropriate therapeutic approach are both essential to accomplish disease control and reduce ophthalmologic complications.
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Gong Y, Wei S, Zhang M, Jin X, Hou B, Wang D. Serum interferon‐gamma/interleukin‐4 imbalance in patients with Eales' disease. Clin Exp Optom 2021; 93:228-32. [PMID: 20533927 DOI: 10.1111/j.1444-0938.2010.00482.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Yan Gong
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
- Department of Ophthalmology, Armed Police General Hospital, Beijing, China E‐mail:
| | - Shi‐hui Wei
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Mao‐nian Zhang
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Xin Jin
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Bao‐ke Hou
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Dan Wang
- Department of Ophthalmology, Armed Police General Hospital, Beijing, China E‐mail:
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Patel D, Majumder PD, Biswas J. Papillophlebitis as an initial presentation of Eales' disease. Oman J Ophthalmol 2021; 13:161-163. [PMID: 33542608 PMCID: PMC7852416 DOI: 10.4103/ojo.ojo_90_2020] [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: 04/13/2020] [Revised: 06/07/2020] [Accepted: 09/06/2020] [Indexed: 11/07/2022] Open
Abstract
Eales' disease (ED), which is an idiopathic obliterative vasculitis, is a diagnosis of exclusion. The optic nerve involvement in ED is not very common. We report a case of ED in a 36-year-old male who initially presented as papillephlebitis. He presented with complaints of decreased vision in his right eye for 2 months. Fundus examination revealed that optic disc edema with hemorrhages, and he was started on oral corticosteroid after the exclusion of infectious etiology. Fundus examination after 2 months revealed thet resolution of optic disc edema, but active periphlebitis with multiple superficial retinal hemorrhages involving inferior and inferotemporal quadrant. Based on negative laboratory results and clinical findings a diagnosis of ED was considered. Regular monitoring of patients with papillephlebitis is recommended.
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Affiliation(s)
- Dhaval Patel
- Department of Vitreoretina, Chennai, Tamil Nadu, India
| | | | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundations, Chennai, Tamil Nadu, India
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17
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Kedia S, Ahuja V. Intestinal tuberculosis or Crohn's disease: Illusion or delusion or allusion. JGH Open 2021; 5:177-179. [PMID: 33553652 PMCID: PMC7857303 DOI: 10.1002/jgh3.12495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Saurabh Kedia
- Department of GastroenterologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Vineet Ahuja
- Department of GastroenterologyAll India Institute of Medical SciencesNew DelhiIndia
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18
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An Isolated Presentation of Ischemic Retinal Vasculitis by the Great Masquerader. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Rajurkar K, Thakar M, Gupta P, Rastogi A. Comparison of fundus fluorescein angiography, optical coherence tomography and optical coherence tomography angiography features of macular changes in Eales disease: a case series. J Ophthalmic Inflamm Infect 2020; 10:34. [PMID: 33314007 PMCID: PMC7733914 DOI: 10.1186/s12348-020-00220-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To study the macular features in Eales disease patients observed with fundus fluorescein angiography (FA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods A cross-sectional study was done on treatment naïve 31 eyes (23 patients) with Eales disease. Baseline parameters such as Best-corrected visual acuity (BCVA), slit-lamp bio microscopy (SLB), indirect ophthalmoscopy, FA, spectral-domain OCT {quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT} and OCTA were performed. Any media opacity precluding the above investigations was excluded. Results Macular findings comprised of- epiretinal membrane, macular exudation, full thickness macular hole, sub internal limiting membrane bleed, cystoid macular oedema, neurosensory detachment and retinal thickening. Sixteen (51.6%) of our patients had macular changes as seen on all modalities together. SLB and indirect ophthalmoscopy missed macular findings in 50% patients and FA in 18.8% patients. OCT and OCTA diagnosed all macular findings. On comparison of mean BCVA in patients with macular involvement on FA, OCT and OCTA, compared to those without macular involvement, patients with macular involvement had lower BCVA (p 0.000, 0.01 and 0.001 respectively). Thus, FA missed many patients who had significant macular involvement and hence less vision. Conclusion Eales disease though described in literature as classically being peripheral retina disease process, also has macular involvement. OCT and OCTA are useful guides to evaluation of macular involvement in these patients. The latter seems to be superior to FA in detecting macular abnormalities in this ailment. OCTA is non-invasive and shows deep capillary plexus changes which are not shown by any other modality.
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Affiliation(s)
- Ketaki Rajurkar
- Guru Nanak Eye Centre, Near Zakir Hussain College, Maharaja Ranjeet Singh Marg, 64 Khamba, New Delhi, Delhi, 110002, India.
