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Baquet-Walscheid K, Rath T, Heiligenhaus A. Ocular Involvement in Selected Rheumatic Diseases - Clinical Manifestation in Adulthood. Klin Monbl Augenheilkd 2024; 241:626-632. [PMID: 38574680 DOI: 10.1055/a-2239-0412] [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: 04/06/2024]
Abstract
Ocular manifestations of rheumatic diseases are common and contribute significantly to the morbidity and reduced quality of life of affected patients. Knowledge of typical clinical manifestations is important for the rheumatologist in order to support the reference of patients with corresponding symptoms for ophthalmological consultation at an early stage of disease, or to initiate regular screening examinations (e.g. in patients with Behçet's syndrome). Conversely, a (possibly urgent) rheumatological assessment is crucial for certain ophthalmological diseases, in order not to overlook a (possibly fatal) systemic associated disease. Patients with rheumatic or inflammatory ocular diseases should always be informed by the treating physician about possible symptoms of other organ manifestations, in order to avoid a delayed diagnosis. "Classic" associations for uveitis are (HLA-B27-associated) spondyloarthritis and acute anterior uveitis, as well as retinal vasculitis with or without panuveitis and Behçet's syndrome. In patients with rheumatoid arthritis or ANCA-associated vasculitis, however, scleritis (with or without peripheral ulcerative keratitis) typically occurs, but a variety of other findings are also possible. Close interdisciplinary collaboration, particularly regarding therapeutic decisions, is crucial to ensuring a good prognosis for the patient.
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Affiliation(s)
- Karoline Baquet-Walscheid
- Augenzentrum am St. Franziskus-Hospital Münster, Deutschland
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
| | - Thomas Rath
- Rheumatologie, Fachklinik Bad Bentheim, Deutschland
| | - Arnd Heiligenhaus
- Augenzentrum am St. Franziskus-Hospital Münster, Deutschland
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
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Guo T, Jin Y, Zhou M, Lei B, Huang L, Chen S, Xue K. Quantitative evaluation of retinal and choroidal vascularity in systemic lupus erythematosus by SS-OCT/OCTA. Graefes Arch Clin Exp Ophthalmol 2023; 261:3385-3393. [PMID: 37367994 DOI: 10.1007/s00417-023-06155-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/19/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE To evaluate changes in retinal and choroidal vascularity using swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) in patients with systemic lupus erythematosus (SLE). METHODS In this prospective, cross-sectional study, 48 SLE patients and 40 healthy control (group HC) participants were included. The SLE patients were divided into two subgroups: patients with SLE with no ocular disease (group I) and patients with SLE with signs of retinopathy (group II). The superficial vessel density (SVD), deep vessel density (DVD), peripapillary retinal vessel densities (pRVD), choroidal thickness (ChT), and choroidal vascularity including total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were measured using SS-OCT/OCTA. Physical and ophthalmic examinations as well as the assessments of immunological markers were performed. The results of SS-OCT/OCTA were compared between group I, group II, and group HC, while the correlations among the parameters were analyzed. RESULTS The SVD, DVD, and pRVD were found to be significantly lower in SLE patients than group HC, especially in SLE patients with signs of retinopathy. ChT were found to be significantly higher in group II. CVI was positively correlated with SVD and DVD in the fovea, as well as the foveal and parafoveal thickness. A significant decrease in SVD and DVD in the fovea among subjects positive for anti-dsDNA antibodies was noted. CONCLUSIONS The application of OCTA in the evaluation of microvasculature may be useful in subclinical changes. Retinal microvascular density decreased in patients with SLE with greater severity of SLE. Disturbed retinal circulation was related to SLE disease activity, disease duration, CVI, and being positive for anti-dsDNA antibodies. The study results also suggest that SLE with signs of retinopathy may affect the choroid with increases in LA, SA, TCA, and ChT.
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Affiliation(s)
- Tingting Guo
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Yihua Jin
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Boya Lei
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Linlin Huang
- Department of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Sheng Chen
- Department of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Kang Xue
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.
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Ferreira A, Vieira RJ, Furtado MJ, Lume M, Andrade JP, Menéres P. Detection of subclinical microvascular changes in systemic lupus erythematous using optical coherence tomography angiography: A systematic review and meta-analysis. Surv Ophthalmol 2023; 68:1115-1128. [PMID: 37544614 DOI: 10.1016/j.survophthal.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune connective tissue disease that affects several vascular territories. We sought to assess the role of optical coherence tomography angiography in detecting subclinical microvascular alterations in SLE patients. PubMed, Scopus, and Web of Science databases were systematically searched until January 21, 2023. Studies using optical coherence tomography angiography as a primary diagnostic method to evaluate the macular microvasculature of SLE patients versus healthy controls were included. Primary outcomes were macular vessel density and foveal zone parameters. A meta-analysis was performed using a random-effects model. Of 301 screened abstracts, 15 were found eligible, enrolling 1,246 eyes from 1,013 patients. SLE patients presented a reduction of macular vessel density at both plexuses in all zones (whole scan, fovea, parafovea, and perifovea), and of foveal density compared with healthy controls. No differences were found at foveal avascular zone parameters. SLE patients presented a reduction of macular vessel density without signs or symptoms of SLE ocular involvement. Optical coherence tomography angiography application for the assessment of subclinical microvascular changes needs to be elucidated with longitudinal studies.
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Affiliation(s)
- André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine of University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Rafael José Vieira
- Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria João Furtado
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal; ICBAS - Instituto de Ciência Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Miguel Lume
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José P Andrade
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine of University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal; ICBAS - Instituto de Ciência Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Chen X, Shi X, Li J, Wang W, Wang C, Cheng Q, Xie Y, Xue J, Du Y. Bilateral central retinal artery occlusion as a presenting manifestation of systemic lupus erythematosus: a case-based review. Rheumatol Int 2023; 43:1947-1956. [PMID: 37318546 DOI: 10.1007/s00296-023-05365-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Central retinal artery occlusion (CRAO) is an ophthalmic emergency that typically results in permanent vision damage even despite vigorous treatment. In this article, we describe a case of acute vaso-occlusive retinopathy that presented as the primary manifestation of SLE in the absence of elevated levels of APLAs. After treatment with intravenous steroids, immunoglobulin, intrathecal injection of dexamethasone, plasma exchange, and intravenous cyclophosphamide, SLE was well controlled in the patient, but her vision was permanently lost in the left eye. We also go over a brief review of the currently available literature on retinal vaso-occlusive disease present in SLE. The pathology mechanism of CRAO is related to immune complex-mediated "vasculitis", which is typically associated with neuropsychiatric lupus. However, the literature review identified antiphospholipid antibody syndrome (APS) in only 6 of 19 patients, indicating that other mechanisms besides APS are associated with CRAO. Systemic immunosuppression and anticoagulants are required for the treatment of this severe vaso-occlusive retinopathy. Early recognition and aggressive intervention may prevent severe loss of vision.
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Affiliation(s)
- Xin Chen
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Rheumatology and Immunology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Xiaowei Shi
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Rheumatology and Immunology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Jinyu Li
- Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wenwen Wang
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Cheng
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yifan Xie
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Xue
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
| | - Yan Du
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Chu YC, Yu KH, Lin WT, Wang WT, Chen DP. Finding the Common Single-Nucleotide Polymorphisms in Three Autoimmune Diseases and Exploring Their Bio-Function by Using a Reporter Assay. Biomedicines 2023; 11:2426. [PMID: 37760867 PMCID: PMC10526089 DOI: 10.3390/biomedicines11092426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
In clinical practice, it is found that autoimmune thyroid disease often additionally occurs with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). In addition, several studies showed that eye-specific autoimmune diseases may have a strong relationship with systemic autoimmune diseases. We focused on Graves' disease (GD) with ocular conditions, also known as Graves' ophthalmopathy (GO), trying to find out the potential genetic background related to GO, RA, and SLE. There were 40 GO cases and 40 healthy controls enrolled in this study. The association between single-nucleotide polymorphisms (SNPs) of the co-stimulatory molecule genes and GO was analyzed using a chi-square test. It showed that rs11571315, rs733618, rs4553808, rs11571316, rs16840252, and rs11571319 of CTLA4, rs3181098 of CD28, rs36084323 and rs10204525 of PDCD1, and rs11889352 and rs4675379 of ICOS were significantly associated with GO based on genotype analysis and/or allele analysis (p < 0.05). After summarizing the GO data and the previously published SLE and RA data, it was found that rs11571315, rs733618, rs4553808, rs16840252, rs11571319, and rs36084323 were shared in these three diseases. Furthermore, the bio-function was confirmed by dual-luciferase reporter assay. It was shown that rs733618 T > C and rs4553808 A > G significantly decreased the transcriptional activity (both p < 0.001). This study is the first to confirm that these three diseases share genetically predisposing factors, and our results support the proposal that rs733618 T > C and rs4553808 A > G have bio-functional effects on the transcriptional activity of the CTLA4 gene.
