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Vongkulsiri S, Vanichseni S, Choontanom R, Keorochana N. Characteristics, Etiology, and Clinical Outcome of Retinal Vasculitis in Tertiary Hospital in Thailand. Ocul Immunol Inflamm 2024; 32:218-225. [PMID: 36731516 DOI: 10.1080/09273948.2023.2165110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/31/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To analyze characteristics, etiology, and outcome of retinal vasculitis in Central Thailand. METHODS A retrospective cohort study. RESULTS Retinal vasculitis was found in 10% of uveitis, 74 from 741 uveitis, noninfectious (64.9%) and infectious group (35.1%). The most common cause was Behcet's disease (48.6%). Behcet's disease was the most common cause of all types of vascular leakage on angiography, including capillary (80.4%), venous (56.3%), and arterial leakage (56%). Final visual acuity was 0.86 ± 0.97 logMAR. Cataract was the most frequent complication (42.5%). Acute clinical course (p = .025) and retinal neovascularization (p = .031) were associated with infectious group. Forty-three percent of vasculitis complicated by ischemia required photocoagulation (33%) and anti-VEGF injection (17%). Furthermore, 17% of vasculitis underwent vitrectomy. CONCLUSION One-half of the retinal vasculitis in Central Thailand were Behcet's disease. Acute onset and retinal neovascularization may suggest infectious etiology. Retinal ischemia should be cautious and undergo early interventions to prevent sight-threatening complications.
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Affiliation(s)
- Sritatath Vongkulsiri
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sujaree Vanichseni
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Raveewan Choontanom
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Narumon Keorochana
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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Hedayatfar A, Anvari P, Herbort CP, Chee SP. Demyelinating plaque-associated uveitis. Graefes Arch Clin Exp Ophthalmol 2024; 262:575-582. [PMID: 37855958 DOI: 10.1007/s00417-023-06270-3] [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: 07/03/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To report the clinical and fluorescein angiographic (FA) features of demyelinating plaque-associated uveitis (DPU), a subset of uveitis in which patients have demyelinating plaques on the brain/cervical magnetic resonance image (MRI) but do not meet the criteria for multiple sclerosis (MS). METHODS In this retrospective observational study, Persian Patients were diagnosed with DPU and included if (1) they never satisfied the MS criteria, (2) all other possible etiologies were excluded, and (3) they were followed for at least 2 years. RESULTS After a median follow-up of 3 years (interquartile range, 2.0-5.3), 8 out of 40 (20%) patients diagnosed with DPU were excluded as they subsequently met the MS criteria. Of remaining 32 patients studied, the mean age was 36.3±9.9 (range 20-56 years), and 30 (93.8%) were female. Twenty-four (75.0%) showed bilateral involvement and 27 (84.4%) had insidious-chronic course. Uveitis was classified as intermediate (with or without anterior uveitis) in 29 (90.6%) and isolated anterior in 3 (9.4%) patients. Nine (28.1%) patients had at least one systemic neurological complaint. Ocular findings were: granulomatous keratic precipitates in 43/44 (97.7%) eyes; snowballs in 25/52 (48.1%) eyes; snowbanks in 4/52 (7.7%) eyes; cystoid macular edema in 20/56 (35.7%) eyes; and optic neuritis in 5/56 (8.9%) eyes. Visual acuity was ≥ 20/40 in 39 eyes (69.6%) at presentation which improved to 46 eyes (81.2%) at 2-year follow up. The two most frequent findings in FA were optic disc leakage/staining in 44/52 (81.5%) eyes, and peripheral retinal perivascular leakage in 39/52 (76.9%) eyes, which in 14/52 (26.9%) eyes extended beyond the equator. CONCLUSION DPU usually presents as a bilateral chronic granulomatous intermediate and, less often, isolated anterior uveitis, especially in females. Most are neurologically asymptomatic. Visual outcome is generally favorable. In FA, peripheral retinal perivascular leakage is common. DPU patients have an increased tendency to develop MS and should be prohibited from anti-TNF treatment.
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Affiliation(s)
- Alireza Hedayatfar
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattar khan St., Niayesh Ave, Tehran, 14455-364, Iran.
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
| | - Pasha Anvari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattar khan St., Niayesh Ave, Tehran, 14455-364, Iran
| | - C P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Lausanne, Switzerland
- Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Invernizzi A, Carreño E, Pichi F, Munk MR, Agarwal A, Zierhut M, Pavesio C. Experts Opinion: OCTA vs. FFA/ICG in Uveitis - Which Will Survive? Ocul Immunol Inflamm 2023; 31:1561-1568. [PMID: 35797139 DOI: 10.1080/09273948.2022.2084421] [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: 02/02/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Will optical coherence tomography angiography (OCTA) replace invasive imaging techniques like fundus fluorescein angiography (FFA) and indocyanine green (ICG) angiography entirely? While OCTA is being increasingly applied in the field of medical retina, will we see this change in the subspeciality of uveitis? In this article, five uveitis specialists with renowned imaging expertise answer to 10 specific questions to address this issue. The final verdict based on the comments of the experts suggests that FFA and ICG cannot be replaced by OCTA in uveitis, at least for now. While OCTA can offer new insights into the pathogenesis of certain inflammatory conditions and help in the diagnosis of complications like inflammatory choroidal neovascularisation, multimodal imaging is still the preferred approach in the assessment of patients with uveitis.
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Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences "L. Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
- The Discipline of Clinical Ophthalmology and Eye Health, Save Sight Institute, Sydney Eye Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ester Carreño
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital NHSFT, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT, UCL Institute of Ophthalmology, London, UK
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Orr S, Pereira A, Jiang S, Golding J, Choudhry N, Kalevar A, Janetos TM, Goldstein DA. Diagnostic and Therapeutic Challenges. Retina 2023; 43:1628-1632. [PMID: 36996467 DOI: 10.1097/iae.0000000000003789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Karaca I, Uludag G, Matsumiya W, Regenold J, Or C, Mobasserian A, Halim MS, Zaidi M, Lajevardi S, Dongchau A, Ghoraba H, Nguyen QD. Six-month outcomes of infliximab and tocilizumab therapy in non-infectious retinal vasculitis. Eye (Lond) 2023; 37:2197-2203. [PMID: 36443499 PMCID: PMC10366079 DOI: 10.1038/s41433-022-02315-9] [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: 03/02/2022] [Revised: 09/03/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the efficacy of infliximab (IFX, 5-10 mg/kg) (Group 1) and tocilizumab (TCZ, 4-8 mg/kg) (Group 2) infusions in non-infectious retinal vasculitis (RV) using Angiographic Scoring for the Uveitis Working Group fluorescein angiography (FA) scoring system. METHODS Records of 14 patients (24 eyes) in Group 1 and 8 patients (11 eyes) in Group 2 were retrospectively evaluated to assess visual acuity (VA), anterior chamber cell and flare, vitreous haze, central subfield thickness (CST), and FA scoring at baseline and 6 months of follow-up. The measurements were employed to grade in each group. RESULTS In Group 1 and 2, respectively, there was no underlying disease in 9 (60%) and 3 (42.9%) patients. Three (42.9%) patients in Group 2 had juvenile idiopathic arthritis (JIA) as the most common identified cause. Mean improvement in VA (log MAR) and CST were 0.04 ± 0.14 and 40.3 ± 78.5 µm in Group 1; 0.04 ± 0.09 and 47.3 ± 82.3 µm in Group 2, respectively. Mean FA scores were significantly reduced from 12.4 ± 5.2 and 11.6 ± 4.4 at baseline to 6.4 ± 5.0 and 5.8 ± 3.9 at 6-month in Group 1 and 2, respectively. In Group 2, 9 eyes of 6 patients (75%) had the history of IFX use prior to TCZ initiation. There was no significant safety concern requiring treatment discontinuation during the follow-up in either group. CONCLUSION IFX and TCZ infusions showed statistically significant improvement of non-infectious RV as shown by ASUWOG FA Scoring System. TCZ, as well as IFX, appeared to be effective treatment options for non-infectious RV.