| | - Meenakshi Thakar
- Guru Nanak Eye Centre, Near Zakir Hussain College, Maharaja Ranjeet Singh Marg, 64 Khamba, New Delhi, Delhi, 110002, India
| | - Priyadarshi Gupta
- Guru Nanak Eye Centre, Near Zakir Hussain College, Maharaja Ranjeet Singh Marg, 64 Khamba, New Delhi, Delhi, 110002, India
| | - Anju Rastogi
- Guru Nanak Eye Centre, Near Zakir Hussain College, Maharaja Ranjeet Singh Marg, 64 Khamba, New Delhi, Delhi, 110002, India
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Gupta P, Biswas J. Further evidence of the association of latent Mycobacterium tuberculosis in Eales' disease. Int Ophthalmol 2020; 41:901-906. [PMID: 33200391 DOI: 10.1007/s10792-020-01645-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To find out association of Eales' disease with Mycobacterium tuberculosis. METHODS A retrospective study was done recruiting patients visiting the uvea clinic with diagnosis of Eales' disease from 2015-2019. Seventy-nine eyes of 50 patients diagnosed as Eales' disease underwent Mantoux test, QuantiFERON-TB Gold test, high resolution computed tomography (HRCT) of the chest and anterior chamber or vitreous tap for TB genome polymerase chain reaction(PCR). RESULTS The study included 41 males and 9 females. The mean age of the patient was 35.62 ± 11.49 y. Out of 50 patients, 42% (n = 21) patients had unilateral involvement. Mantoux test was positive in 73% patients. QuantiFERON-TB Gold test was positive in 56% patients. HRCT chest was suggestive of pulmonary tuberculosis in 34% patients. Out of 6 patients, PCR from anterior chamber tap showed TB genome positive in 2 (33.3%) patients. Out of 9 patients, vitreous tap PCR was positive for TB genome in 2 (22.2%) patients. CONCLUSIONS Our study showed that one or more tests were positive for TB in Eales' disease suggesting a pivotal role of TB as a primary etiology for this disease. We conclude that Eales' disease is associated with Mycobacterium tuberculosis infection.
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Affiliation(s)
- Prasad Gupta
- Department of Uvea, Medical and Vision Research Foundation, Sankara Nethralaya, No. 41 (old 18), College RoadTamil Nadu, Chennai, 600006, India.
| | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundation, Sankara Nethralaya, No. 41 (old 18), College RoadTamil Nadu, Chennai, 600006, India
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21
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Retinal vasculitis: A framework and proposal for a classification system. Surv Ophthalmol 2020; 66:54-67. [PMID: 32450158 DOI: 10.1016/j.survophthal.2020.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Abstract
Retinal vasculitis, a poorly understood process involving inflammation or ischemia of the retinal vessel wall, may occur in association with a systemic process, although it can also be isolated to the retina. Because of the limited ability to perform histopathological studies on retinal vessels, there is no gold standard for diagnosis. Thus, there is utility in creating a classification system for retinal vasculitis and improving diagnostic strategies for this disease. We provide a framework for understanding retinal vasculitis based on size, location, and etiology. We hope that this information can be implemented in the clinical setting to provide some diagnostic strategies for this often confusing entity.
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22
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Zhao G, Sun H, Zhang T, Liu JX. Copper induce zebrafish retinal developmental defects via triggering stresses and apoptosis. Cell Commun Signal 2020; 18:45. [PMID: 32169084 PMCID: PMC7071659 DOI: 10.1186/s12964-020-00548-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/06/2020] [Indexed: 02/07/2023] Open
Abstract
Background The disorder of copper homeostasis is linked with disease and developmental defects, and excess copper_nanoparticles (CuNPs) and ion (Cu2+) will induce developmental malformation and disease in organisms. However, little knowledge is available regarding its potential regulation mechanisms, and little study links excess copper with retinal developmental malformation and disease. Methods Embryos were stressed with copper (CuNPs and Cu2+), and cell proliferation and apoptosis assays, reactive oxygen species (ROS) and endoplasmic reticulum (ER) signaling detections, and genetic mutants cox17−/− and atp7a−/− application, were used to evaluate copper induced retinal developmental malformation and the underlying genetic and biological regulating mechanisms. Results Copper reduced retinal cells and down-regulated expression of retinal genes, damaged the structures of ER and mitochondria in retinal cells, up-regulated unfold protein responses (UPR) and ROS, and increased apoptosis in copper-stressed retinal cells. The copper induced retinal defects could be significantly neutralized by ROS scavengers reduced Glutathione (GSH) & N-acetylcysteine (NAC) and ER stress inhibitor 4- phenylbutyric acid (PBA). Blocking the transportation of copper to mitochondria, or to trans-Golgi network and to be exported into plasma, by deleting gene cox17 or atp7a, could alleviate retinal developmental defects in embryos under copper stresses. Conclusions This is probably the first report to reveal that copper nanoparticles and ions induce retinal developmental defects via upregulating UPR and ROS, leading to apoptosis in zebrafish embryonic retinal cells. Integrated function of copper transporter (Cox17 and Atp7a) is necessary for copper induced retinal defects. Graphical abstract ![]()
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Affiliation(s)
- Guang Zhao
- College of Fisheries, Key Laboratory of Freshwater Animal Breeding, Ministry of Agriculture, Huazhong Agricultural University, Wuhan, 430070, China
| | - HaoJie Sun
- College of Fisheries, Key Laboratory of Freshwater Animal Breeding, Ministry of Agriculture, Huazhong Agricultural University, Wuhan, 430070, China
| | - Ting Zhang
- College of Fisheries, Key Laboratory of Freshwater Animal Breeding, Ministry of Agriculture, Huazhong Agricultural University, Wuhan, 430070, China
| | - Jing-Xia Liu
- College of Fisheries, Key Laboratory of Freshwater Animal Breeding, Ministry of Agriculture, Huazhong Agricultural University, Wuhan, 430070, China.