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Affiliation(s)
- Yen-Chang Chu
- Department of Ophthalmology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Kuang-Hui Yu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Wei-Tzu Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (W.-T.L.); (W.-T.W.)
| | - Wei-Ting Wang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (W.-T.L.); (W.-T.W.)
| | - Ding-Ping Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (W.-T.L.); (W.-T.W.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Neto EDS, Neto TSR, Signorelli F, Balbi GGM, Higashi AH, Monteiro MLR, Bonfá E, Andrade DCO, Zacharias LC. Ocular retinal findings in asymptomatic patients with antiphospholipid syndrome secondary to systemic lupus erythematosus. Clin Rheumatol 2023:10.1007/s10067-023-06613-9. [PMID: 37126136 DOI: 10.1007/s10067-023-06613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
The objective is to perform a multimodal ophthalmological evaluation, including optical coherence angiography (OCTA), asymptomatic APS secondary to SLE (APS/SLE), and compare to SLE patients and control group (CG). We performed a complete structural/functional ophthalmological evaluation using OCTA/microperimetry exam in all participants. One hundred fifty eyes/75 asymptomatic subjects [APS/SLE (n = 25), SLE (n = 25), and CG (n = 25)] were included. Ophthalmologic abnormalities occurred in 9 (36%) APS/SLE, 11 (44%) SLE, and none of CG (p < 0.001). The most common retinal finding was Drusen-like deposits (DLDs) exclusively in APS/SLE and SLE (16% vs. 24%, p = 0.75) whereas severe changes occurred solely in APS/SLE [2 paracentral acute middle maculopathy (PAMM) and 1 homonymous quadrantanopsia]. A trend of higher frequency of antiphospholipid antibody (aPL) triple positivity (100% vs. 16%, p = 0.05) and higher mean values of adjusted Global Antiphospholipid Syndrome Score (aGAPSS) (14 ± 0 vs. 9.69 ± 3.44, p = 0.09) was observed in APS/SLE with PAMM vs. those without this complication. We identified that ophthalmologic retinal abnormalities occurred in more than 1/4 of asymptomatic APS/SLE and SLE. DLDs are the most frequent with similar frequencies in both conditions whereas PAMM occurred exclusively in APS/SLE patients. The possible association of the latter condition with aPL triple positivity and high aGAPSS suggests these two conditions may underlie the retinal maculopathy. Our findings in asymptomatic patients reinforce the need for early surveillance in these patients. Key Points • Retinal abnormalities occur in more than 1/4 of asymptomatic APS/SLE and SLE patients. • The occurrence of PAMM is possibly associated with APS and DLDs with SLE. • Presence of aPL triple positivity and high aGAPSS seem to be risk factors for PAMM.
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Affiliation(s)
- Epitácio D S Neto
- Division of Ophthalmology, Faculty of Medicine, Sao Paulo University, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Taurino S R Neto
- Division of Ophthalmology, Faculty of Medicine, Sao Paulo University, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Flávio Signorelli
- Division of Rheumatology, Faculty of Medicine, Sao Paulo University, São Paulo, Brazil
| | - Gustavo G M Balbi
- Division of Rheumatology, Faculty of Medicine, Sao Paulo University, São Paulo, Brazil
| | - Alex H Higashi
- Division of Ophthalmology, Faculty of Medicine, Sao Paulo University, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Mário Luiz R Monteiro
- Division of Ophthalmology, Faculty of Medicine, Sao Paulo University, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology, Faculty of Medicine, Sao Paulo University, São Paulo, Brazil
| | - Danieli C O Andrade
- Division of Rheumatology, Faculty of Medicine, Sao Paulo University, São Paulo, Brazil
| | - Leandro C Zacharias
- Division of Ophthalmology, Faculty of Medicine, Sao Paulo University, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, 01246-903, Brazil
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Tseng CH, Tai YH, Hong CT, Dai YX, Chen TJ, Cherng YG, Lai SC. Systemic Lupus Erythematosus and Risk of Dry Eye Disease and Corneal Surface Damage: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3776. [PMID: 36900786 PMCID: PMC10001508 DOI: 10.3390/ijerph20053776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Systemic lupus erythematosus (SLE) potentially involves multiple parts of the ocular system, including the lacrimal glands and the cornea. The present study sought to assess the risk of aqueous-deficient dry eye disease (DED) and corneal surface damage in patients with SLE. We conducted a population-based cohort study using Taiwan's National Health Insurance research database to compare the risks of DED and corneal surface damage between subjects with and without SLE. Proportional hazard regression analyses were used to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the study outcomes. The propensity score matching procedure generated 5083 matched pairs with 78,817 person-years of follow-up for analyses. The incidence of DED was 31.90 and 7.66 per 1000 person-years in patients with and without SLE, respectively. After adjusting for covariates, SLE was significantly associated with DED (aHR: 3.30, 95% CI: 2.88-3.78, p < 0.0001) and secondary Sjögren's syndrome (aHR: 9.03, 95% CI: 6.86-11.88, p < 0.0001). Subgroup analyses demonstrated that the increased risk of DED was augmented among patients with age < 65 years and female sex. In addition, patients with SLE had a higher risk of corneal surface damage (aHR: 1.81, 95% CI: 1.35-2.41, p < 0.0001) compared to control subjects, including recurrent corneal erosion (aHR: 2.98, 95% CI: 1.63-5.46, p = 0.0004) and corneal scar (aHR: 2.23, 95% CI: 1.08-4.61, p = 0.0302). In this 12-year nationwide cohort study, we found that SLE was associated with increased risks of DED and corneal surface damage. Regular ophthalmology surveillance should be considered to prevent sight-threatening sequelae among patients with SLE.
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Affiliation(s)
- Ching-Han Tseng
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu 31064, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shih-Chung Lai
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
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Park JB, Kim K, Kang MS, Kim ES, Yu SY. Subretinal fluid in a patient with systemic lupus erythematosus. Taiwan J Ophthalmol 2022; 12:472-476. [PMID: 36660116 PMCID: PMC9843574 DOI: 10.4103/2211-5056.362602] [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: 09/30/2022] [Accepted: 11/01/2022] [Indexed: 12/11/2022] Open
Abstract
A 28-year-old male patient presented to the outpatient department with visual disturbance in both eyes. The patient had a history of stage IV lupus nephritis that was diagnosed at the age of 14 years and had undergone hemodialysis at the age of 23 years. After he started hemodialysis, the systemic condition was well controlled, and systemic steroids were not used. His best-corrected visual acuity (BCVA) was 20/200 in the right eye and 20/100 in the left eye. Funduscopic examination revealed shallow subretinal fluid (SRF) and serous retinal detachment in both eyes. The first impression of this patient was central serous chorioretinopathy. However, the late phase of fluorescein angiography (FA) demonstrated multiple subretinal leakages, and the late phase of indocyanine green angiography showed choroidal vascular engorgement and multiple hyperfluorescent plaques in both eyes. Systemic lupus erythematosus showed moderate activity according to the results of the systemic evaluation. Based on the clinical examination, lupus choroidopathy was suspected in both eyes. Half-fluence photodynamic therapy (PDT) was administered to both eyes rather than systemic steroids because the patient was systemically stable. Three months after PDT, no SRF was observed in either eye. In addition, multiple subretinal leakages on FA were reduced compared to those before treatment. There was no recurrence of SRF for 4 years after PDT, and the final BCVA was 20/70 in the right eye and 20/40 in the left eye. During this time, numerous hypoautofluorescence spots appeared adjacent to the major retinal vessels in fundus autofluorescence.
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Affiliation(s)
- Jong Beom Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Min Seok Kang
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea,Address for correspondence: Prof. Seung-Young Yu, Department of Ophthalmology, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea. E-mail:
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Liu R, Wang Y, Xia Q, Xu T, Han T, Cai S, Luo SL, Wu R, Shao Y. Retinal thickness and microvascular alterations in the diagnosis of systemic lupus erythematosus: a new approach. Quant Imaging Med Surg 2022; 12:823-837. [PMID: 34993121 DOI: 10.21037/qims-21-359] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the differences of retinal thickness (RT) and superficial vascular density (SVD) between patients with systemic lupus erythematosus (SLE) and healthy controls using optical coherence tomography angiography (OCTA). METHODS Individuals with SLE (n=12; 24 eyes) and healthy controls (n=12; 24 eyes) were recruited to this study. The study protocol was in accordance with the tenets of the Declaration of Helsinki (as revised in 2013). The monocular best-corrected visual acuity (BCVA) was determined using a Snellen eye chart. Each image was segmented into 9 early treatment diabetic retinopathy study subregions, within which the macular RT and SVD were measured by OCTA. The vascular perfusion area as a percentage of the measured area was considered to be the vascular density. RESULTS The mean age of the SLE group was 33.80±9.49 years, and the mean age of the control group was 33.20±9.41 years. The mean duration of SLE was 4.33±2.67 years. The BCVA was significantly different between the SLE and control groups (0.17±0.20 vs. 0.05±0.07, respectively; P=0.021). In the SLE group, inner RT was reduced in the outer superior and temporal regions and full RT was reduced in the outer temporal region, compared with the control group (P<0.05). In the outer temporal region, the area under the receiver operating characteristic curve (AUC) for the inner RT was 0.805 [95% confidence interval (CI): 0.674 to 0.935], and the full RT was 0.828 (95% CI: 0.701 to 0.955). Thinning of RT was negatively correlated with erythrocyte sedimentation rate (ESR) in the inner retina at the outer temporal and outer superior regions and the full retina at the outer temporal region (P<0.05). The SVD was significantly lower in SLE participants than in controls in the central region, all 4 inner quadrants, and 4 outer quadrants (P<0.05). In the SLE group, SVD was positively correlated with inner RT in the outer superior region, inner RT, and full RT in the outer temporal region (P<0.05). CONCLUSIONS Variations in RT within the macular area may affect visual acuity. The OCTA measurement of RT may be a potential marker for diagnosis of SLE and an indicator of its inflammatory activity.