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Affiliation(s)
- Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Gunay Uludag
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Moosa Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Ami Dongchau
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
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Nagaraj KB, Hiremath CDH, Tumbadi KL, Pankaja PS, Shilpa YD, Hemalatha BC. Clinical study of profile of retinal detachment in vasculitis and its management at tertiary eye care hospital. Indian J Ophthalmol 2023; 71:2041-2044. [PMID: 37203078 PMCID: PMC10391391 DOI: 10.4103/ijo.ijo_2157_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention. Methods It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three-port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection. Results In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re-procedure but was lost for follow-up. The anatomical success was 83.33% on the first surgery. Conclusion The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated.
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Affiliation(s)
- Kalpana B Nagaraj
- Medical Superintendent and Chief of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - Chan-Drashekarayya H Hiremath
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - Kavitha L Tumbadi
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - P S Pankaja
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - Y D Shilpa
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - B C Hemalatha
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
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Komatsu K, Harada Y, Hiyama T, Sada I, Hirooka K, Kiuchi Y. Corneal Endothelial Cell Loss after Ciliary Sulcus Placement of Ahmed Glaucoma Valve in Patients with Noninfectious Uveitic Glaucoma. J Pers Med 2022; 12:2075. [PMID: 36556295 PMCID: PMC9785813 DOI: 10.3390/jpm12122075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
This study was performed to investigate the corneal endothelial cell density (CECD) reduction and treatment efficacy in patients with uveitic glaucoma treated by the ciliary sulcus placement of the Ahmed glaucoma valve (AGV). This retrospective study included 27 eyes of 27 patients with noninfectious uveitis who underwent the sulcus placement of the AGV. Each patient underwent a clinical assessment including a CECD measurement before surgery and at 3, 6, 9, and 12 months after surgery. The mean CECD was 2431.4 ± 367.5 cells/mm2 at preoperative baseline and 2360.5 ± 391.3 cells/mm2 at 12 months (p = 0.074), with a reduction rate of 2.73 ± 9.29%. The CECD reduction was significantly greater in patients with unilateral uveitis than that with bilateral uveitis. The rate of successful intraocular pressure control was 88% at 12 months, and the number of intraocular pressure-lowering medications was significantly reduced (p < 0.001). The current study showed that the implantation of an Ahmed tube into the ciliary sulcus provided stable intraocular pressure control in patients with glaucoma secondary to noninfectious uveitis, and CECD reduction was moderate in most patients at 12 months.
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Affiliation(s)
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Baquero-Ospina P, Paquentín-Jiménez R, Hubbe-Tena C, Concha-Del-Rio LE. Combined Ophthalmology and Rheumatology Evaluation in Systemic Autoimmune Diseases with Ocular Involvement: A Third Level Reference Center in Mexico. Ocul Immunol Inflamm 2022:1-7. [PMID: 35759649 DOI: 10.1080/09273948.2022.2079532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM A cross-sectional descriptive study to determine the frequency of ocular manifestations associated with systemic autoimmune diseases in a third-level hospital in Mexico. METHODS Records from 2014 to 2017 at the Inflammatory Eye Disease Clinic of the Asociación Para Evitar la Cegueraen México were examined by both an ophthalmologist and a rheumatologist on the same day. Diagnosis was achieved from initial ocular manifestations with later systemic assessment. RESULTS Out of 311 medical records, 276 were included, 75% of the patients were female. Keratoconjunctivitis sicca was the most frequent ocular manifestation (33.3%), followed by anterior uveitis (29.5%), scleritis (23.2%), and peripheral ulcerative keratitis (7.2%). The leading autoimmune diseases were spondyloarthritis (29%), rheumatoid arthritis (28.6%), primary Sjögren's syndrome (10.5%) and granulomatosis with polyangiitis (9.1%). 41.3% of systemic disease diagnoses were made after an initial ocular manifestation. CONCLUSIONS Inflammatory eye manifestations can imply systemic autoimmune diseases. It is crucial to suspect and confirm this association and provide timely interdisciplinary management.
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Affiliation(s)
- Pablo Baquero-Ospina
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
| | - Rebeca Paquentín-Jiménez
- Community Service at Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
| | - Claudia Hubbe-Tena
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
| | - Luz Elena Concha-Del-Rio
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, I.A.P, Mexico City, Mexico
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Hébert M, Couture S, Schmit I. Bilateral Panuveitis with Occlusive Vasculitis following Coronavirus Disease 2019 Vaccination. Ocul Immunol Inflamm 2022; 31:660-664. [PMID: 35226580 DOI: 10.1080/09273948.2022.2042325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a case of bilateral panuveitis and occlusive vasculitis following COVID-19 vaccination. STUDY DESIGN Case report. RESULTS A 41-year-old otherwise healthy male presented with progressive vision loss and floaters starting 48 hours after a first dose of COVID-19 vaccine. Examination initially showed bilateral anterior uveitis, but this evolved into bilateral panuveitis with occlusive vasculitis despite topical corticosteroids over two weeks. The patient underwent extensive testing for other etiologies which were excluded. He was successfully treated with a gradual taper of topical and systemic corticosteroids leading to improvement of signs and symptoms. Follow-up is maintained for observation of avascular zones with possible neovascularization which could require laser as needed. CONCLUSIONS The temporal association between vaccine and presentation makes this a plausible etiology. This remains a rare adverse event, but clinicians should be aware of this possibility to include it in their differential diagnosis when confronted with idiosyncratic ocular presentations.