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The Role of Optical Coherence Tomography Angiography in the Management of Uveitis. Int Ophthalmol Clin 2018; 56:1-24. [PMID: 27575755 DOI: 10.1097/iio.0000000000000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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24
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Majumder PD, Sitaula RK, Biswas J. Pediatric Eales Disease: An Indian Tertiary Eye Center Experience. J Pediatr Ophthalmol Strabismus 2018; 55:270-274. [PMID: 29709043 DOI: 10.3928/01913913-20180213-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical profiles, etiologies, treatment modalities, and outcomes for Eales disease in patients younger than age 16 years in India. METHODS Retrospective review of medical records of patients with Eales disease who had a minimum 5-year follow-up period. RESULTS A total of 25 eyes of 13 patients were included. Of these 13 patients, 12 (94%) had bilateral Eales disease and 11 (84.6%) were men. Mean patient age was 14.1 years (range: 11 to 16 years). Diminution of vision (36%) was the most common presenting complaint, followed by both diminutions of vision and floaters (32%). Sclerosed vessels were seen in all eyes, and 21 (84%) eyes had active periphlebitis at presentation. Neovascularization elsewhere was seen in 20 (80%) eyes and neovascularization of the optic disc was seen in 1 (4%) eye. Veno-venous shunts were found in 12 (48%) eyes, and 18 (72%) eyes had vitreous hemorrhage. All eyes received photocoagulation; 84.6% of patients received oral steroids, with 7.7% of patients treated with azathioprine and 38.4% treated with anti-tubercular therapy. Vitrectomy was performed in 36% of eyes for non-clearing vitreous hemorrhage and tractional retinal detachment. Vision improved in 7 (28%) eyes, was stable in 12 (48%) eyes, and worsened in 6 (24%) eyes. Recurrence of the disease more than five times during the 5-year follow-up period occurred in 20% of patients. CONCLUSIONS Recurrent vasculitis and vitreous hemorrhage in children should raise the suspicion of pediatric Eales disease. [J Pediatr Ophthalmol Strabismus. 2018;55(4):270-274.].
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25
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The main aspects of retinal vein occlusion etiopathogenisis in young adults. Part I. Neuroretinovasculitis (prothrombotic potential, clinical manifestations). OPHTHALMOLOGY JOURNAL 2018. [DOI: 10.17816/ov11257-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This review is dedicated to the neuroretinovasculitis, which is the leading cause of retinal vein occlusion in young adults. Presumed etiological factors, possible pathogenic mechanisms, and clinical manifestation are analyzed. Advisability of multidisciplinary approach in management and individual approach in treatment of patients with neuroretinovasculitis with secondary retinal vein occlusion are justified.
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Trad S, Saadoun D, Errera MH, Abad S, Bielefeld P, Terrada C, Sène D, Bodaghi B, Sève P. [Ocular tuberculosis]. Rev Med Interne 2018; 39:755-764. [PMID: 29891262 DOI: 10.1016/j.revmed.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
Despite extensive investigations, including the use of Interferon-gamma release assays (IGRA), the diagnosis of intraocular tuberculosis (TB) remains challenging. Ocular evidence of Mycobacterium tuberculosis in low endemic countries for TB is extremely rare, leading mostly to a TB-related ocular inflammation presumptive diagnosis. This present work aims: to highlights the main clinical patterns suggestive of ocular TB; and the latest recommended guidelines for diagnosing ocular TB to clarify interferon-gamma release assay (IGRA) contribution and accuracy to the management of intraocular TB and its diagnosis, in addition to other available diagnostic tools, such as tuberculin skin test, bacteriologic and histologic analysis from intra/extra ocular sample and radiographic investigations; to define the accuracy of these diagnostic tools according to the endemic TB prevalence; and finally to identify therapeutic strategies adapted to the main clinical presentations of ocular TB. Our review of the literature shows that management of suspected ocular TB differs significantly based on whether patients are from high or low TB prevalence countries since accuracy of chest X-ray, tuberculin skin test and IGRA is significantly different. Taking into account these discrepancies, distinct guidelines should be determined for managing patients with suspected ocular TB, taking into consideration home prevalence of TB-patients.
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Affiliation(s)
- S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt France.
| | - D Saadoun
- Centre national de référence maladies autoimmunes systémiques rares, centre national de référence maladies autoinflammatoires et amylose, département de médecine interne et d'immunologie clinique, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France
| | - M H Errera
- Service d'ophthalmologie du centre hospitalier national des Quinze-Vingts et DHU Sight Restore, 75012 Paris, France; Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne assistance publique-hôpitaux de Paris (AP-HP), 125, route de Stalingrad, 93000 Bobigny, France; UMR1125, LI2P, faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, France
| | - P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon Bourgogne 21000 Dijon, France
| | - C Terrada
- Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France; Centre médical Roule-Péretti, 169, avenue Achille-Peretti, 92200, Neuilly-sur-Seine, France
| | - D Sène
- Département de médecine interne, APHP, hôpital Lariboisière, 75010 Paris, France; Université Paris Diderot, 75010 Paris, France
| | - B Bodaghi
- Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France; Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France; Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France
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Tomkins-Netzer O, Leong BCS, Zhang X, Lightman S, McCluskey PJ. Effect of Antituberculous Therapy on Uveitis Associated With Latent Tuberculosis. Am J Ophthalmol 2018; 190:164-170. [PMID: 29604284 DOI: 10.1016/j.ajo.2018.03.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the clinical features of patients with uveitis associated with latent tuberculosis (TB) and examine the effect of anti-TB treatment (ATT) on uveitis outcome. DESIGN Retrospective cohort study. METHODS One hundred ninety-nine eyes of 129 patients diagnosed with uveitis associated with latent TB were evaluated for recurrence of disease following treatment. Eighty-nine of the patients (69%) received ATT and information was gathered retrospectively regarding clinical outcome, vision, and treatment. Outcome measures included best-corrected visual acuity (BCVA) and rate of disease recurrence. RESULTS This study included 89 patients (69%) who received ATT and 40 patients who did not. The uveitis was treated with local and systemic anti-inflammatory and immunosuppressive therapy in all patients. The mean change in BCVA following treatment was 4.5 ± 1.4 letters over the follow-up period, with no difference between eyes of patients receiving ATT and those who did not. Sixty-eight eyes (34.9%) had a recurrence of uveitis (0.64 ± 0.08 recurrences per year), with eyes of patients receiving ATT less likely to develop a recurrence compared to those not receiving ATT (29.5% vs 48.2%, odds ratio 0.47, 95% confidence interval 0.29-0.77, P = .003). Eyes treated with ATT recurred at an estimated median of 120 months, compared with 51 months in eyes with no treatment (P = .005). CONCLUSIONS Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB.