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Affiliation(s)
- Ren Liu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Wang
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiang Xia
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tian Xu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Han
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuang Cai
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shui-Lin Luo
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui Wu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
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10
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Shi WQ, Han T, Liu R, Xia Q, Xu T, Wang Y, Cai S, Luo SL, Shao Y, Wu R. Retinal Microvasculature and Conjunctival Vessel Alterations in Patients With Systemic Lupus Erythematosus-An Optical Coherence Tomography Angiography Study. Front Med (Lausanne) 2021; 8:724283. [PMID: 34926488 PMCID: PMC8674305 DOI: 10.3389/fmed.2021.724283] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the conjunctival and fundus retinal vessel density in patients with systemic lupus erythematosus (SLE) with optical coherence tomography angiography (OCTA), and to investigate the relationship between vessel density and clinical indicators. Methods: Twelve patients with SLE (24 eyes) and 12 healthy controls (24 eyes) were recruited. OCTA was used to examine the superficial retina layer (SRL) and deep retina layer (DRL) in the macular retina and conjunctival capillary plexus of each eye. We calculated the density of the temporal conjunctival vessels, fundus microvascular (MIR), macrovascular (MAR) and total MIR(TMI) and compared the results in both groups. We used annular partitioning (C1–C6), hemispheric quadrants, and Early Treatment Diabetic Retinopathy Study partitioning (ETDRS) to analyze changes in the retinal vascular density. Correlation analysis was used to investigate the association between blood capillary density and clinical indicators. Results: OCTA results showed significant differences in the conjunctival microvascular density (p < 0.001). There was no significant difference in MIR, TMI, and MAR in the superficial layers between the SLE and healthy group (p > 0.05). The DRL and DTMI (Deeper TMI) densities were decreased in the macular regions of SLE patients (p < 0.05). In the hemispheric segmentation analysis, the superficial MIR was significantly decreased in the IL (inferior left) region of the SLE patients (p < 0.05), and the deep MIR in the IR (inferior right) region was significantly reduced (p < 0.05). In the ETDRS partitioning analysis, the superficial MIR in the inferior, right, and left subdivisions was significantly decreased in the SLE patients (p < 0.05). In the circular segmentation analysis, the deep MIR in the C1 and C3 regions was significantly reduced in SLE patients (p < 0.05), while the superficial MIR density was decreased only in the C3 region (p < 0.05). The conjunctival vascular density was negatively correlated with the STMI (Superficial TMI) (r = −0.5107; p = 0.0108) and DTMI (r = −0.9418, p < 0.0001). There was no significant correlation between vascular density and SLEDAI-2k (Systemic Lupus Erythematosus Disease Activity Index−2000) (P > 0.05). Conclusion: Clinically, patients with SLE and patients suspected of SLE should receive OCTA examination in a comprehensive eye examination to detect changes in ocular microcirculation at an early stage.
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Affiliation(s)
- Wen-Qing Shi
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Han
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ren Liu
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiang Xia
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tian Xu
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Wang
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuang Cai
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shui-Lin Luo
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui Wu
- Department of Immunology and Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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An Q, Gao J, Liu L, Liao R, Shuai Z. Analysis of Foveal Microvascular Abnormalities in Patients with Systemic Lupus Erythematosus Using Optical Coherence Tomography Angiography. Ocul Immunol Inflamm 2021; 29:1392-1397. [PMID: 32286113 DOI: 10.1080/09273948.2020.1735452] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To analyze the abnormalities of foveal microvasculature in patients with systemic lupus erythematosus (SLE).Methods: A cross-sectional study of 41 eyes of patients diagnosed with SLE and 40 eyes of healthy controls. Sections measuring 6 mm×6 mm centered on the fovea were obtained using optical coherence tomography angiography (OCTA).Results: The area and perimeter of foveal avascular zone (FAZ) in SLE patients were greater than those in controls (both p < .05). The parafoveal vessel densities in the deep capillary plexus (DCP) of SLE patients were significantly decreased than those in controls (p < .001). There was a negative correlation between SLE disease activity index and parafoveal vessel density in DCP (p < .05).Conclusion: Enlargement of the FAZ and decline of the parafoveal vessel density of DCP were revealed by OCTA in patients with SLE. Moreover, a negative correlation between parafoveal vessel density in DCP and disease activity index was detected in SLE patients.
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Affiliation(s)
- Qi An
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jian Gao
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lun Liu
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rongfeng Liao
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zongwen Shuai
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Anitua E, Muruzabal F, Pino A, Prado R, Azkargorta M, Elortza F, Merayo-Lloves J. Proteomic Characterization of Plasma Rich in Growth Factors and Undiluted Autologous Serum. Int J Mol Sci 2021; 22:ijms222212176. [PMID: 34830053 PMCID: PMC8618701 DOI: 10.3390/ijms222212176] [Citation(s) in RCA: 3] [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: 09/23/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
Over the last three decades, there has been special interest in developing drugs that mimic the characteristics of natural tears for use it in the treatment of several ocular surface disorders. Interestingly, the composition of blood plasma is very similar to tears. Therefore, different blood-derived products like autologous serum (AS) and plasma rich in growth factors (PRGF) have been developed for the treatment of diverse ocular pathologies. However, scarce studies have been carried out to analyze the differences between both types of blood-derived products. In the present study, blood from three healthy donors was drawn and processed to obtain AS and PRGF eye drops. Then, human corneal stromal keratocytes (HK) were treated with PRGF or undiluted AS. Proteomic analysis was carried out to analyze and characterize the differential protein profiles between PRGF and AS, and the differentially expressed proteins in HK cells after PRGF and AS treatment. The results obtained in the present study show that undiluted AS induces the activation of different pathways related to an inflammatory, angiogenic, oxidative stress and scarring response in HK cells regarding PRGF. These results suggest that PRGF could be a better alternative than AS for the treatment of ocular surface disorders.
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Affiliation(s)
- Eduardo Anitua
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- Correspondence:
| | - Francisco Muruzabal
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
| | - Ander Pino
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
| | - Roberto Prado
- BTI—Biotechnology Institute, 01007 Vitoria, Spain; (F.M.); (A.P.); (R.P.)
- University Institute for Regenerative Medicine and Oral Implantology—UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
| | - Mikel Azkargorta
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed-ISCIII, Bizkaia Science and Technology Park, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Felix Elortza
- Proteomics Platform, CIC bioGUNE, CIBERehd, ProteoRed-ISCIII, Bizkaia Science and Technology Park, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Jesús Merayo-Lloves
- Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain;
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Mahmoud MSED, Hamid MA, Abdelkader MF. Anterior Segment Optical Coherence Tomography of Tear Film and Cornea in Systemic Lupus Erythematosus Patients. Clin Ophthalmol 2021; 15:3391-3399. [PMID: 34408395 PMCID: PMC8367206 DOI: 10.2147/opth.s323673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study tear film and corneal thickness measurements in systemic lupus erythematosus (SLE) patients compared to age-matched controls using anterior segment optical coherence tomography (AS-OCT). Methods This was a cross-sectional study. Study participants were divided into 3 groups: Group A: SLE patients with clinical dry eye, Group B: SLE patients without clinical dry eye and Group C: healthy controls. The lower tear meniscus parameters measured using AS-OCT were tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA). The central corneal and corneal epithelial thickness were automatically calculated. Results The study included 40 eyes in Group A, 60 in Group B, and 100 in Group C. Mean age was 26.9±6.6 years for Group A, 27.6±7.3 years for Group B and 35.7±9.2 years for Group C (p= 0.06). All subjects were females except for 1 male patient in Group A. Mean TMH, TMA and TMD in Group C were 487.7±185.6 µm, 0.068±0.040 mm2, and 341.2±99.1 µm, respectively, which was significantly higher compared to Group A (225.5±27.9 µm, 0.018±0.004 mm2 and 171.9±26.0 µm, respectively, all p < 0.001) and Group B (395.4±118.8 µm, p < 0.001; 0.05±0.04 mm2, p=0.016 and 280.6±93.4 µm, p < 0.001, respectively). Group B eyes also had significantly higher parameters compared to Group A (all p < 0.001). Mean corneal and epithelial thickness in Group C were 501.6±37.5 µm and 53.3±4.5 µm, respectively, which was significantly higher compared to Group A (496.1±24.1 µm, p=0.044 and 49.5±3.5 µm, p < 0.001, respectively) and Group B (504.2±22.03 µm, p=0.046 and 47.5±5.6 µm, p < 0.001, respectively). Group B eyes also had a significantly higher corneal thickness (p=0.031) and epithelial thickness (p=0.011) compared to Group A. Conclusion We demonstrated significant reduction of tear meniscus dimensions, central corneal thickness and epithelial thickness in SLE patients compared to age-matched controls using AS-OCT.