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Affiliation(s)
- Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Chu de Québec - Université Laval, Quebec City, Canada
| | - Simon Couture
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Chu de Québec - Université Laval, Quebec City, Canada
| | - Isabelle Schmit
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Chu de Québec - Université Laval, Quebec City, Canada
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Harada Y, Hiyama T, Kiuchi Y. Methotrexate Effectively Controls Ocular Inflammation in Japanese Patients With Non-infectious Uveitis. Front Med (Lausanne) 2021; 8:732427. [PMID: 34869426 PMCID: PMC8636923 DOI: 10.3389/fmed.2021.732427] [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: 06/29/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
This single-center retrospective study investigated the clinical characteristics and efficacy of methotrexate (MTX) for the treatment of non-infectious uveitis for more than 6 months at Hiroshima University, from February 2016 to May 2021. Outcome variables included changes in systemic immunosuppressive treatment and intraocular inflammation. Out of 448 patients with non-infectious uveitis, 35 patients (14 male patients and 21 female patients; 65 eyes) treated with MTX for more than 6 months were analyzed. There were 15 patients with anterior uveitis and 20 with posterior and panuveitis. The mean dose of systemic corticosteroids decreased from 12.1 mg/day at baseline to 1.3 mg/day at 6 months and 0.6 mg at 12 months after starting MTX, and approximately 90% of patients were corticosteroid-free at 12 months. The percentage of eyes with inactive uveitis at 6, 12, and 24 months was 49.2%, 59.6%, and 90.0%, respectively. Mean relapse rate score also significantly decreased from 2.88 at baseline to 0.85 at 12 months (p < 0.001). Inflammatory control was achieved with MTX doses of 8-16 mg/week, with a median dose of 12 mg/week. Adverse effects of MTX were observed in 34.3% of patients, and 11.4% required discontinuation; most commonly hepatotoxicity (58.3%), followed by fatigue (25.0%), and hair loss (16.7%). No significant differences were found between the survival curves of patients with anterior uveitis and posterior/panuveitis (Wilcoxon rank-sum test). The percentage of eyes without IOP-lowering eye drops was significantly higher in patients with posterior/panuveitis at 24 months (p = 0.001). Our study suggests that MTX is effective in controlling ocular inflammation for Japanese patients with non-infectious uveitis. Relatively high incidence of MTX-related adverse effects in the Japanese population indicates that careful monitoring and dose adjustments are crucial for the long-term use of this therapy.
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Affiliation(s)
- Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Casselman P, Cassiman C, Casteels I, Schauwvlieghe P. Insights into multiple sclerosis-associated uveitis: a scoping review. Acta Ophthalmol 2021; 99:592-603. [PMID: 33326162 DOI: 10.1111/aos.14697] [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: 05/06/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE This paper is a scoping review of research on multiple sclerosis (MS)-associated uveitis to determine its epidemiology, pathophysiology, clinical features and treatment. METHODS A comprehensive search of the medical databases MEDLINE (PubMed), EMBASE, Web of Science and Cochrane was carried out on 25 November 2019, to identify papers published between 1980 and 2019 that focus on patients with MS-associated uveitis. RESULTS Based on large cohort studies (n ≥ 1000), the prevalence of uveitis in patients with MS is estimated to be 0.53-1.34% (mean = 0.83%), and MS is diagnosed in 0.52-3.20% (mean = 1.30%) of patients with uveitis. The condition is most frequent among middle-aged women. Patients usually complain of floaters and/or blurred vision, with bilateral intermediate uveitis (with retinal vasculitis) as the most frequent ophthalmological finding. Both MS and intermediate uveitis are associated with HLA-DRB1*15:01 and IL-2RA gene polymorphism rs2104286 A > G, suggesting a common genetic background. T cells, and possibly B cells, play an important role in both autoimmune disorders. Multiple sclerosis (MS)-related uveitis is classically treated as non-infectious uveitis, with corticosteroids as the first treatment step. Other treatments include immunosuppressants, cryotherapy, laser photocoagulation and vitrectomy. These treatment options have a limited, if any, effect on the course of MS and can be complicated by side-effects. As treatment strategies for MS have increased in the last decade, it would be interesting to evaluate the efficacy of these new treatments during the course of uveitis. Moreover, the correlation between retinal periphlebitis and MS could be established more accurately with the recently developed techniques of wide-field fluorescein angiography in a large cohort of MS patients. CONCLUSION MS-associated uveitis is a rare, highly discussed pathology about which much is still unknown. Large epidemiological studies and extrapolation of new MS treatments to this condition are warranted.
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Affiliation(s)
| | | | - Ingele Casteels
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
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Yang S, Huang Z, Hu Y, Zhang J, Liu X, Li H, Xie L, Wen F, Liang D, Su W. The Efficacy of Adalimumab as an Initial Treatment in Patients with Behçet's Retinal Vasculitis. Front Pharmacol 2021; 12:609148. [PMID: 34239438 PMCID: PMC8258106 DOI: 10.3389/fphar.2021.609148] [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: 01/15/2021] [Accepted: 05/21/2021] [Indexed: 12/18/2022] Open
Abstract
Background: No study has evaluated the effectiveness of Adalimumab (ADA) as first-line in treatment-naïve patients with retinal vasculitis due to Behçet’s Uveitis (BU). Objective: To compare the efficacy of ADA plus conventional therapy and conventional therapy alone as initial treatments in naïve BU patients characterized by retinal vasculitis. Methods: Medical records of BU patients characterized by retinal vasculitis treated with conventional therapy (CT, refers to glucocorticoid and immunosuppressive agents) alone or ADA plus conventional therapy with at least 6 months of follow-up between February 2015 and June 2020 were analyzed. Only patients who were first diagnosed with BU without previous systemic treatment were reviewed. The retinal vasculitis score based on fluorescein angiography (FA), best-corrected visual acuity, glucocorticoid-sparing effect, the number of relapses and ocular complications were evaluated. Results: A total of 45 patients (87 eyes) were included. Twenty-four patients (55.33%) in the CT group were treated with conventional therapy and 21 patients (46.67%) in the ADA group were treated with ADA plus conventional therapy. The inflammatory parameters improved in both groups. FA scores showed significantly greater improvement in ADA group than CT group (p < 0.001). The median number of relapses was significantly lower, and the duration of remission was longer in ADA group than CT group (p < 0.001). At the last visit, a significantly better BCVA improvement (p = 0.024), better inflammation control (anterior chamber inflammation p = 0.017 and vitritis p < 0.001) and lower daily glucocorticoid dosage (p = 0.005) were identified in patients received ADA therapy. In CT group, 1 patient suffered hepatitis B and tuberculosis, 1 had growth retardation, 1 patient had with osteoporosis, then followed by other mild AEs (mostly respiratory upper tract infections); while in ADA group, 1 patient experienced a mild pneumonia (n = 1) while milder AEs were represented mostly by respiratory upper tract infections followed by gastrointestinal discomfort. Conclusion: ADA plus conventional therapy achieved superiority over conventional therapy as initial treatment in naïve BU patients with retinal vasculitis.