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Affiliation(s)
- Oren Tomkins-Netzer
- UCL/Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom; Technion, Institute of Technology, Bnai Zion Medical Center, Haifa, Israel.
| | | | - Xiaozhe Zhang
- UCL/Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom
| | - Peter J McCluskey
- Save Sight Institute, Sydney Medical School, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia
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Goel N, Kumar V, Arora S, Jain P, Ghosh B. Spectral domain optical coherence tomography evaluation of macular changes in Eales disease. Indian J Ophthalmol 2018; 66:433-438. [PMID: 29480258 PMCID: PMC5859602 DOI: 10.4103/ijo.ijo_845_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT). Methods: A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed. Results: Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 μm) in eyes with macular involvement than those without it (243.8 ± 19.3 μm). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively. Conclusion: While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.
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Affiliation(s)
- Neha Goel
- ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Vinod Kumar
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Arora
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Pooja Jain
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Basudeb Ghosh
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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29
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Kharel Sitaula R, Iyer V, Noronha V, Dutta Majumder P, Biswas J. Role of high-resolution computerized tomography chest in identifying tubercular etiology in patients diagnosed as Eales' disease. J Ophthalmic Inflamm Infect 2017; 7:4. [PMID: 28101723 PMCID: PMC5241593 DOI: 10.1186/s12348-016-0120-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high resolution computerized tomography of chest is an important diagnostic imaging tool to identify any pulmonary tubercular lesion. It's role in Eales' disease to identify any possible association with pulomonary tuberculosis has not been studied earlier. So, this study was conducted to assess the role of high resolution computerized tomography (HRCT) chest in identifying tuberculous etiology in Eales' disease. RESULTS It was a retrospective study conducted at a tertiary care eye hospital in South India between January 2009 and October 2014 were included. A total of 29 diagnosed cases of Eales' (24 male and 5 female) were included in the study. These patients were followed up for a mean period of 739.75 days. Out of them, 13 (44.8%) had bilateral and 16 (55.2%) had unilateral ocular involvement. Eight cases (34.5%) patients had vitreous inflammation. Mantoux test was positive in 12 (41.4%) cases and chest x-ray suggestive of TB was present in four cases (13.8%). QuantiFERON TB gold was positive in 15 (51.7%) and HRCT chest suggestive of TB was positive in 15 (51.7%) case. Out of 15 Eales' cases with positive HRCT scan suggestive of TB, the commonly noted lesions were calcified nodules 34.5%, mediastinal hilar lymphadenopathy 13.8%, parenchymal soft tissue lesions in 3.4%. Five (17.2%) cases underwent pars plana vitrectomy for non resolving vitreous hemorrhage and one case underwent retinal attachment surgery with encirclage. Six patients were started on 9 months regimen of ATT by the chest physician. Final visual outcome improved in 17(40.5%) eyes, maintained in 21(50%) eyes but vision deterioration in 7(16.7%) eyes. CONCLUSIONS HRCT chest is an important diagnostic tool to rule out pulmonary tuberculosis in Eales' disease.
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Affiliation(s)
- Ranju Kharel Sitaula
- Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Vandana Iyer
- Medical Research Foundations, Sankara Nethralaya, 18- College Road, 600006, Chennai, India
| | | | | | - Jyotirmay Biswas
- Director of Uvea and Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, 18- College Road, 600006, Chennai, India.
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Pathanapitoon K, Kunavisarut P, Sirirungsi W, Rothova A. Looking for Ocular Tuberculosis: Prevalence and Clinical Manifestations of Patients with Uveitis and Positive QuantiFERON®-TB Gold Test. Ocul Immunol Inflamm 2016; 26:819-826. [DOI: 10.1080/09273948.2016.1245760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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Ramanujam S, Muthuvel B, Aravind C B, Biswas J, Konerirajapuram NS. The 88-kDa Eales' protein in serum is a complex of haptoglobin, complement C3, and galectin-1 as identified by liquid chromatography coupled mass spectrometry. Proteomics Clin Appl 2016; 11. [PMID: 27739660 DOI: 10.1002/prca.201600068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/25/2016] [Accepted: 10/11/2016] [Indexed: 11/06/2022]
Abstract
PURPOSE Eales' disease (ED), an enigmatic inflammatory disease, affects peripheral retinal veins and thereby vision in males. This study was aimed at identifying and deciphering the role of a novel 88-kDa protein reported in the serum and vitreous of patients with ED. EXPERIMENTAL DESIGN The purified 88-kDa protein was identified by UPLC coupled ESI-QTOF-MS. The identified proteins were quantified in the serum from 20 ED patients and controls (age and sex matched), respectively by ELISA. The interaction of these proteins was studied using co-immunoprecipitation, western blot, and MS analyses. N-glycosylation of protein was observed by MS and lectin blot. RESULTS The 88-kDa protein was identified to be a complex of haptoglobin, complement C3, and galectin-1. ELISA results showed a 1.5-fold increase in levels of haptoglobin (p = 0.008), with level of complement C3 unaltered and 1.2-fold decreased serum galectin-1 levels (p = 0.003) in ED patients compared to controls. Co-immunoprecipitation illustrated the interaction between haptoglobin and complement C3. Reduced sialylation and increased β-1, 6-N-acetyl-glucosamine branched N-glycans were observed in haptoglobin of ED patients. CONCLUSION The 88-kDa protein, a complex of haptoglobin, complement C3, and galectin-1, may play a potential role in ED pathogenesis while levels galectin-1 and haptoglobin may serve as potential biomarker of ED.