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Affiliation(s)
| | - Mohamed A Hamid
- Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt
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Uribe-Reina P, Muñoz-Ortiz J, Cifuentes-González C, Reyes-Guanes J, Terreros-Dorado JP, Zambrano-Romero W, López-Rojas C, Mantilla-Sylvain F, Mantilla-Hernández RD, de-la-Torre A. Ocular Manifestations in Colombian Patients with Systemic Rheumatologic Diseases. Clin Ophthalmol 2021; 15:2787-2802. [PMID: 34234401 PMCID: PMC8254180 DOI: 10.2147/opth.s306621] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To establish the prevalence of ocular involvement in a Colombian population with rheumatologic diseases. DESIGN Observational cross-sectional study. METHODS We included a probabilistic sample size of 797 patients who attended a rheumatologic disease center in Bogotá, Colombia. Statistical analysis with descriptive measures and Chi-square independence test between rheumatologic diseases and ophthalmological symptoms and diseases was performed. RESULTS Eighty-four percent of the population were women, and the mean age was 54.61± 15.64 years. The most common condition was rheumatoid arthritis (33.37%), followed by fibromyalgia (22.71%), Sjögren Syndrome (19.72%), and systemic lupus erythematosus (9.91%). Almost 7% of the patients presented polyautoimmunity. Thirty-five percent of the patients reported one or more ophthalmological symptoms, being dry eye sensation the most common (30.86%), followed by ocular pain (2.76%), red-eye, and decreased visual acuity (both 2.63%). Similarly, 21.45% of the patients presented one or more ophthalmological diagnoses, being keratoconjunctivitis sicca the most common (15.93%), followed by cataract, uveitis (1.38% each), and scleritis (1.25%). CONCLUSION Almost a third of the patients reported any ocular involvement. It is crucial to be aware of the most common ophthalmic manifestations among the different rheumatologic diseases in our population, to offer early specialist referral and timely treatment.
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Affiliation(s)
- Pilar Uribe-Reina
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Juan Pablo Terreros-Dorado
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Zambrano-Romero
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Fundación Para la Investigación en Dermatología y Reumatología (FUNINDERMA), Bogotá, Colombia
| | - Carolina López-Rojas
- Escuela Barraquer, Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Fabien Mantilla-Sylvain
- Fundación Para la Investigación en Dermatología y Reumatología (FUNINDERMA), Bogotá, Colombia
| | | | - Alejandra de-la-Torre
- Neuroscience Research Group “NeURos”, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Abstract
This article provides an overview of rare orbital diseases. Congenital
malformations, inflammatory diseases, benign and malignant neoplasias are
described. Although it represents a relatively small area of the body the
orbit contains multiple different tissues. Therefore, a great variety of
diseases can be found within the orbital space. That is the reason, why both
the completeness and the level of detail in the description of particular
diseases must be somewhat limited. Nevertheless, clinical manifestations,
important aspects of diagnosis, treatment strategies, and, when specific
data are available, the prognosis are described. The authors tried to
highlight the most characteristic aspects of the different diseases to
describe their relevant aspects in spite of the brevity of the
subsections.
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Affiliation(s)
- Ulrich Kisser
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Halle/S. (Klinikdirektor: Prof. Dr. med. A. Viestenz)
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
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Ophthalmic manifestations in patients with collagen vascular disorders: a hospital-based retrospective observational study. Int Ophthalmol 2021; 41:2765-2775. [PMID: 33830371 DOI: 10.1007/s10792-021-01833-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/29/2021] [Indexed: 01/19/2023]
Abstract
AIM To study frequency and characteristics of ocular manifestations in Indian patients with collagen vascular disorders. METHODS The medical records of 73 patients (Males: Females 16:57) aged between 22 and 78 years (mean ± SD = 43.5 ± 12.9 years) with collagen vascular diseases were analyzed retrospectively for demography, subtypes of collagen vascular disease, and findings of complete ophthalmic examination. RESULTS Lupus erythematosus (LE) in 39(53.4%, (SLE 18, DLE 21), systemic sclerosis in 27(37%), dermatomyositis in 5(6.8%), and primary Sjögren's syndrome in 2(2.7%) patients, respectively, were observed. Only 35(47.9%) patients had ocular manifestations. In LE keratoconjunctivitis sicca (n = 6), keratitis (n = 5), severe blepharitis (n = 3), retinopathy (n = 2), and optic neuritis in one patient, respectively, were major ocular manifestations. Major abnormalities occurring in systemic sclerosis included restricted eyelid mobility of variable severity (n = 8), eyelid telangiectasia (n = 5), keratoconjunctivitis sicca (n = 6), cataract (n = 5), shallow fornices (n = 4), conjunctival surface disease (n = 4), and uveitis, keratitis, episcleritis in one patient each, respectively. One patient with dermatomyositis had heliotrope rash. Two patients with primary Sjögren's syndrome had keratoconjunctivitis sicca. CONCLUSIONS The study shows that LE frequently presented with keratoconjunctivitis sicca, retinopathy, and optic neuritis. Systemic sclerosis commonly develops eyelid immobility, blepharitis and telangiectasia, ocular surface disease and keratoconjunctivitis sicca, corneal abnormalities, and uveitis. A comprehensive ocular evaluation is imperative for early detection and management particularly of ocular surface disease, uveitis, and retinopathy to prevent potential sight-threatening complications. Limitations include retrospective study design and small number of patients for stratification.
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The effect of long-term hydroxychloroquine use on the corneal endothelium in patients with systemic lupus erythematosus. Int Ophthalmol 2020; 41:937-943. [PMID: 33196914 DOI: 10.1007/s10792-020-01649-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effect of long-term effects of hydroxychloroquine (HCQ) use on the corneal endothelium in patients with systemic lupus erythematosus (SLE). METHODS The study included 30 eyes of 15 patients who used HCQ for at least five years and were followed up in the rheumatology clinic for SLE and 29 eyes of 15 patients newly diagnosed with SLE who had not taken any medication. All patients underwent complete ophthalmologic examinations, central corneal thickness measurements, endothelial cell counts and endothelial morphological examinations by specular microscopy. RESULTS The mean age was 41.25 ± 6.89 years in group 1 and 41.81 ± 5.78 years in group 2 (p = 0.737). The mean corneal endothelial cell density was 2662 ± 184 cells/mm2 in group 1 and 2649 ± 315 cells/mm2 in group 2 (p = 0.843). The percentage of cell hexagonality was 46.6 ± 11.8% in group 1 and 48.7 ± 13.8% in group 2 (p = 0.625). A difference was noted in endothelial cell variation in both groups, at 36.7 ± 6.9% in group 1 and 39.9 ± 6.2% in group 2 (p = 0.057) but not statistically significant. No difference was observed between the two groups in terms of central corneal thickness. The duration of HCQ use was negatively correlated with hexagonality (r = -0.564, p = 0.001) CONCLUSION: Long-term use of HCQ in SLE patients had no negative effect on endothelial cell density and cell variation, but a negative correlation existed between the duration of HCQ usage and hexagonality.
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Ish S, Sharma D, Verma R, Kumari S, Garkoti H. Bilateral central retinal artery occlusion - A catastrophic presentation of systemic lupus erythematosus. Oman J Ophthalmol 2020; 13:149-151. [PMID: 33542604 PMCID: PMC7852415 DOI: 10.4103/ojo.ojo_133_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 03/28/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder. Here, we present a rare case of a middle-aged male, diagnosed with SLE, manifesting as bilateral central retinal artery occlusion (CRAO). Severe ocular complications such as CRAO may occur during an acute flare or even early in the disease process. It is important to recognize this potentially devastating complication.
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Affiliation(s)
- Somya Ish
- Department of Ophthalmology, PGIMER and Dr. RML Hospital, New Delhi, India
| | - Deepa Sharma
- Department of Ophthalmology, PGIMER and Dr. RML Hospital, New Delhi, India
| | - Rahul Verma
- Department of Ophthalmology, PGIMER and Dr. RML Hospital, New Delhi, India
| | - Sudha Kumari
- Department of Ophthalmology, PGIMER and Dr. RML Hospital, New Delhi, India
| | - Himanshu Garkoti
- Department of Ophthalmology, PGIMER and Dr. RML Hospital, New Delhi, India
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Bilateral simultaneous Central Retinal Artery Occlusion (CRAO) in a patient with Systemic Lupus Erythematosus (SLE). Am J Ophthalmol Case Rep 2020; 19:100833. [PMID: 32904183 PMCID: PMC7451415 DOI: 10.1016/j.ajoc.2020.100833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/20/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective of the study is to report a rare case of severe vaso-occlusive retinopathy with bilateral simultaneous Central Retinal Artery Occlusion (CRAO) in a patient with Systemic Lupus Erythematosus (SLE). OBSERVATIONS A female patient aged 22 years, presented with a sudden onset of painless diminution of vision in both eyes for three weeks. She had systemic features of SLE for six months at the time of the study. A diagnosis of bilateral CRAO was made after an examination of the fundus and by ruling out other causes of severe vaso-occlusion based on clinical and angiogram findings. Her antiphospholipid antibody (APLA) levels were normal. The visual prognosis was poor even after treatment with intravenous steroids and panretinal photocoagulation. CONCLUSION AND IMPORTANCE This case highlights the importance of bilateral CRAO as an initial presentation of severe systemic disease. This case demonstrates that despite apparent normal APLA levels, a state of hypercoagulability can exist in SLE patients. In addition, it demonstrates that severe vaso-occlusive complications such as CRAO, which results in blindness, can also develop in a patient with apparently well-controlled SLE. Therefore, it is important to take cognizance of this sight-threatening complication in SLE patients at initial presentation. A holistic approach to management, both systemic and ocular, is required to prevent sight-threatening complications from vaso-occlusion. Early and aggressive intervention can be beneficial in the prevention of severe visual loss.