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Affiliation(s)
- Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhaohao Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunwei Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiuxing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - He Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lihui Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dan Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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13
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Wang P, Chin EK, Almeida DR. Idiopathic retinal arterial occlusive vasculitis in the setting of multiple arterial occlusions. Am J Ophthalmol Case Rep 2021; 22:101086. [PMID: 33912730 PMCID: PMC8065184 DOI: 10.1016/j.ajoc.2021.101086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose We present a patient with vaso-occlusive retinal vasculitis to summarize this uncommon entity and review the clinical features and management challenges applicable to patients with retinal vasculitis. Observations A 76-year-old male presented with sudden-onset severe central vision loss. On examination, vitreous hemorrhage, neovascularization of the optic nerve, peripheral segmental periphlebitis, vessel sclerosis, vascular sheathing, and retinal hemorrhages were observed, and a diagnosis of active vaso-occlusive retinal vasculitis was made. The patient then underwent a complete infectious, inflammatory, and neoplastic workup which returned negative. The patient was treated with locally with a sub-Tenon's injection of 40 mg triamcinolone on presentation and later with oral prednisone. At three-month follow-up, vision improved to 20/300 with regressing neovascularization and clearing of vitreous hemorrhage in the right eye (OD). Conclusions Considering novel associations of occlusive retinal vasculitis, it is important to recognize that idiopathic occlusive retinal vasculitis, although uncommon, can occur and represents a prototypical disease form. It is imperative that these patients have a complete infectious, inflammatory, and neoplastic workup owing to the possible overlap of masquerade clinical signs and symptoms.
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Affiliation(s)
- Patrick Wang
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - Eric K Chin
- Retina Consultants of Southern California, Redlands, CA, USA.,Loma Linda University Medical Center, Veterans Affair Hospital, Loma Linda, CA, USA
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14
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Khatri A, Wagle B, Hony KC, Chaurasiya BD, Timalsena S, Singh K, Agrawal R. Post typhoid fever neuroretinitis with serous retinal detachment and choroidal involvement-A case report. Am J Ophthalmol Case Rep 2021; 21:101025. [PMID: 33615037 PMCID: PMC7878975 DOI: 10.1016/j.ajoc.2021.101025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/04/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To report post typhoid fever neuroretinitis with Serous Retinal Detachment and choroidal involvement. Observation Patients with diminished vision post typhoid fever can present with neuroretinitis with serous retinal detachment. Conclusion and importance With help from noninvasive imaging such as optical coherence tomography angiography(OCTA) and Deep Range Imaging(DRI), we were able to conclude choroidal involvement – which has not been discussed in literatures yet.OCTA and choroidal thicknessboth served as agood indicators for monitoring the response of treatment in this case.
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Affiliation(s)
- Anadi Khatri
- Department of Vitreoretinal Services, Birat Eye Hospital, Biratnagar, Nepal.,Department of Ophthalmology, Birat Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Bivek Wagle
- Morehouse School of Medicine, Atlanta, GA, USA
| | - K C Hony
- Department of Ophthalmology,Birat Eye Hospital, Biratnagar, Nepal
| | | | - Satish Timalsena
- Department of Ophthalmology,Birat Eye Hospital, Biratnagar, Nepal
| | | | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Singapore Eye Research Institute, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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15
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Hiyama T, Harada Y, Kiuchi Y. Efficacy and Safety of Adalimumab Therapy for the Treatment of Non-infectious Uveitis: Efficacy comparison among Uveitis Aetiologies. Ocul Immunol Inflamm 2021; 30:951-958. [PMID: 33560160 DOI: 10.1080/09273948.2020.1857791] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To assess the efficacy and safety of adalimumab treatment in patients with Non-infectious uveitis.Methods: This was a single-center retrospective chart review of patients with active Non-infectious uveitis who had received adalimumab in Japan. Outcome variables included change in systemic immunosuppressive treatment, intraocular inflammation, visual acuity, and relapse rate.Results: In total, 48 patients were included. After the initiation of adalimumab, more than 80% of the patients received systemic corticosteroid ≤5 mg from 3 months onwards. Intraocular inflammation, relapse rate, and visual acuity showed persistent improvement. Adalimumab and methotrexate combination therapy was required in 71.4% of the patients with Vogt-Koyanagi-Harada disease/sympathetic ophthalmia, whereas it was required in only 18.0% of the patients with Behçet's disease. There were no serious side effects that required discontinuation of adalimumab.Conclusion: Adalimumab is efficacious and safe for the treatment of patients with Non-infectious uveitis. Differences in the efficacy of adalimumab treatment may exist between patients with Vogt-Koyanagi-Harada disease/sympathetic ophthalmia and patients with Behçet's disease.
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Affiliation(s)
- Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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16
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Mahendradas P, Sridharan A, Kawali A, Sanjay S, Venkatesh R. Role of Ocular Imaging in Diagnosis and Determining Response to Therapeutic Interventions in Posterior and Panuveitis. Asia Pac J Ophthalmol (Phila) 2021; 10:74-86. [PMID: 33512829 DOI: 10.1097/apo.0000000000000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT This review provides a comprehensive description and careful interpretation of various ocular imaging techniques to visualize the different ocular structures in posterior and panuveitis. This can help in the diagnosis, follow-up, and monitoring the response to treatment in patients with different posterior and panuveitic entities.
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Affiliation(s)
| | - Akhila Sridharan
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramesh Venkatesh
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
- Department of Vitreoretinal Services, Narayana Nethralaya, Bangalore, India
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17
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18
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Optical coherence tomography diagnostic signs in posterior uveitis. Prog Retin Eye Res 2020; 75:100797. [DOI: 10.1016/j.preteyeres.2019.100797] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
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19
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Diagnostic and Therapeutic Challenges. Retina 2019; 39:1819-1823. [DOI: 10.1097/iae.0000000000002219] [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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20
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Abroug N, Zina S, Khairallah M, Ksiaa I, Kechida M, Ben Amor H, Khochtali S, Khairallah M. Diagnosing retinal vasculitis and its implications for treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1613153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Melek Kechida
- Internal Medicine Department, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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21
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Victor AA, Sukmana N. RETINAL VASCULITIS ASSOCIATED WITH EPSTEIN-BARR VIRUS INFECTION, A CASE REPORT. Retin Cases Brief Rep 2018; 12:314-317. [PMID: 28030457 DOI: 10.1097/icb.0000000000000508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report a case of retinal vasculitis associated with Epstein-Barr virus infection. METHODS Case report. RESULTS A 26-year-old woman came with blurry vision. Funduscopy illustrated vasculitis with frosted branch-like appearance. The patient was treated with systemic acyclovir and topical steroid. Circulating polymerase chain reaction was positive for Epstein-Barr virus antibodies. Two months of treatment resolved the clinical manifestations. CONCLUSION Epstein-Barr infection should be considered as the etiology of retinal vasculitis with similar clinical manifestations.