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Affiliation(s)
- Saravanan Ramanujam
- R. S. Mehta Jain Department of Biochemistry and Cell Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Department of Biochemistry, Tamil Nadu Dr MGR Medical University, Chennai, India
| | - Bharathselvi Muthuvel
- R. S. Mehta Jain Department of Biochemistry and Cell Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Department of Biological Sciences, BITS, Pilani, Rajasthan, India
| | - Babu Aravind C
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Jyothirmay Biswas
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - N Sulochana Konerirajapuram
- R. S. Mehta Jain Department of Biochemistry and Cell Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Mendonça MD, Guedes M, Matias G, Costa J, Viana-Baptista M. Steroid-responsive painful ophthalmoplegia: Tolosa–Hunt syndrome, Eales disease, or both? Cephalalgia 2016; 37:191-194. [DOI: 10.1177/0333102416631282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Tolosa–Hunt syndrome (THS) is one of the most common ‘benign’ causes of painful ophthalmoplegia. Diagnosis is based on clinical and imaging findings and the exclusion of other causes because there is no specific biomarker for the syndrome. Eales disease, an idiopathic inflammatory venous disease that primarily affects the eye, can also affect the central (as stroke or myelitis) and peripheral nervous system. Case report We report the case of a 32-year-old woman with a subacute left ophthalmoplegia and evidence of a gadolinium-enhanced lesion suggesting an inflammatory granuloma that resolved within 48 hours after treatment with steroids. A diagnosis of THS was considered at this time. On a follow-up ophthalmological examination, a diagnosis of Eales disease with involvement of the left eye was made. The patient was treated successfully. Conclusion Eales disease could be a cause of painful ophthalmoplegia and may mimic THS. Long-term follow-up of patients diagnosed with THS may be necessary to exclude other diagnoses.
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Affiliation(s)
- Marcelo D Mendonça
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marta Guedes
- Ophthalmology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Gonçalo Matias
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Costa
- Ophthalmology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viana-Baptista
- Neurology Department, Hospital Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Abstract
The syndrome of recurrent vitreous hemorrhages in young men was described for the first time by Henry Eales in 1880. The association with a clinical manifestation of ocular inflammation was reported 5years later. Eales disease affects young adults who present with ischemic retinal vasculitis, with the peripheral retina most commonly affected. Most cases have been reported in South Asia. Although the etiology of this abnormality is unknown, it may be related to an immune sensitivity to Mycobacterium tuberculosis antigens. Its pathogenesis is related to extensive ischemia that affects the retina, secondary to an obliterative retinal vasculopathy with release of angiogenic factors of the VEGF type. Involvement of the retina is the hallmark of the disease, which manifests as follows: periphlebitis, retinal capillary ischemia most often affecting the periphery with secondary proliferative retinopathy and retinal and/or papillary neovascularization, recurrent vitreous hemorrhages and tractional retinal detachment. These complications are potentially blinding. The natural history of Eales disease varies, with temporary or permanent remission in some cases and continuous progression in others. Progression is often bilateral, which necessitates regular follow-up. The treatment of Eales disease depends on the stage of the disease and is not well defined. Observation only, pars plana vitrectomy surgery and/or intravitreal injections of anti-VEGF are recommended in cases of vitreous hemorrhage, associated with corticosteroids when retinal vasculitis is present. Laser pan-retinal photocoagulation is necessary when neovascularization is present.
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Vodopivec I, Oakley DH, Perugino CA, Venna N, Hedley-Whyte ET, Stone JH. A 44-year-old man with eye, kidney, and brain dysfunction. Ann Neurol 2016; 79:507-19. [PMID: 26691497 DOI: 10.1002/ana.24583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/28/2022]
Abstract
Retinal vasculopathy with cerebral leukodystrophy (RVCL) is a rare, autosomal dominant condition caused by mutations of TREX1 (3-prime repair exonuclease-1). The phenotypic expressions range from isolated retinal involvement to varying degrees of retinopathy, cerebral infarction with calcium depositions, nephropathy, and hepatopathy. We report a case of RVCL caused by a novel TREX1 mutation. This patient's multisystem presentation, retinal involvement interpreted as "retinal vasculitis," and improvement of neuroimaging abnormalities with dexamethasone led to the accepted diagnosis of a rheumatologic disorder resembling Behçet disease. Clinicians should consider RVCL in any patient with retinal capillary obliterations associated with tumefactive brain lesions or nephropathy.