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Chan AJ, Rai AS, Lake S. Orbital myositis in systemic lupus erythematosus: A case report and literature review. Eur J Rheumatol 2020; 7:135-137. [PMID: 32809933 DOI: 10.5152/eurjrheum.2020.19217] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/08/2020] [Indexed: 11/22/2022] Open
Abstract
Orbital myositis is a rare manifestation of systemic lupus erythematosus (SLE). Herein, we report a case of orbital myositis in a patient with SLE, along with a literature review. A 45-year-old female patient presented with pain in the right eye, chemosis, proptosis, and limited abduction. Computed tomography of her orbits revealed thickening of her right lateral rectus muscle. She had no other systemic symptoms. There was no elevation in the biomarkers of inflammation or disease activity. She was treated with high-dose steroids, and her symptoms resolved rapidly. It is important to maintain a high index of suspicion for orbital myositis in patients with SLE even when there are no systemic disease activities, such that early treatment can be initiated. It is also important to rule out other mimickers such as orbital cellulitis and thyroid eye disease.
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Affiliation(s)
- Alvita J Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amandeep S Rai
- Department of Ophthalmology & Vision Sciences, University of Toronto, Ontario, Canada
| | - Shirley Lake
- Sunnybrook Research Institute, Holland Musculoskeletal Program, Toronto, Ontario, Canada
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21
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Assessment of superficial and deep retinal vessel density in systemic lupus erythematosus patients using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2020; 258:1261-1268. [PMID: 32162113 DOI: 10.1007/s00417-020-04626-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/13/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the retinal microvascular density in SLE patients using optical coherence tomography angiography (OCTA) and to correlate vascular density with the disease activity and damage risk. METHODS Twenty eyes of 20 SLE patients were compared with 20 eyes of normal subjects. The retinal capillary plexuses were examined by OCTA. The disease activity and damage risk were evaluated by the SLEDAI-2 K and SLICC/ACR SDI scoring systems. RESULTS No difference was found between SLE patients' central foveal thickness (CFT) and foveal avascular zone (FAZ) area and the normal (P > 0.05). SLE patients had slightly lower superficial vessel densities than normal in the upper and lower macular regions (P < 0.05), sparing the middle sectors (P > 0.05). In the deep plexus, vessel density loss was detected in all sectors (P < 0.001). The vessel density in 300-μm-wide region around the FAZ (FD-300) and the acircularity index (AI) were affected in the SLE in comparison to the normal group (P < 0.05). No significant correlation was found between the SLEDAI-2 k and the retinal vessel density in either layer, while the SLICC/SDI had moderate inverse correlation with vessel density in some sectors (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the deep capillary plexus had high sensitivity and specificity for detecting vascular damage in SLE patients. CONCLUSIONS OCTA permits noninvasive quantitative assessment of retinal vessel density in SLE, allowing early detection of altered retinal circulation. Vessel density could be included in future assessment of SLE activity and damage scores.
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Unique changes in the retinal microvasculature reveal subclinical retinal impairment in patients with systemic lupus erythematosus. Microvasc Res 2019; 129:103957. [PMID: 31733303 DOI: 10.1016/j.mvr.2019.103957] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine the changes of the microvasculature and microstructure in the inner intra-retinal layers in systemic lupus erythematosus (SLE) patients without lupus retinopathy (LR). METHODS Thirty-two SLE patients (58 eyes) without LR (NLR), 14 patients (22 eyes) with LR and 50 healthy subjects (50 eyes) were enrolled. Spectral domain optical coherence tomography equipped with Angiovue was used to obtain three-dimensional retinal thickness maps and microvascular images of the superficial and deep retinal capillary plexuses (SRCP/DRCP) around the macula. Quantitative analyses were performed using a custom automated algorithm. Disease activity of patients was assessed using the SLE disease activity index (SLEDAI). RESULTS Retinal capillary skeleton density of the SRCP in SLE patients without LR was significantly lower than the controls in almost all regions, which further decreased in the LR group (P < .05). No significant changes were evident in DRCP of the NLR group (P > .05). The inner retina in the LR group was significantly thinner than the controls in most regions, though there were only a few regions that were different between the NLR and the control groups (P < .05). There were significant differences of the SLEDAI scores between the two SLE groups. CONCLUSION Significantly lower density in SRCP and regional thinning in inner retina were observed in the SLE patients without clinical fundus changes. OCT equipped with Angiovue might be useful in evaluating the microvascular and microstructural disorders of the inner retinal layers in SLE patients, which may contribute a quantitative approach to the early diagnosis and progression of LR.
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Cunningham ET, Tabbara KF, Zierhut M. Systemic Lupus Erythematosus and the Eye. Ocul Immunol Inflamm 2019; 26:1143-1145. [PMID: 30452316 DOI: 10.1080/09273948.2018.1539589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c UCSF School of Medicine , The Francis I. Proctor Foundation , San Francisco , California , USA
| | - Khalid F Tabbara
- d The Eye Center , The Eye Foundation for Research in Ophthalmology , Riyadh , Saudi Arabia.,e Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Manfred Zierhut
- f Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
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24
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Conigliaro P, Cesareo M, Chimenti MS, Triggianese P, Canofari C, Barbato C, Giannini C, Salandri AG, Nucci C, Perricone R. Take a look at the eyes in Systemic Lupus Erythematosus: A novel point of view. Autoimmun Rev 2019; 18:247-254. [DOI: 10.1016/j.autrev.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/20/2018] [Indexed: 01/17/2023]
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25
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Lin WV, Saumur M, Al-Mohtaseb Z. Scleritis, keratitis, and orbital cellulitis: isolated ocular manifestation of systemic lupus erythematosus. Lupus 2018; 27:1985-1988. [PMID: 30092731 DOI: 10.1177/0961203318792365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic autoimmune diseases are associated with ocular inflammatory conditions such as episcleritis, scleritis, keratitis, and uveitis. However, ocular manifestations have been reported to correlate with the extent of systemic disease. We present a patient with scleritis, keratitis, and orbital cellulitis, as the isolated manifestation of systemic lupus erythematosus (SLE). No microbial etiology was identified and antibiotics did not produce clinical improvement. The patient improved significantly with steroids and disease-modifying antirheumatic drugs. Although ocular inflammation has been previously remarked in SLE of systemic severity, in this case there were no other organs with SLE involvement. We briefly discuss the ocular manifestations of SLE, which can involve all segments of the eye, including cornea, sclera, retina, uvea, optic nerve, and orbit.
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Affiliation(s)
- W V Lin
- 1 School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - M Saumur
- 2 Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
- 3 Ben Taub General Hospital, Harris Health System, Houston, Texas, USA
| | - Z Al-Mohtaseb
- 2 Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
- 3 Ben Taub General Hospital, Harris Health System, Houston, Texas, USA
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26
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de Andrade FA, Guimarães Moreira Balbi G, Bortoloti de Azevedo LG, Provenzano Sá G, Vieira de Moraes Junior H, Mendes Klumb E, Abramino Levy R. Neuro-ophthalmologic manifestations in systemic lupus erythematosus. Lupus 2017; 26:522-528. [DOI: 10.1177/0961203316683265] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect different ocular structures, such as cornea, conjunctiva, episclera, sclera, uveal tract, retina, optic nerve and vessels. Neuro-ophthalmologic manifestations in SLE include different degrees of involvement of retina, choroid and optic nerve. Retinal changes are one of the most common ocular involvements and are frequently used as clinical criteria for activity, even if isolated. Studies show that up to 29% of patients with active SLE manifest retinal disease. The exact prevalence of choroidal disease is unknown, but is thought to be less common than retinopathy, due to under-diagnosis. Optic nerve disease, represented by optic neuritis and anterior/posterior ischaemic optic neuropathy, affects approximately 1% of SLE patients. These ocular manifestations have been associated with neurologic flares, antiphospholipid antibodies, nephropathy, and increased mortality. The aim of this paper is to review the different aspects of neuro-ophthalmologic involvement in SLE. Since these manifestations are frequent and potentially severe, a multi-professional team approach is needed to investigate properly and provide early aggressive treatment in order to avoid visual sequelae.