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Affiliation(s)
- Andi A Victor
- Vitreo-Retinal Division, Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Prof. Dr. Isak Salim Aini Eye Hospital, Jakarta, Indonesia
| | - Nanang Sukmana
- Division of Clinical Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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22
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Agrawal R, Ang B, Balne PK, Richards C, Smart T, Cardoso J, Shima D, Jones PH, Pavesio C. Non-Occlusive Retinal Vascular Inflammation and Role of Red Blood Cell Deformability in Birdshot Chorioretinopathy. Ocul Immunol Inflamm 2018; 27:978-986. [PMID: 29985708 DOI: 10.1080/09273948.2018.1485959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To investigate differences in red blood cell (RBC) deformability between birdshot chorioretinopathy (BCR) subjects and matched controls, and to postulate its relationship with lack of vascular occlusion in BCR. Methods: In a single center, prospective, non-randomized mechanistic study, blood samples were collected from eight healthy controls and nine BCR patients, and subjected to biochemical and hematological tests, as well as RBC indices assessment using dual-beam optical tweezers. Results: The mean age of the controls was 52.37 ± 10.70 years and BCR patients was 53.44 ± 12.39 years. Initial cell size (Io) for the controls was 8.48 ± 0.25 μm and 8.87 ± 0.31 μm for BCR RBCs (p = 0.014). The deformability index (DI) for the controls was 0.066 ± 0.02 and that for BCR RBCs was 0.063 ± 0.03 (p = 0.441). Conclusion: There was no statistically significant difference in DI between RBCs from BCR and healthy controls. This may explain the rare occurrence of retinal vascular occlusion despite the underlying vasculitic pathophysiology of BCR.
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Affiliation(s)
- Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust , London , UK.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore.,Department of Mechanical Engineering, University College London , London , UK.,Institute of Ophthalmology, University College London , London , UK
| | - Bryan Ang
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore
| | - Praveen Kumar Balne
- Translational Pre-Clinical Model Platform, Singapore Eye Research Institute , Singapore
| | | | - Thomas Smart
- Department of Physics and Astronomy, University College London , London , UK
| | - João Cardoso
- Moorfields Eye Hospital, NHS Foundation Trust , London , UK
| | - David Shima
- Institute of Ophthalmology, University College London , London , UK
| | - Philip H Jones
- Department of Physics and Astronomy, University College London , London , UK
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust , London , UK.,Institute of Ophthalmology, University College London , London , UK
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23
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The main aspects of retinal vein occlusion etiopathogenisis in young adults. Part I. Neuroretinovasculitis (prothrombotic potential, clinical manifestations). OPHTHALMOLOGY JOURNAL 2018. [DOI: 10.17816/ov11257-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This review is dedicated to the neuroretinovasculitis, which is the leading cause of retinal vein occlusion in young adults. Presumed etiological factors, possible pathogenic mechanisms, and clinical manifestation are analyzed. Advisability of multidisciplinary approach in management and individual approach in treatment of patients with neuroretinovasculitis with secondary retinal vein occlusion are justified.
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24
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Agarwal A, Afridi R, Agrawal R, Do DV, Gupta V, Nguyen QD. Multimodal Imaging in Retinal Vasculitis. Ocul Immunol Inflamm 2017; 25:424-433. [DOI: 10.1080/09273948.2017.1319494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rupesh Agrawal
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore
| | - Diana V. Do
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Quan Dong Nguyen
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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25
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Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, Gupta V, Gupta A, Do DV, Nguyen QD. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary-referral institutions. Clin Exp Ophthalmol 2017; 46:62-74. [DOI: 10.1111/ceo.12997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Aniruddha Agarwal
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Samendra Karkhur
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital; University of Milan; Milan Italy
| | - Ramandeep Singh
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Mangat R Dogra
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Amod Gupta
- Advanced Eye Center, Department of Ophthalmology; Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh India
| | - Diana V Do
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
| | - Quan D Nguyen
- Ocular Imaging Research and Reading Center (OIRRC); Menlo Park California USA
- Byers Eye Institute; Stanford University; Palo Alto California USA
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26
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Pelegrín L, Hernández-Rodríguez J, Espinosa G, Llorenç V, Sainz-de-la-Maza M, Fontenla JR, Martínez JA, Cid MC, Adán A. Characterization of isolated retinal vasculitis. Analysis of a cohort from a single center and literature review. Autoimmun Rev 2017; 16:237-243. [PMID: 28137481 DOI: 10.1016/j.autrev.2017.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/06/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Isolated retinal vasculitis (IRV) is an inflammatory condition of unknown etiology confined to the retinal vessels. In contrast to secondary retinal vasculitis (RV), IRV has not been well characterized. OBJECTIVE To describe and characterize isolated forms of RV. METHODS We performed a retrospective review (2006-2016) of IRV patients from a multidisciplinary Uveitis Unit. RV diagnosis was based on funduscopic and fluorescein angiography findings. To distinguish between secondary RV and IRV, evaluations included clinical assessment, several inflammatory, autoimmune and microbiological laboratory markers, and a chest radiography. Ophthalmological features at disease onset, therapeutic interventions, ocular relapses, visual outcomes and laboratory findings were recorded. Our cases were subsequently compared with those from a literature review. RESULTS Among 192 patients with RV, 11 (5.7%) were diagnosed with IRV. Seven patients with initially presumed IRV were reclassified as secondary after further evaluation. IRV generally affected adult women. Bilateral ocular involvement and retinal phlebitis were common findings. 72% of patients presented with visual loss, which was severe in 27%. Treatments used included systemic glucocorticoids (82%), additional immunosuppressive agents (27%), intravitreal therapy (37%), panretinal photocoagulation (37%) and pars plana vitrectomy (26%). The annual relapse rate was 0.46. Although final visual acuity was considered good in 86%, 45% experienced worsening and only 27% improved. CONCLUSIONS IRV is a rare sight-threatening condition. Despite intensive local and systemic immunosuppressive treatment, visual improvement is observed in only 27% of cases. When IRV is suspected, a differential diagnosis excluding a systemic disease is always warranted. A multidisciplinary approach and a guided clinical, laboratory and imaging evaluation have proven to be useful to distinguish retinal single-organ vasculitis from secondary forms of RV.