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Affiliation(s)
- Ivana Vodopivec
- Harvard Medical School, Boston, MA.,Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Derek H Oakley
- Harvard Medical School, Boston, MA.,Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, MA
| | - Cory A Perugino
- Harvard Medical School, Boston, MA.,Rheumatology Unit, Massachusetts General Hospital, Boston, MA
| | - Nagagopal Venna
- Harvard Medical School, Boston, MA.,Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - E Tessa Hedley-Whyte
- Harvard Medical School, Boston, MA.,Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, MA
| | - John H Stone
- Harvard Medical School, Boston, MA.,Rheumatology Unit, Massachusetts General Hospital, Boston, MA
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Gupta B, Agrawal R, Swampillai AJ, Lim RHF, Kee A, Gunasekaran D, Pavesio C. Ocular manifestations of tuberculosis: an update. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1152887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Patel AK, Newcomb CW, Liesegang TL, Pujari SS, Suhler EB, Thorne JE, Foster CS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Artornsombudh P, Kothari S, Kempen JH. Risk of Retinal Neovascularization in Cases of Uveitis. Ophthalmology 2016; 123:646-54. [PMID: 26686964 PMCID: PMC4766036 DOI: 10.1016/j.ophtha.2015.10.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/24/2015] [Accepted: 10/28/2015] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate the risk of and risk factors for retinal neovascularization (NV) in cases of uveitis. DESIGN Retrospective cohort study. PARTICIPANTS Patients with uveitis at 4 US academic ocular inflammation subspecialty practices. METHODS Data were ascertained by standardized chart review. Prevalence data analysis used logistic regression. Incidence data analysis used survival analysis with time-updated covariates where appropriate. MAIN OUTCOME MEASURES Prevalence and incidence of NV. RESULTS Among uveitic eyes of 8931 patients presenting for initial evaluation, 106 of 13,810 eyes had NV (prevalence = 0.77%, 95% confidence interval [CI], 0.60-0.90). Eighty-eight more eyes developed NV over 26,465 eye-years (incidence, 0.33%/eye-year; 95% CI, 0.27-0.41). Factors associated with incident NV include age <35 years compared with >35 years (adjusted hazard ratio [aHR], 2.4; 95% CI, 1.5-3.9), current cigarette smoking (aHR, 1.9; 95% CI, 1.1-3.4), and systemic lupus erythematosus (aHR, 3.5, 95% CI, 1.1-11). Recent diagnosis of uveitis was associated with an increased incidence of NV (compared with patients diagnosed >5 years ago, aHR, 2.4 [95% CI, 1.1-5.0] and aHR, 2.6 [95% CI, 1.2-6.0] for diagnosis within <1 year vs. 1-5 years, respectively). Compared with anterior uveitis, intermediate uveitis (aHR, 3.1; 95% CI, 1.5-6.6), posterior uveitis (aHR, 5.2; 95% CI, 2.5-11), and panuveitis (aHR, 4.3; 95% CI, 2.0-9.3) were associated with a similar degree of increased NV incidence. Active (aHR, 2.1, 95% CI, 1.2-3.7) and slightly active (aHR, 2.4, 95% CI, 1.3-4.4) inflammation were associated with an increased incidence of NV compared with inactive inflammation. Neovascularization incidence also was increased with retinal vascular occlusions (aHR, 10, 95% CI, 3.0-33), retinal vascular sheathing (aHR, 2.6, 95% CI, 1.4-4.9), and exudative retinal detachment (aHR, 4.1, 95% CI, 1.3-13). Diabetes mellitus was associated with a somewhat increased incidence of retinal NV (aHR, 2.3, 95% CI, 1.1-4.9), and systemic hypertension (aHR 1.5, 95% CI, 0.89-2.4) was associated with nonsignificantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus. CONCLUSIONS Retinal NV is a rare complication of uveitis, which occurs more frequently in younger patients, smokers, and those with intermediate/posterior/panuveitis, systemic vasculopathy, retinal vascular disease, or active inflammation. Inflammation and retinal NV likely are linked; additional studies are needed to further elucidate this connection.
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Affiliation(s)
- Apurva K Patel
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Retina Northwest P.C., Portland, Oregon
| | - Craig W Newcomb
- Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania
| | - Teresa L Liesegang
- Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon
| | - Siddharth S Pujari
- Om Eye Care Hospital, Belgaum, Karnataka, India; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts
| | - Eric B Suhler
- Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace A Levy-Clarke
- Devers Eye Institute, Portland, Oregon; The Tampa Bay Uveitis Center, Safety Harbor, Florida
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | - James T Rosenbaum
- Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Internal Medicine, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Devers Eye Institute, Portland, Oregon
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | - Pichaporn Artornsombudh
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Division of Ophthalmology Somdech Phra Pinklao Hospital, Naval Medical Department, Royal Thai Navy, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Srishti Kothari
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts
| | - John H Kempen
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Ocular Inflammation Service University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania.
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Gomathy Narayanan I, Saravanan R, Bharathselvi M, Biswas J, Sulochana KN. Localization of Human Copper Transporter 1 in the Eye and its Role in Eales Disease. Ocul Immunol Inflamm 2016; 24:678-683. [PMID: 26807780 DOI: 10.3109/09273948.2015.1071404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Copper (Cu) is an essential trace element; however excess is toxic due to the pro-oxidant activity. Increased intracellular Cu levels in vitreous and monocyte were reported in Eales disease (ED) previously. Copper transporter1 (CTR1) maintains copper homeostasis and hence, we studied the presence of CTR1 in ocular tissues and its role in ED. METHODS Real-time PCR, ELISA and Western blot experiments were performed in donor eyeballs tissues and PBMCs isolated from controls and ED. Immunostaining were performed for CTR1 from donor eyeballs and one ED case. RESULTS CTR1 protein was expressed in all ocular tissues. PBMCs showed a three-fold increase in CTR1 protein in ED when compared with controls. Retinal sections from ED patients also revealed increased CTR1 protein expression in retinal tissues, compared with control. CONCLUSIONS CTR1 was significantly increased in ED when compared with controls, indicating its considerable role in the ED pathology.