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Affiliation(s)
- F A de Andrade
- Ophthalmologist, PGCM, Universidade do Estado do Rio de Janeiro, Brazil
| | - G Guimarães Moreira Balbi
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Brazil
| | - L G Bortoloti de Azevedo
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Brazil
| | - G Provenzano Sá
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Brazil
| | - H Vieira de Moraes Junior
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Brazil
| | - E Mendes Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Brazil
| | - R Abramino Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Brazil
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Hasanreisoglu M, Gulpinar Ikiz GD, Kucuk H, Varan O, Ozdek S. Acute lupus choroidopathy: multimodal imaging and differential diagnosis from central serous chorioretinopathy. Int Ophthalmol 2017; 38:369-374. [PMID: 28050729 DOI: 10.1007/s10792-016-0433-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/27/2016] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Systemic lupus erythematosus (SLE) is a thoroughly examined multi-organ disease whose common ocular complications are also well documented. However, SLE choroidopathy, being a rare ocular complication, is needed to be better understood, in order to make the differential diagnosis from clinical conditions such as central serous chorioretinopathy and provide adequate prompt treatment. OBJECTIVE To provide a clear understanding for the clinical course of SLE choroidopathy by the help of enhanced depth imaging optical coherence tomography, fluorescein angiography, and indocyanine angiography. DESIGN The study is designed as a case presentation, consisting of the physical examination results and the data gathered by the relevant screening methods for each visit, applied by the same ophthalmologists and technicians. SETTING The visits were organized as same day examinations as needed, in a university hospital which works as a referral center.
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Affiliation(s)
- Murat Hasanreisoglu
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey.
| | | | - Hamit Kucuk
- Department of Rheumatology, School of Medicine, Gazi University, Ankara, Turkey
| | - Ozkan Varan
- Department of Rheumatology, School of Medicine, Gazi University, Ankara, Turkey
| | - Sengul Ozdek
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey
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28
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Monov S, Hristova R, Dacheva R, Toncheva R, Shumnalieva R, Shoumnalieva-Ivanova V, Monova D. Acute necrotizing retinal vasculitis as onset of systemic lupus erythematosus: A case report. Medicine (Baltimore) 2017; 96:e5754. [PMID: 28079801 PMCID: PMC5266163 DOI: 10.1097/md.0000000000005754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by autoantibody production, complement activation, and deposition of immune complexes in tissues and organs. SLE can involve any region of the visual system. Although ocular manifestations are not part of the classification criteria for SLE, they can be observed in up to one-third of the patients with SLE. They are rarely reported at the time of disease onset. Retinal vasculitis is usually associated with active generalized disease. Due to its low frequency, we report a case of acute necrotizing retinal vasculitis as onset of SLE. PATIENT CONCERNS AND DIAGNOSIS A 25-year-old white female was referred to the rheumatology clinic with gradually and rapid deterioration of the vision due to abnormal vessel permeability in the right fundus with edema along the vessels, occlusion of arterial branches in the middle periphery with leakage of the dye in these areas and indentical but less prominent changes with cotton wool spots in the papillomacular area and extensive hemorrhages in the left eye. The onset of malar rash, arthralgias and positive antinuclear, anti-double stranded DNA, anti-ribosomal P and anti-β2 glycoprotein I antibodies with decreased C4 complement levels, as well as the positive lupus-band test confirmed the diagnosis of SLE. INTERVENTIONS Aggressive immunomodulating therapy with high-dose methylprednisolone, intravenous immunoglobulin, and cyclophosphamide was used for suppression of the disease activity followed by azathioprine as maintaince therapy. OUTCOMES Substantial improvement and partial resorption of the vasculitic changes, including central retinal artery and vein, was achieved prominently in the left eye. The study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from the patient. Because of this, there is no need to conduct special ethic review and the ethical approval is not necessary. LESSONS Inclusion of ocular manifestations among the classification criteria for SLE would enable earlier establishment of the diagnosis and therapeutic interventions in some instances of SLE.
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Affiliation(s)
- Simeon Monov
- Clinic of Rheumatology, University Hospital “St. Iv. Rilski,” Department of Internal Medicine
| | - Ruska Hristova
- Clinic of Ophthalmology, University Hospital “TsaritsaYoanna,”
| | - Rositza Dacheva
- Clinic of Rheumatology, University Hospital “St. Iv. Rilski,” Department of Internal Medicine
| | - Reni Toncheva
- Ophthalmology Outpatient Clinic, University Hospital “St. Iv. Rilski,”
| | - Russka Shumnalieva
- Clinic of Rheumatology, University Hospital “St. Iv. Rilski,” Department of Internal Medicine
| | | | - Daniela Monova
- Department of Internal Medicine, Medical Institute-MID, Medical University, Sofia, Bulgaria
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29
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Wuthisiri W, Lai YH, Capasso J, Blidner M, Salz D, Kruger E, Levin AV. Autoimmune retinopathy associated with systemic lupus erythematosus: A diagnostic dilemma. Taiwan J Ophthalmol 2017; 7:172-176. [PMID: 29034159 PMCID: PMC5637385 DOI: 10.4103/tjo.tjo_40_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Visual loss in systemic lupus erythematosus (SLE) due to autoimmune retinopathy (AIR) is rare and easily misdiagnosed as hydroxychloroquine retinopathy. We report the rare clinical presentation of severe visual loss in a patient with SLE due to nonparaneoplastic AIR as differentiated from hydroxychloroquine toxicity. A 70-year-old female diagnosed and treated for lupus for 17 years and had been taking hydroxychloroquine for 15 years. Over the past 2 years, she developed progressive peripheral visual loss oculus uterque which rapidly advanced in the latter 6 months. Hydroxychloroquine toxicity was initially suspected, but diagnostic testing revealed a retinal degeneration. Antiretinal autoantibody testing using Western blot analysis revealed autoantibodies against 44-kDa, 46-kDa (anti-enolase), and 68-kDa proteins. Visual acuity improved in the first 6 months of treatment with mycophenolate mofetil. Our case suggests that AIR should be considered in the differential diagnosis of rapid, severe visual loss in patients with hydroxychloroquine treatment.
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Affiliation(s)
- Wadakarn Wuthisiri
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yu-Hung Lai
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jenina Capasso
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, USA
| | - Martin Blidner
- The Arthritis Center of NEPA, Wilkes-Barre, Philadelphia, PA, USA
| | - David Salz
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, USA.,Thomas Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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30
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Peponis V, Kyttaris VC, Tyradellis C, Vergados I, Sitaras NM. Ocular manifestations of systemic lupus erythematosus: a clinical review. Lupus 2016; 15:3-12. [PMID: 16482739 DOI: 10.1191/0961203306lu2250rr] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although the eye itself is regarded an ‘immune-privileged’ organ, systemic lupus erythematosus (SLE) can affect every ocular structure, leading, if left untreated, to significant visual loss or even blindness. Since ocular inflammation in SLE can antedate the diagnosis of the systemic disease and cause significant morbidity, prompt diagnosis and treatment of the underlying systemic autoimmune disease is imperative.
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Affiliation(s)
- V Peponis
- Department of Ophthalmology, General Hospital of Piraeus Tzaneion, Greece
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31
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Duru N, Altinkaynak H, Uysal BS, Duru Z, Can ME, Erten S, Yuksel N, Kalkan Akcay E. Increased Tear Film Osmolarity in Systemic Lupus Erythematosus. Semin Ophthalmol 2016; 32:582-587. [DOI: 10.3109/08820538.2015.1131838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Necati Duru
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Hasan Altinkaynak
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Betul Seher Uysal
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Zeynep Duru
- Department of Ophthalmology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mehmet Erol Can
- Department of Ophthalmology, Keçiören Education and Research Hospital, Ankara, Turkey
| | - Sukran Erten
- Department of Rheumatology, Yıldırım Beyazıt University, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Nilay Yuksel
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Emine Kalkan Akcay
- Department of Ophthalmology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
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32
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Kharel Sitaula R, Shah DN, Singh D. Role of lupus retinopathy in systemic lupus erythematosus. J Ophthalmic Inflamm Infect 2016; 6:15. [PMID: 27174124 PMCID: PMC4864796 DOI: 10.1186/s12348-016-0081-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background Lupus retinopathy is one of the most common vision-threatening complications of systemic lupus erythematosus. The presence of lupus retinopathy is an accurate guide to the presence of active systemic disease activity. Results A prospective study was conducted looking at 91 established cases of systemic lupus erythematosus to evaluate lupus retinopathy. The patients were divided into two groups according to the presence or absence of lupus retinopathy, and a comparison of clinical and laboratory findings between two groups was done. Among 91 SLE patients, 5 were male and 86 were female; of which, 85 (93.4 %) were outpatients and 6 (6.6 %) were inpatients. Lupus retinopathy was found in 13 eyes of 11 cases out of 91 cases (12.1 %). Among these 13 eyes with lupus retinopathy, 61.5 % had mild type of lupus retinopathy, 15.4 % had moderate type, and 23.1 % had severe lupus retinopathy. The mean age of the cases at ophthalmological examination with and without retinopathy was 30.4 and 31.9 years, respectively. The mean serum creatinine level was 190.4 μmol/l which was higher than in the patients without retinopathy (96.2 μmol/l). The mean ESR in patients with retinopathy was higher than without retinopathy (34.2 vs. 32). Similarly, the mean platelet count in SLE patients with retinopathy was 154,245/μl and in SLE patients without retinopathy was 135,828/μl. Conclusions Retinal lesions in SLE patients are of critical importance, both visually and prognostically.