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Affiliation(s)
- Laura Pelegrín
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - Gerard Espinosa
- Uveitis Unit, Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Víctor Llorenç
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maite Sainz-de-la-Maza
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José R Fontenla
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José A Martínez
- Department of Infectious Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Affiliation(s)
- Julie Vadboncoeur
- Resident in Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Katarzyna Biernacki
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Alexandre Prat
- Department of Neurology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Laurence Jaworski
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
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Trese MG, Yonekawa Y, Thomas BJ, Randhawa S. Vasculitic central retinal vein occlusion: The presenting sign of seronegative rheumatoid arthritis. Am J Ophthalmol Case Rep 2016; 2:26-29. [PMID: 29503893 PMCID: PMC5757365 DOI: 10.1016/j.ajoc.2016.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/15/2016] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To report the case of a patient who presented with a vasculitic central retinal vein occlusion (CRVO), which was the result of an undiagnosed systemic inflammatory condition, seronegative rheumatoid arthritis (RA). OBSERVATIONS The patient presented with reduced vision in the left eye and polyarthralgia. Fundoscopic examination revealed a central retinal vein occlusion (CRVO) with concurrent evidence of vasculitis. Work-up for polyarthralgia included comprehensive serologic testing for connective tissue disease, including Vectra® disease activity (DA) testing. Results of these studies confirmed the diagnosis of seronegative rheumatoid arthritis (RA). Systemic steroid therapy was initiated with subsequent anatomic and visual improvement. CONCLUSIONS AND IMPORTANCE We hypothesize that the systemic inflammation-a hallmark of RA-led to the development of a vasculitic CRVO and, thus, the retinal manifestations served as the disease marker that prompted thorough work-up of the patient's disease, even in the face of initial seronegativity. This case serves as a reminder that, in the setting of CRVO and polyarthralgia, systemic inflammatory conditions must be considered as the underlying etiology. Further, this case report highlights our evolving understanding of the role that serologic markers play in the diagnosis and monitoring of RA.
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Affiliation(s)
| | | | | | - Sandeep Randhawa
- Associated Retinal Consultants, Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Abstract
PURPOSE To evaluate the efficacy of systemic infliximab for the induction of remission in patients with retinal vasculitis, inadequately responsive to other immunomodulatory therapy, based on fluorescein angiography grading for retinal vasculitis evaluation. METHODS We analyzed 60 patients with retinal vasculitis, from the Massachusetts Eye Research and Surgery Institution in Cambridge, MA. Response to therapy was based on analysis of serial fluorescein angiography and fundus photography, including a baseline angiogram before initiation of infliximab. RESULTS Sixty patients received infliximab therapy between July 2007 and July 2012 at Massachusetts Eye Research and Surgery Institution for a diagnosis of retinal vasculitis. All had previously showed a poor clinical response to other immunomodulatory regimens, or ceased therapy due to intolerable side effects. The initial dose of infliximab was 5 mg/kg in all patients and remained at this dose for the extent of treatment in 57 (95%) patients. At 6 months, 45 of 51 (88.23%) patients were maintaining remission with therapy, 5 (9.8%) were in partial remission, and 1 patient had failed. At 12 months, 39 of 39 (100%) patients were maintaining remission with therapy. CONCLUSION Infliximab is effective for the treatment of recalcitrant noninfectious retinal vasculitis, refractory to conventional immunomodulatory therapy.
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Spectrum of Retinal Vascular Diseases Associated With Paracentral Acute Middle Maculopathy. Am J Ophthalmol 2015; 160:26-34.e1. [PMID: 25849522 DOI: 10.1016/j.ajo.2015.04.004] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the spectrum of retinal diseases that can demonstrate paracentral acute middle maculopathy and isolated ischemia of the intermediate and deep capillary plexus. DESIGN Retrospective, multicenter, observational case series. METHODS This is a retrospective case series review of 9 patients (10 eyes) from 5 centers with paracentral acute middle maculopathy lesions and previously unreported retinal vascular etiologies. Case presentations and multimodal imaging, including color photographs, near-infrared reflectance, fluorescein angiography, spectral-domain optical coherence tomography (SD OCT), and orbital color Doppler imaging, are described. Baseline and follow-up findings are correlated with clinical presentation, demographics, and systemic associations. RESULTS Five men and 4 women, aged 27-66 years, were included. Isolated band-like hyperreflective lesions in the middle retinal layers, otherwise known as paracentral acute middle maculopathy, were observed in all patients at baseline presentation. Follow-up SD OCT analysis of these paracentral acute middle maculopathy lesions demonstrated subsequent thinning of the inner nuclear layer. Novel retinal vascular associations leading to retinal vasculopathy and paracentral acute middle maculopathy include eye compression injury causing global ocular ischemia, sickle cell crisis, Purtscher's retinopathy, inflammatory occlusive retinal vasculitis, post-H1N1 vaccine, hypertensive retinopathy, migraine disorder, and post-upper respiratory infection. CONCLUSION Paracentral acute middle maculopathy lesions may develop in a wide spectrum of retinal vascular diseases. They are best identified with SD OCT analysis and may represent ischemia of the intermediate and deep capillary plexus. These lesions typically result in permanent thinning of the inner nuclear layer and are critical to identify in order to determine the cause of unexplained vision loss.
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Abstract
PURPOSE To present the case of a young Turkish pregnant patient with bilateral, sight-threatening retinal ischemic vasculopathy and systemic signs suggestive of Behçet disease (oral ulceration, arthritis, and pseudofolliculitis). METHODS Case report. RESULTS Multiple areas of superficial, retinal white lesions and few hemorrhages related to occlusions of small retinal vessels were observed at presentation in the macular zone of both eyes. There was gradual improvement of retinal lesions after the administration of corticosteroids and immunosuppressive treatment. CONCLUSION We report the case of a young pregnant patient with bilateral, sight-threatening retinal ischemic vasculopathy and systemic signs of Behçet disease. Although the systemic signs were highly suggestive of Behçet disease, the ocular presentation was unusual for this multisystemic inflammatory disorder. The differential diagnosis included a number of causes of ischemic retinal vasculopathy, such as systemic vasculitis, antiphospholipid syndrome, Susac syndrome, Purtscher-like retinopathy, and a new variant of acute macular neuroretinopathy (paracentral, acute middle maculopathy), which are further discussed.
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Donnithorne KJ, Read RW, Lowe R, Weiser P, Cron RQ, Beukelman T. Retinal vasculitis in two pediatric patients with systemic lupus erythematosus: a case report. Pediatr Rheumatol Online J 2013; 11:25. [PMID: 23734963 PMCID: PMC3682897 DOI: 10.1186/1546-0096-11-25] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/31/2013] [Indexed: 12/17/2022] Open
Abstract
We report two pediatric female patients with systemic lupus erythematosus (SLE) who presented with decreased vision. Both patients were found to have retinal vasculitis and occlusive disease. The first patient also presented with vitreous hemorrhage and later non-arteritic ischemic optic neuropathy. She was treated with panretinal photocoagulation and steroid therapy and later in her disease course was treated with rituximab and cyclophosphamide. Her vision remained decreased. The second patient was treated with rituximab and monthly cyclophosphamide infusions early in her disease course, and her vision improved dramatically. The difference in the presentations and outcomes of these two pediatric patients with SLE highlights the spectrum of severity of SLE retinopathy. We suggest that early recognition of disease and early intervention with B-cell depletion therapy in addition to a traditional cytotoxic agent should be considered in pediatric patients with SLE and occlusive retinopathy.