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Affiliation(s)
- Iyer Gomathy Narayanan
- a RS Mehta Jain Department of Biochemistry and Cell Biology , Vision Research Foundation, Sankara Nethralaya , Chennai , India.,b Birla Institute of Technology and Science , Pilani , India
| | - R Saravanan
- c Tamil Nadu Dr. MGR Medical University , Chennai , India
| | - M Bharathselvi
- a RS Mehta Jain Department of Biochemistry and Cell Biology , Vision Research Foundation, Sankara Nethralaya , Chennai , India.,b Birla Institute of Technology and Science , Pilani , India
| | - Jyotirmay Biswas
- a RS Mehta Jain Department of Biochemistry and Cell Biology , Vision Research Foundation, Sankara Nethralaya , Chennai , India.,d Uveitis Clinic , Medical Research Foundation , Chennai , India
| | - K N Sulochana
- a RS Mehta Jain Department of Biochemistry and Cell Biology , Vision Research Foundation, Sankara Nethralaya , Chennai , India
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Gupta V, Shoughy SS, Mahajan S, Khairallah M, Rosenbaum JT, Curi A, Tabbara KF. Clinics of Ocular Tuberculosis. Ocul Immunol Inflamm 2015; 23:14-24. [DOI: 10.3109/09273948.2014.986582] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The use of a vascular endothelial growth factor inhibitor (ranibizumab) in macular edema due to eales disease. Retin Cases Brief Rep 2014; 6:122-4. [PMID: 25390730 DOI: 10.1097/icb.0b013e31821608e8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the results of intravitreal use of ranibizumab in a patient with macular edema due to Eales disease. METHOD This was an open-label, Phase 1, 6-month study of the safety and efficacy of intravitreally administered ranibizumab in patients with macular edema due to Eales disease. A single patient was eligible for the study during the 2 years of recruitment. She received 3 monthly intravitreal injections of 0.5 mg of ranibizumab for 3 months. At each of her monthly visits during the 6-month study, she was evaluated with a full ocular examination and optical coherence tomography imaging of the macula. Primary outcome measure was change in optical coherence tomography central subfield thickness at 6 months. RESULTS The central macular thickness as measured on optical coherence tomography reduced from 269 μm at baseline to 186 μm at 3 months. This reduction was transient with subsequent increase to 262 μm at the conclusion of the study at 6 months. CONCLUSION Ranibizumab use led to transient resolution of macular edema at 3 months; however, this reduction in edema was not sustained.
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La Distia Nora R, van Velthoven ME, ten Dam-van Loon NH, Misotten T, Bakker M, van Hagen MP, Rothova A. Clinical manifestations of patients with intraocular inflammation and positive QuantiFERON-TB gold in-tube test in a country nonendemic for tuberculosis. Am J Ophthalmol 2014; 157:754-61. [PMID: 24262781 DOI: 10.1016/j.ajo.2013.11.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate clinical manifestations of patients with uveitis and scleritis of unknown origin and positive QuantiFERON-TB Gold In-Tube test (quantiferon) in a country not endemic for tuberculosis. DESIGN Multicenter retrospective cohort study. METHODS Retrospective review of the clinical, laboratory, and imaging data of 77 patients. Main outcome measures consisted of ocular and systemic features as well as results of laboratory examinations. RESULTS Out of all, 60 of 71 (85%) were living for at least 6 months in tuberculosis-endemic regions. Location of uveitis was variable; posterior uveitis (29/77; 38%) was the most frequent. Two clinical entities were commonly noted: retinal occlusive vasculitis (21/77; 27%) and serpiginoid choroiditis (11/77; 14%). Antituberculosis treatment was completed in 32 patients; 29 of them (91%) achieved complete remission. Mean quantiferon level was 7.5 U/mL; 71% had values above 2 U/mL and 41% above 10 U/mL. We observed no associations between quantiferon levels and clinical and/or imaging features. Previous tuberculosis infection was diagnosed in 5 of 77 patients (6.5%), while hilar/mediastinal lymphadenopathy was found in 25 of 76 patients (33%). Of these, 12 were consistent with the diagnosis of sarcoidosis, 9 were typical for (prior) tuberculosis, and 4 were compatible with both diagnoses. CONCLUSIONS Ocular features of patients with idiopathic uveitis and positive quantiferon were diverse, but retinal occlusive vasculitis and serpiginoid choroiditis were common. The quantiferon levels were usually highly elevated and 33% of patients exhibited lymphadenopathy, suggesting frequently the diagnosis of sarcoidosis. Ocular inflammation reacted favorably to antituberculosis treatment, although only a small minority had documented (prior) tuberculosis.