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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, PO Box-5889, Maharajgunj, Kathmandu, Nepal.
| | - Dev Narayan Shah
- Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Tribhuvan University Institute of Medicine, PO Box-5889, Maharajgunj, Kathmandu, Nepal
| | - Divya Singh
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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Shoughy SS, Tabbara KF. Ocular findings in systemic lupus erythematosus. Saudi J Ophthalmol 2016; 30:117-21. [PMID: 27330388 PMCID: PMC4908056 DOI: 10.1016/j.sjopt.2016.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 01/05/2016] [Accepted: 02/09/2016] [Indexed: 12/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Ocular complications occur in up to one-third of patients with SLE. The ocular findings may represent the initial manifestation of the disease and may lead to severe ocular morbidity and loss of vision. Early diagnosis and prompt management of patients with SLE are mandatory and require collaboration between the ophthalmologist and the rheumatologist.
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Affiliation(s)
- Samir S Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia
| | - Khalid F Tabbara
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; The Wilmer Ophthalmological Institute of The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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35
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Silpa-archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol 2015; 100:135-41. [PMID: 25904124 DOI: 10.1136/bjophthalmol-2015-306629] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022]
Abstract
Systemic lupus erythematosus (SLE) can involve many parts of the eye, including the eyelid, ocular adnexa, sclera, cornea, uvea, retina and optic nerve. Ocular manifestations of SLE are common and may lead to permanent blindness from the underlying disease or therapeutic side effects. Keratoconjunctivitis sicca is the most common manifestation. However, vision loss may result from involvement of the retina, choroid and optic nerve. Ocular symptoms are correlated to systemic disease activity and can present as an initial manifestation of SLE. The established treatment includes prompt systemic corticosteroids, steroid-sparing immunosuppressive drugs and biological agents. Local ocular therapies are options with promising efficacy. The early recognition of disease and treatment provides reduction of visual morbidity and mortality.
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Affiliation(s)
- Sukhum Silpa-archa
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA Faculty of Medicine, Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Joan J Lee
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
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36
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Dry eye and corneal langerhans cells in systemic lupus erythematosus. J Ophthalmol 2015; 2015:543835. [PMID: 25893112 PMCID: PMC4393942 DOI: 10.1155/2015/543835] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/13/2015] [Indexed: 12/02/2022] Open
Abstract
Purpose. Investigation of dry eye and corneal Langerhans cells (LCs) in systemic lupus erythematosus (SLE). Methods. Prospective consecutive case series of 27 SLE patients and 27 control subjects. Dry eye was evaluated by lid-parallel conjunctival folds (LIPCOF), Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) questionnaire. In vivo investigation of corneal LCs density and morphology (LCM) was performed with confocal corneal microscopy (Heidelberg Retina Tomograph with Rostock Cornea Module). Results. Tear production and stability were pathological in SLE subjects compared to control (Schirmer: 8.45 ± 9.82 mm/5 min versus 11.67 ± 3.21 mm/5 min; TBUT: 6.86 ± 3.53 s versus 11.09 ± 3.37 s). OSDI was significantly greater in SLE patients (25.95 ± 17.92) than in controls (11.06 ± 7.18). Central LC density was greater in SLE patients (43.08 ± 48.67 cell/mm2) than in controls (20.57 ± 21.04 cell/mm2). There was no difference in the peripheral LC density (124.78 ± 165.39 versus 78.00 ± 39.51 cell/mm2). LCM was higher in SLE patients in the centre (1.43 ± 0.79) and in the periphery (2.89 ± 0.42) compared to controls (centre: 1.00 ± 0.69, periphery: 2.35 ± 0.54). Conclusions. Significant changes in dry eye parameters and marked increase of central LCs could be demonstrated in SLE patients. SLE alters not only the LC density but also the morphology, modifies corneal homeostasis, and might contribute to the development of dry eye.
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Abstract
Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.
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38
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Soluble fas and the -670 polymorphism of fas in lupus nephritis. Int J Nephrol 2014; 2014:780406. [PMID: 25505993 PMCID: PMC4251877 DOI: 10.1155/2014/780406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/10/2014] [Accepted: 10/23/2014] [Indexed: 11/17/2022] Open
Abstract
This study was performed to clarify the role of soluble Fas (sFas) in lupus nephritis (LN) and establish a potential relationship between LN and the −670 polymorphism of Fas in 67 patients with systemic lupus erythematosus (SLE), including a subset of 24 LN patients with proteinuria. Additionally, a group of 54 healthy subjects (HS) was included. The allelic frequency of the −670 polymorphism of Fas was determined using PCR-RFLP analysis, and sFas levels were assessed by ELISA. Additionally, the WT-1 protein level in urine was measured. The Fas receptor was determined in biopsies by immunohistochemistry (IHC) and in situ hybridization (FISH) and apoptotic features by TUNEL. Results. The −670 Fas polymorphism showed that the G allele was associated with increased SLE susceptibility, with an odds ratio (OR) of 1.86. The sFas was significantly higher in LN patients with the G/G genotype, and this subgroup exhibited correlations between the sFas level and proteinuria and increased urinary WT-1 levels. LN group shows increased expression of Fas and apoptotic features. In conclusion, our results indicate that the G allele of the −670 polymorphism of Fas is associated with genetic susceptibility in SLE patients with elevated levels of sFas in LN with proteinuria.
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Kunavisarut P, Pathanapitoon K, Rothova A. Purtscher-like Retinopathy Associated with Systemic Lupus Erythematosus. Ocul Immunol Inflamm 2014; 24:60-8. [DOI: 10.3109/09273948.2014.932816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand and
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand and
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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Mirfazaelian H, Khademi B, Bagheri B, Daneshbod Y. The orbital mass. Int J Rheum Dis 2014; 17:333-5. [DOI: 10.1111/1756-185x.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hadi Mirfazaelian
- Department of Emergency Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Behzad Khademi
- Department of Ophthalmology; Shiraz University of Medical Sciences; Shiraz Iran
| | - Babak Bagheri
- Department of Ophthalmology; Bagheri Optic Clinic; Shiraz Iran
| | - Yahya Daneshbod
- Department of Molecular pathology; Dr. Daneshbod Pathology Laboratory; Shiraz Iran
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Anitua E, Muruzabal F, De la Fuente M, Merayo-Lloves J, Orive G. Effects of heat-treatment on plasma rich in growth factors-derived autologous eye drop. Exp Eye Res 2014; 119:27-34. [DOI: 10.1016/j.exer.2013.12.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 01/28/2023]
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Denniston AK, Gayed M, Carruthers D, Gordon C, Murray PI. Rheumatic Disease. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang TJ, Wang IJ, Hu CC, Lin HC. Comorbidities of dry eye disease: a nationwide population-based study. Acta Ophthalmol 2012; 90:663-8. [PMID: 20809911 DOI: 10.1111/j.1755-3768.2010.01993.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the comorbidities of dry eye disease in a nationwide population-based data in Taiwan. METHODS This study features a study group and a comparison group. The study group comprised 12 007 patients who sought ambulatory care for treatment of dry eye in 2005 and 2006. In total, 36 021 randomly selected patients were in the comparison group. Conditional logistic regression analyses conditioned on gender, age, monthly income and level of urbanization of the community in which the patient resided were conducted to calculate the odds ratio (OR) for each of 33 comorbidities among patients with and without dry eye disease. RESULTS The regression analyses revealed that compared to patients without dry eye disease, patients with dry eye disease were more likely to have comorbidities of ischaemic heart disease (OR = 1.36), hyperlipidaemia (OR = 1.68), cardiac arrhythmias (OR = 1.55), peripheral vascular disorders (OR = 1.57), stroke (OR = 1.31), migraines (OR = 1.76), myasthenia gravis (OR = 2.85), RA (OR = 2.86), systemic lupus erythematosus (OR = 3.98), asthma (OR = 1.25), pulmonary circulation disorders (OR = 1.37), diabetes with complications (OR = 1.31), hypothyroidism (OR = 1.94), liver diseases (OR = 1.71), peptic ulcers (OR = 1.76), hepatitis B (OR = 1.64), deficiency anaemias (OR = 1.31), depression (OR = 2.11), psychoses (OR = 1.87) and solid tumours without metastasis (OR = 1.41). CONCLUSIONS This study demonstrates significantly higher prevalence of medical comorbidities in patients with dry eye disease in Taiwan.