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Affiliation(s)
- Katherine J Donnithorne
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Russell W Read
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Lowe
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Weiser
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Randy Q Cron
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy Beukelman
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Yoshizawa C, Saito W, Kase M, Ishida S. Clinical Features of Central Retinal Vein Occlusion With Inflammatory Etiology. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:270-6. [PMID: 26107597 DOI: 10.1097/apo.0b013e318266de04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to characterize central retinal vein occlusion (CRVO) with inflammatory etiology. DESIGN A retrospective study. METHODS We retrospectively reviewed 51 eyes of 48 patients with CRVO between 2004 and 2009 and investigated whether they had inflammatory findings related to retinal vasculitis, that is, severe peripheral retinal vascular changes based on fluorescein angiography and anterior vitreous cells. The extent of vascular leakage was classified as "mild," "moderate," and "severe" in angiographic images. RESULTS Six eyes of 5 patients (11.8%) had both inflammatory criteria. All patients were male and with a diagnosis of ischemic CRVO. No causative etiology was detected in any patient. The mean age was 46.4 (SD, 23.3) years. The age range was not limited to young generation. These patients received systemic corticosteroid therapy with a mean follow-up period of 41.8 months. The mean logMAR visual acuity [1.29 (SD, 0.77)] and central retinal thickness [1290.5 (SD, 399.0) μm)] at the initial visit were significantly (P = 0.004 and P = 0.001) improved at the final visit [0.94 (SD, 0.69) and 266.7 (SD, 135.4) μm, respectively]. CONCLUSIONS Central retinal vein occlusion with idiopathic inflammatory conditions appears to have clinical characteristics of broad age range and good response to systemic corticosteroid therapy.
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Affiliation(s)
- Chikako Yoshizawa
- From the Departments of *Ophthalmology, and †Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine; and ‡Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
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Atisha-Fregoso Y, Hinojosa-Azaola A, Alcocer-Varela J. Localized, single-organ vasculitis: clinical presentation and management. Clin Rheumatol 2012; 32:1-6. [PMID: 22918493 DOI: 10.1007/s10067-012-2069-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/09/2012] [Indexed: 10/28/2022]
Abstract
The term vasculitis usually evokes a systemic disease with catastrophic outcomes; however, vasculitides may also present in a localized form, with a better prognosis when compared with their systemic counterpart. In order to avoid confusion and facilitate classification, the term single-organ vasculitis (SOV) has been proposed. Remarkably, current criteria for the classification of the vasculitis do not include the SOV term, due in part to the lack of appropriate definitions, since most data come from case series; moreover, the scarce information available is also extremely heterogeneous. This review focuses on the epidemiology, clinical course, prognosis, and suggested treatment of the SOV, with emphasis in the most recent information available.
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Affiliation(s)
- Yemil Atisha-Fregoso
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15 Col. Sección XVI, Tlalpan, 14080, México, D.F., México
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Treatment of macular edema because of occlusive vasculitis with bevacizumab (avastin): efficacy of three consecutive monthly injections. Retina 2012; 31:1863-70. [PMID: 21799465 DOI: 10.1097/iae.0b013e318219de8b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To report the efficacy of intravitreal bevacizumab, administered in a series of three monthly injections followed by a period of observation, in the treatment of cystoid macular edema because of occlusive vasculitis. METHODS This is a retrospective review of 13 consecutive eyes of 13 patients with cystoid macular edema because of occlusive vasculitis, which had been unresponsive to other medications and were treated with intravitreal bevacizumab (1.25 mg). The evaluation consisted of a complete ophthalmologic examination, including best-corrected visual acuity measurement, ophthalmoscopy, fluorescein angiography, and optical coherence tomography. The eyes received a series of 3 monthly injections followed by a 3-month observation period. RESULTS A significant improvement in foveal thickness and visual acuity was obtained after the first injection, which increased after the second and the third injections and was maintained for 1.5 months after the last injection. The 2 parameters returned to the baseline values 3 months after the last treatment. There were no ocular or systemic adverse effects. CONCLUSION Intravitreal injection of bevacizumab seems to be well tolerated and is associated with short-term improvement of visual acuity and decreased retinal thickness in patients with cystoid macular edema because of vasculitis that is resistant to conventional therapy.
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Hernandez-Da Mota SE, Arellanes-Garcia L, Recillas-Gispert C, Cornejo-Ballesteros H, Melgoza-del-Angel C, Teran-Estrada L, Sanchez-Gonzalez R. Lupus relapse presented as frosted branch retinal angiitis: case report. Ocul Immunol Inflamm 2012; 19:367-9. [PMID: 21970665 DOI: 10.3109/09273948.2011.603879] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe a systemic lupus erythematosus (SLE) relapse, which presented as frosted branch retinal angiitis. DESIGN Clinical case report. METHODS A 16-year-old female patient had an SLE relapse that appeared as frosted branch angiitis while being treated with deflazacort and azathioprine. RESULTS Complete resolution of the vasculitis was achieved with a 3-day course of pulsed intravenous methylprednisolone and oral prednisone 3 weeks later. CONCLUSIONS Even with proper immunosuppressive treatment, SLE can relapse. This case presented as frosted branch retinal angiitis, which is a clinical picture that is rarely described in SLE.
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Martínez-Berriotxoa A, Fonollosa A, Artaraz J. [Uveitis: diagnostic approach]. Rev Clin Esp 2012; 212:442-52. [PMID: 22296724 DOI: 10.1016/j.rce.2011.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/15/2011] [Accepted: 12/12/2011] [Indexed: 12/31/2022]
Abstract
A 32 year-old woman was referred from the Ophthalmology Department to rule out a possible systemic disease. Her only past medical history of relevance was a tuberculosis contact during childhood. She complained of floaters and progressive blurring of vision in both eyes for some months, as well as arthralgia and cough. Her visual acuity was 0.3 in the right eye and 0.4 in the left eye. Biomicroscopy showed bilateral anterior granulomatous uveitis (1+ cells). Funduscopy showed bilateral vitritis 3+, snow banking and peripheral phlebitis. Fluorescein angiography did not show central vasculitis, and optical coherence tomography showed bilateral cystoid macular oedema. Fundus autofluorescence was normal. How would you initially assess this patient in order to decide which systemic examination should be performed, bearing in mind the ophthalmological manifestations?
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Affiliation(s)
- A Martínez-Berriotxoa
- Sección de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital de Cruces, Vizcaya, España.