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Apinyawasisuk S, Rothova A, Kunavisarut P, Pathanapitoon K. Clinical features and etiology of retinal vasculitis in Northern Thailand. Indian J Ophthalmol 2013; 61:739-42. [PMID: 24178403 PMCID: PMC3917393 DOI: 10.4103/0301-4738.120216] [Citation(s) in RCA: 11] [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: 02/01/2013] [Accepted: 07/02/2013] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report on the clinical features and etiology of patients with retinal vasculitis (RV). MATERIALS AND METHODS We reviewed medical records of 47 patients (75 affected eyes) diagnosed with RV. Clinical presentations, ocular complications, associated systemic diseases, and treatment regimens were registered. RESULTS Etiology of RV included infectious causes in 10/47, (21%) while an association with systemic and/or ocular non-infectious disorders was noted in 22/47 (47%). Eales' disease and Behcet's disease represented the most common clinical entities in non-infectious group while tuberculosis-associated RV was diagnosed in 6/10 (60%) among those with infectious disorders. RV was bilateral in 28/47 (60%) patients. Retinal veins were most commonly affected (72%, 34/47). Involvement of arteries was present in 12/47 (25%) and was associated with viral infections and Behcet's disease. Ocular complications developed in 60/75 (80%) eyes. The most common complications were elevated intraocular pressure and/or glaucoma (33/75, 44%). Retinal detachment, vitreous hemorrhage, and cystoid macular edema developed in similar percentages (15%). CONCLUSIONS RV in Thailand manifested mostly in male patients, was typically bilateral and involved mostly veins. Involvement of arteries was observed in patients with viral infections and Behcet's disease. Tuberculosis was the most common infectious cause.
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Affiliation(s)
- Supanut Apinyawasisuk
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aniki Rothova
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Patricio MS, Portelinha J, Passarinho MP, Guedes ME. Tubercular retinal vasculitis. BMJ Case Rep 2013; 2013:bcr-2013-008924. [PMID: 23737572 DOI: 10.1136/bcr-2013-008924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intraocular tuberculosis (TB) infection can have different clinical manifestations including retinal vasculitis. It more frequently involves the veins and is associated with retina haemorrhages and neovascularisation. The diagnosis may be difficult and presumptive being based on clinical findings and evidence of systemic TB infection. The authors present a case of a 61-year-old woman with blurred vision and floaters in her left eye for 6 years, associated with recurrent vitreous haemorrahages. A temporal branch retinal vein occlusion was presumed. Four years later her right eye was also involved. Her best-corrected visual acuity (BCVA) was 20/50 in both eyes. Fundoscopic examination showed bilateral venous occlusion with vascular staining on fluorescein angiography suggestive of vasculitis secondary to Eales Disease (ED). The interferon gamma release assay (IGRA-QuantiFERON-TB Gold) was positive and antituberculosis treatment (ATT) was started. Her final BCVA was 20/20 bilaterally, without recurrences over a follow-up of 15 months. The use of ATT is likely to reduce recurrent vitreous haemorrhages and eliminate future recurrences.
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Abstract
PURPOSE OF REVIEW Despite recent downtrends, tuberculosis remains a worldwide public health concern. This review provides an update on recent demographic data, clinical and experimental data, and diagnostic modalities. RECENT FINDINGS Quantitative PCR showing mycobacterial load in intraocular fluids may have an emerging role in the diagnosis of ocular tuberculosis when used in combination with ophthalmic features of tuberculosis. Recent investigations in porcine models of ocular tuberculosis have provided valuable insight into the microbiologic, histologic, and clinical features of Mycobacterium tuberculosis infection of the choroid. Differentiating features between sarcoidosis and tuberculosis include tuberculin skin test status, the presence of ocular surface disease, and the anatomic relationship between vasculitis and choroiditis. SUMMARY The diagnosis of presumed ocular tuberculosis remains a clinical challenge with currently available diagnostic modalities. Although newer interferon-γ release assays can distinguish exposure to M. tuberculosis from the Bacille-Calmette-Guérin vaccine strain, they currently lack the specificity to distinguish between latent tuberculosis infection and active tuberculosis. Continued improvement in the currently available molecular diagnostic techniques including quantitative PCR may be valuable in our ability to establish an earlier etiologic diagnosis and institute appropriate antimycobacterial therapy.
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Cai SJ, Su G, Li H, Xie B, Luo JM. Profiling of human leukocyte antigens in Eales disease and tuberculosis. Int Ophthalmol 2013; 33:475-9. [DOI: 10.1007/s10792-013-9718-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 01/09/2013] [Indexed: 11/29/2022]
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Singh R, Toor P, Parchand S, Sharma K, Gupta V, Gupta A. Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales' disease. Ocul Immunol Inflamm 2012; 20:153-7. [PMID: 22486260 DOI: 10.3109/09273948.2012.658134] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report mycobacterial load in the vitreous of patients labeled as having Eales' disease. METHODS Eighty-eight patients were prospectively enrolled into 3 groups: 28 patients with so-called Eales' disease (group A); 30 positive controls with specific uveitis syndromes (group B), and 30 negative controls (group C). The undiluted vitreous humor samples were collected and subjected to real-time PCR assay for MPB64 gene of Mycobacterium tuberculosis (MTB) and load quantified. RESULTS Sixteen (57.14%) vitreous fluid samples in group A; 1 sample in group B, and none of the samples in group C were positive for MTB genome from the vitreous. The copies of MTB genomes in the positive samples in group A were 1.52 × 10(4) to 1.01 × 10(6). CONCLUSION MTB genome was demonstrated in more than 50% of vitreous fluid samples with significant bacillary load, indicating that half of patients with so-called Eales' disease are indeed cases of tubercular vasculitis.
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Affiliation(s)
- Rishiraj Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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