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Affiliation(s)
- Tsung-Jen Wang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
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Sitaula R, Shah DN, Singh D. The spectrum of ocular involvement in systemic lupus erythematosus in a tertiary eye care center in Nepal. Ocul Immunol Inflamm 2012; 19:422-5. [PMID: 22106910 DOI: 10.3109/09273948.2011.610023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Manifestations of Systemic lupus erythematosus are protean and the eye can get affected in more than a third of the cases. This study was conducted to evaluate the spectrum of ocular manifestation among Nepalese patients diagnosed with Systemic lupus erythematosus. METHODS In this hospital based cross-sectional study, 91 established cases of Systemic lupus erythematosus were enrolled from January 2008 to June 2009 AD. Patient particulars including age, sex, duration, systemic involvement, laboratory findings and treatment history were noted. Detailed ophthalmological examination was carried. RESULTS Out of 91 patients, 94.5% were females and 5.5% were males. Female/Male ratio was 17:1. Mean age of the patients was 26.59 ± 10.33 years. Ocular involvement was present in 47.3% (43) of the patients, the commonest manifestation being dry eye (39.5%) followed by lupus retinopathy (21%) and drug induced ocular complications (21%). CONCLUSIONS Ocular manifestations in Systemic lupus erythematosus are not uncommon.
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Affiliation(s)
- Ranju Sitaula
- Department of Ophthalmology, B P Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
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Abstract
Non-infectious vasculitides comprise a large number of diseases. Many of these diseases can cause inflammation within the orbit and a clinical presentation, which mimics numerous other processes. Orbital disease can often be the initial presentation of a systemic process and early diagnosis can help prevent long-term, potentially fatal consequences. The evaluation and treatment of non-infectious orbital vasculitides are often complicated and require a thorough understanding of the disease and underlying systemic associations. The long-term prognosis visually and systemically must be weighed against the risks and benefits of the treatment regimen. A large variety of corticosteroid formulations currently exist and are the mainstay of initial treatment. Traditional steroid-sparing immunosuppressive agents are also an important arsenal against these vasculitides. Recently, a new class of drugs called biologics, which target the various mediators of the inflammation cascade, may potentially provide more effective and less toxic treatment. This review aims to synthesize the current literature on non-infectious orbital vasculitides.
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Wirostko BM, Tressler C, Hwang LJ, Burgess G, Laties AM. Ocular safety of sildenafil citrate when administered chronically for pulmonary arterial hypertension: results from phase III, randomised, double masked, placebo controlled trial and open label extension. BMJ 2012; 344:e554. [PMID: 22354598 PMCID: PMC3283528 DOI: 10.1136/bmj.e554] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the ocular effects and safety profile of chronic sildenafil oral dosing in patients with pulmonary arterial hypertension. DESIGN 12 week, double masked, randomised, placebo controlled, phase III trial with open label extension. SETTING 53 institutions worldwide. PARTICIPANTS 277 adults with idiopathic pulmonary arterial hypertension or pulmonary arterial hypertension associated with connective tissue disease or after congenital heart disease repair (mean pulmonary artery pressure ≥25 mm Hg; pulmonary capillary wedge pressure ≤15 mm Hg at rest). INTERVENTIONS During the double masked study, oral sildenafil 20 mg, 40 mg, or 80 mg or placebo (1:1:1:1) three times daily for 12 weeks was added to baseline drug treatment. In the extension study, the placebo, 20 mg and 40 mg groups received 40 mg three times daily titrated to 80 mg three times daily at week 6. After unmasking, the dose was titrated according to clinical need. MAIN OUTCOME MEASURE Ocular safety (ocular examinations, visual function tests, participants' reports of adverse events, and visual disturbance questionnaire completed by investigators) by treatment group at 12 weeks, 24 weeks, 18 months, and yearly. RESULTS Findings of the objective assessments-that is, intraocular pressure and visual function tests (visual acuity, colour vision, and visual field)-were similar across groups (20 mg, n=69; 40 mg, n=67; 80 mg, n=71; placebo, n=70). No clinically significant changes occurred between baseline and 12 weeks, except for an efficacy signal in contrast sensitivity for the sildenafil 40 mg three times daily group. In right eyes, changes in intraocular pressure from baseline to week 12 ranged from a mean of -0.5 (95% confidence interval -1.3 to 0.2) mm Hg with placebo, -0.2 (-0.9 to 0.5) mm Hg with sildenafil 40 mg, and -0.1 (-0.7 to 0.5) mm Hg with 80 mg to 0.3 (-0.4 to 0.9) mm Hg with sildenafil 20 mg (the approved dose for pulmonary arterial hypertension). Mean changes from baseline to week 12 in contrast sensitivity in right eyes were -0.02 (SD 0.12) in the sildenafil 20 mg three times daily group compared with -0.05 (0.18) in the placebo group (P=0.044). Percentages of participants with deterioration in visual acuity (Snellen) from baseline to week 12 ranged from 10% (n=7) in the placebo group to 3% (n=2) in the sildenafil 20 mg three times daily group; the same percentages had visual field changes from normal to abnormal during the period in these two groups. The investigators did not deem any findings on colour vision assessment to be clinically significant. Findings of the objective assessments in the 40 mg and 80 mg three times daily sildenafil treatment groups and in left eyes were not substantially different, nor were any measures different throughout the open label extension compared with week 12. However, objective data were limited after month 18, as most participants had missing data or visual parameters were no longer collected by investigators. Incidence of ocular adverse events reported on the case report forms and assessed by the investigator was low with all doses, but a modest, dose related incidence of chromatopsia, cyanopsia, photophobia, and visual disturbance was reported with 80 mg three times daily consistent with the indicated dosing for erectile dysfunction. Retinal haemorrhages, captured on funduscopy, occurred in 2% (4/207) of sildenafil treated participants and none in the placebo group during the double masked study and in 4% (10/259) during the open label extension. CONCLUSIONS Sildenafil dosing up to 80 mg three times daily is safe and well tolerated from an ocular perspective in patients with pulmonary arterial hypertension. Daily chronic dosing in this patient population was not associated with visual change and had no detrimental effect on best corrected visual acuity, contrast sensitivity, colour vision, or visual field, or on slit lamp examinations, funduscopy, or intraocular pressure during the duration of this study. TRIAL REGISTRATION Clinical trials NCT00644605 and NCT00159887.
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Sheth S, Rush RB. Bilateral central retinal artery occlusions and hughes syndrome. Retin Cases Brief Rep 2012; 6:304-306. [PMID: 25389739 DOI: 10.1097/icb.0b013e318236fe89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The purpose of this study to report a case of bilateral retinal artery occlusions in a patient with systemic lupus erythematosus and antiphospholipid antibodies. METHODS A 28-year-old woman with systemic lupus erythematosus presented with sudden painless bilateral vision loss. Clinical examination and flourescein angiography were performed, and a diagnosis of bilateral central retinal artery occlusions was made. Laboratory evaluations were ordered. RESULTS Laboratory evaluation revealed the presence of antiphospholipid antibodies.The patient was treated with corticosteroids, azathioprine, aspirin, and warfarin. The patient's visual acuity gradually improved over 2 weeks and then remained stable for 6 months without any further thrombotic events. CONCLUSION The presence of bilateral retinal artery occlusions in a young patient should prompt an immediate evaluation for antiphospholipid antibodies, especially if the patient has been previously diagnosed with systemic lupus erythematosus. Correctly diagnosing patients with antiphospholipid antibodies is important because it implies the need for long-term anticoagulative and antiaggregative therapies to reduce the patient's risk of recurrent, life-threatening, thrombotic events.
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Lin CJ, Chiu YM, Chen SN, Hwang JF, Hu PS. Unusual maculopathy secondary to hypergammaglobulinemia in a patient with systemic lupus erythematosus. Retin Cases Brief Rep 2012; 6:27-29. [PMID: 25390704 DOI: 10.1097/icb.0b013e3181fe92bf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report the unusual findings of fluorescein angiography and optical coherence tomography in a case of systemic lupus erythematosus with hypergammaglobulinemia. DESIGN Interventional case report. RESULTS A 59-year-old woman had systemic lupus erythematosus but had stopped taking medication for 6 months. Blurred vision was noted, and the fundoscopic findings revealed serous macular detachment. Results of optical coherence tomography demonstrated intraretinal and subretinal fluid, but fluorescein angiography showed no leakage. Her best-corrected visual acuity improved after posterior sub-Tenon triamcinolone injection. CONCLUSION Patients with atypical macular detachment may be afflicted with a serum immunogammopathy such as multiple myeloma, Waldenström's macroglobulinemia, and benign polyclonal gammopathy. Systemic lupus erythematosus should also be ruled out.
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Affiliation(s)
- Chun-Ju Lin
- From the *Department of Ophthalmology, Changhua Christian Hospital, Changhua County, Taiwan; †Department of Optometry, Chung Hwa University of Medical Technology, Tainan County, Taiwan; ‡School of Medicine, Chung Shan Medical University, Taichung City, Taiwan; §Department of Allergy, Immunology, and Rheumatology, Changhua Christian Hospital, Changhua County, Taiwan; and ¶Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Wee SW, Kim JC. Two Clinical Manifestations of Anterior Segment Associated with Systemic Lupus Erythematosus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.7.1035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Wook Wee
- Department of Ophthalmology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jae Chan Kim
- Department of Ophthalmology, College of Medicine, Chung-Ang University, Seoul, Korea
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