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Visual acuity recovery in a case of idiopathic retinal vasculitis aneurysms and neuroretinitis. Optom Vis Sci 2012; 89:E356-63. [PMID: 22266813 DOI: 10.1097/opx.0b013e3182429c53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe the visual recovery after intravitreal injections of the antivascular endothelial growth factor, bevacizumab, in a case of vaso obliteration from idiopathic retinal vasculitis, aneurysm, and neuroretinitis (IRVAN). The name IRVAN was given to the condition to highlight the key findings present in the disease. IRVAN is a severe, sight threatening condition that can lead to peripheral capillary non-perfusion and vision loss from the ischemic sequelae of vascular occlusion. Panretinal photocoagulation (PRP) is the current standard of care for IRVAN but visual outcome is poor if PRP is initiated after neovascularization develops. Intravitreal bevacizumab has success at treating neovascularization from other ischemic retinopathies and inflammatory retinal conditions that have similar characteristics to IRVAN. CASE REPORT This case report describes a patient with decreased vision in the OS. The patient presented with best-corrected visual acuity of 20/20 in the OD and count fingers at 4 ft in the OS. Evaluation revealed findings consistent with an advanced stage of IRVAN. Anterior and posterior neovascularization had developed from extensive capillary non-perfusion in both retinas. A dense vitreous hemorrhage blocked vision OS. Bilateral intravitreal injections of bevacizumab and extensive PRP were given in the area of retinal ischemia for treatment. After 4 months, the patient's vision had improved from count fingers in the OS to 20/40. CONCLUSIONS IRVAN has favorable outcomes when treated with a combination of PRP and intravitreal injections of antivascular endothelial growth factor. This case demonstrates the effectiveness of this combination treatment in a case of IRVAN with both posterior and anterior neovascularization.
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Saurabh K, Das RR, Biswas J, Kumar A. Profile of retinal vasculitis in a tertiary eye care center in Eastern India. Indian J Ophthalmol 2011; 59:297-301. [PMID: 21666315 PMCID: PMC3129755 DOI: 10.4103/0301-4738.81998] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims: To provide a fact file on the etiology, clinical presentations and management of retinal vasculitis in Eastern India. Materials and Methods: Retrospective, record based analysis of retinal vasculitis cases in a tertiary care center in Eastern India from January 2007 to December 2009. Results: One hundred and thirteen eyes of 70 patients of retinal vasculitis were included in this study. Sixty (85.7%) patients were male (mean age 33± 11.1 years) and 10 (14.3%) were female (mean age 32.4 ± 13.6 years). Vasculitis was bilateral in 43 (61.4%) and unilateral in 27 (38.6%) patients. Commonest symptoms were dimness of vision (73; 64.6%) and floaters (36; 31.9%). Vascular sheathing (82; 72.6%) and vitritis (51; 45.1%) were commonest signs. Mantoux test was positive in 21 (30%) patients but tuberculosis was confirmed in only four (5.71%) patients. Raised serum angiotensin-converting enzyme level and positive antinuclear antibody level were reported in four (5.71%) patients each. Human leukocyte antigen B5 (HLA B5) marker was present in one (1.4%) patient. However, none of the total 70 patients were found to have a conclusively proven systemic disease attributable as the cause of retinal vasculitis. Oral corticosteroid (60; 85.7%) was the mainstay of treatment. Forty-eight (42.5%) eyes maintained their initial visual acuity and 43 (38%) gained one or more line at mean follow-up of 16.6± 6.3 months. Conclusion: Retinal vasculitis cases had similar clinical presentations and common treatment plan. There was no systemic disease association with vasculitis warranting a careful approach in prescribing investigations.
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Affiliation(s)
- Kumar Saurabh
- Department of Vitreoretina, Sankara Nethralaya, Kolkata, West Bengal, India.
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Abu El-Asrar AM, Herbort CP, Tabbara KF. Differential diagnosis of retinal vasculitis. Middle East Afr J Ophthalmol 2011; 16:202-18. [PMID: 20404987 PMCID: PMC2855661 DOI: 10.4103/0974-9233.58423] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Mili-Boussen I, Letaief I, Zbiba W, Trabelsi O, Ben Younes N, Abid J, Azzabi S, Khalfallah N, Errais K, Ouertani A. Les vascularites rétiniennes : profils épidémiologiques, cliniques et étiologiques. J Fr Ophtalmol 2010; 33:529-37. [DOI: 10.1016/j.jfo.2010.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
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Ornek K, Onaran Z, Yimazbaş P. Retinal vasculitis following pars plana vitrectomy for retained lens material. Clin Exp Optom 2010; 94:106-7. [PMID: 20608945 DOI: 10.1111/j.1444-0938.2010.00503.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kemal Ornek
- School of Medicine, Department of Ophthalmology, Kırıkkale University, Kırıkkale, Turkey.
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Abu El-Asrar AM, Herbort CP, Tabbara KF. A clinical approach to the diagnosis of retinal vasculitis. Int Ophthalmol 2009; 30:149-73. [DOI: 10.1007/s10792-009-9301-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 01/14/2009] [Indexed: 11/29/2022]
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Hernández-Rodríguez J, Tan CD, Molloy ES, Khasnis A, Rodríguez ER, Hoffman GS. Vasculitis involving the breast: a clinical and histopathologic analysis of 34 patients. Medicine (Baltimore) 2008; 87:61-69. [PMID: 18344804 DOI: 10.1097/md.0b013e31816a8d1f] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Vasculitis of the breast (VB) may be an isolated finding or a manifestation of systemic vasculitis. In the current study we sought to characterize isolated VB (IVB) and compare it to VB in the setting of systemic vasculitis. We studied VB cases in the literature and patients cared for at our institution. We analyzed clinical, laboratory, and histologic features (including vessel size and type of inflammatory infiltrates); course of illness; biopsy procedure; and treatment. Based on the presence of localized or systemic disease at the time of disease presentation and during the follow-up, we divided patients into 3 groups: IVB (Group 1), VB with proven or indirect evidence of systemic vasculitis (Group 2), and VB with possible systemic involvement (Group 3). We identified a total of 34 cases of VB (30 from PubMed [National Library of Medicine, Bethesda, MD] and 4 from our pathology database). All patients presented with breast lesions, which were the only expression of disease in 16 (47%). Eighteen, 6, and 10 patients belonged to Group 1, 2, and 3, respectively. Constitutional symptoms were present less often in Group 1. Musculoskeletal symptoms occurred only in Groups 2 and 3. Patients in Groups 2 and 3 had higher erythrocyte sedimentation rates and lower hemoglobin levels, and also received corticosteroids more frequently than those in Group 1. No differences were found in the other analyzed parameters between groups. In summary, VB is uncommon, and in about half of the cases, occurs in the form of IVB. Histologic characteristics do not correlate with disease extent. In IVB patients, constitutional and musculoskeletal manifestations are usually absent. Such patients generally do not require systemic therapy and may be cured by resection alone.
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Affiliation(s)
- José Hernández-Rodríguez
- From the Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases (JHR, ESM, AK, GSH) and Department of Anatomic Pathology (CDT, ERR), Cleveland Clinic, Cleveland, OH
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Bibliography. Current world literature. Neuro-ophthalmology. Curr Opin Ophthalmol 2006; 17:574-5. [PMID: 17065928 DOI: 10.1097/icu.0b013e32801121a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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