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Morrison T, Gottman M, Do T, Rosenbaum JT, Ghetie D, Friedman M. Scleritis and Development of Immune-Mediated Disease: A Retrospective Chart Review. J Rheumatol 2024; 51:825-830. [PMID: 38302174 DOI: 10.3899/jrheum.2023-0788] [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] [Accepted: 12/15/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Scleritis may be idiopathic or caused by trauma, infections, or an immune-mediated disease (IMD). Our study aimed to understand the relationship between scleritis and IMD, including presenting characteristics, serologies, and treatment course. Understanding these associations may allow clinicians to risk-stratify patients and predict their clinical and treatment course. METHODS We conducted a retrospective chart review of 341 patients with scleritis seen at a tertiary care center between January 1, 2005, and December 31, 2020. Demographics, scleritis characteristics, treatment response, recurrence, and serologic data were compared among patients with idiopathic and IMD-associated scleritis. RESULTS Among patients with scleritis seen, 145 patients (43%) had an associated IMD, most commonly rheumatoid arthritis (RA; 39%), vasculitis (21%), or inflammatory bowel disease (14%). In most cases, the IMD diagnosis predated the scleritis presentation (63%), though vasculitis cases were more likely to develop during or after scleritis episodes. There were no significant differences in demographics or treatment failures among patients with scleritis with and without associated IMDs. Patients with IMDs were more likely to have a recurrence of scleritis (62% vs 49%, P = 0.02). CONCLUSION At our ophthalmology center, 43% of patients with scleritis had an associated IMD, and most patients with an IMD were symptomatic from this disease prior to scleritis presentation. RA was the most commonly associated condition and typically predated the scleritis, whereas vasculitis was more likely diagnosed during or after the scleritis episode. Scleritis among patients with IMD is more likely to recur compared to scleritis that is idiopathic.
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Affiliation(s)
- Tessalyn Morrison
- T. Morrison, MD, MPH, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont;
| | - Moriah Gottman
- M. Gottman, MS, School of Medicine, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Toan Do
- T. Do, MD, Department of Allergy and Immunology, University of California San Diego, San Diego, California
| | - James T Rosenbaum
- J.T. Rosenbaum, MD, Legacy Health Systems, Portland, Oregon, now with Corvus Pharmaceuticals, Burlingame, California
| | - Daniela Ghetie
- D. Ghetie, MD, M. Friedman, MD, Department of Medicine, Division of Rheumatology, Oregon Health & Science University, Portland, Oregon, now with Alpine Immune Sciences, Seattle, Washington, USA
| | - Marcia Friedman
- D. Ghetie, MD, M. Friedman, MD, Department of Medicine, Division of Rheumatology, Oregon Health & Science University, Portland, Oregon, now with Alpine Immune Sciences, Seattle, Washington, USA
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Kudsi M, Al-Darwish L, Khalayli N, Abouharb D, Abouharb L, Almajzoub R, Deeb H. Characterizing autoimmune uveitis to systemic diseases: a retrospective study from a Syrian tertiary reference center. Ann Med Surg (Lond) 2024; 86:3929-3935. [PMID: 38989239 PMCID: PMC11230743 DOI: 10.1097/ms9.0000000000002054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/30/2024] [Indexed: 07/12/2024] Open
Abstract
Background Uveitis, a notable cause of severe visual impairment, is frequently characterized as infectious or noninfectious autoimmune uveitis (AU), the latter of which is commonly associated with younger individuals and systemic diseases. Despite the condition's widespread impact, there are substantial gaps in the comprehension of its pathogenesis, clinical presentation, and therapeutic response, particularly concerning systemic disease-associated uveitis. Aim of the study The current study aims to bridge these gaps through an extensive examination of demographic and clinical features in AU patients, thereby informing future research, and therapeutic strategies, and improving patient outcomes. Methods This retrospective observational study analyzed 261 patients with systemic disease-associated uveitis from January 2018 to December 2022 in Damascus, Syria. With diagnoses made using the Standardization of Uveitis Nomenclature Working Group Criteria, the study evaluated tailored treatment efficacy at the 24-month post-treatment mark, alongside comprehensive ophthalmic examinations, laboratory evaluations, and radiographic assessments. Results In our study, included 87 patients with Systemic Disease-Associated Autoimmune Uveitis (SDA-AU). Women represented 64.36% of this group, and the mean age at diagnosis was 39.8±17.9 years (range 7-71) for men and 43.8±15.4 years (range 11-69). The most reported symptom was a painful red eye (52.87%). The onset of symptoms was sudden for 32.18% of patients, while 67.81% reported gradual development. Complications occurred in 33.33% of patients, including cataracts (41.37% of those with complications) and glaucoma (17.24%). Laboratory evaluations showed elevated inflammation markers in 66.66% of patients. Upon the 24-month assessment, 48.27% of patients achieved complete remission, 37.93% showed significant improvement, while disease worsened in 13.79% of cases. Conclusion Our findings demonstrated that the presentation of AU in this cohort frequently precedes the diagnosis of systemic diseases, affirming the vital role of an early and accurate diagnosis of uveitis for the detection of underlying systemic conditions. In conclusion, our study underlines the significance of a comprehensive and multidisciplinary approach in the management of SD-AU, leading to improved prognosis and quality of life for patients.
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Affiliation(s)
| | - Lama Al-Darwish
- Faculty of Pharmacy, Al-Sham Private University, Damascus, Syria
| | | | - Dani Abouharb
- Université Paris Cité, UFR de Médecine, Paris, France
| | - Lana Abouharb
- Université Paris Cité, UFR de Médecine, Paris, France
| | | | - Haya Deeb
- Faculty of Medicine, Damascus University
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3
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Leal I, Nogueira V, Matos DB, Araújo J, Berens O, Ribeiro M, Furtado MJ, Liverani M, Silva MI, Guedes M, Cordeiro M, Ribeiro M, José P, Barão R, Nunes Ferreira R, Fonseca S, Mano S, Pina S, Santos MJ, Fonseca JE, Fonseca C, Figueira L. Design and Development of a Web-Based Prospective Nationwide Registry for Ocular Inflammatory Diseases: UVEITE.PT - The Portuguese Ocular Inflammation Registry. Ocul Immunol Inflamm 2024; 32:342-350. [PMID: 36780588 DOI: 10.1080/09273948.2023.2171891] [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: 07/05/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
Uveitis is a heterogeneous collection of infrequent diseases, which poses significant challenges to cost-effective research in the field. Medical registries are being increasingly recognized as crucial tools to provide high-quality data, thus enabling prospective clinical research. This paper describes the design and technical structure development of an innovative countrywide electronic medical record for uveitis, Uveite.pt, and gives an overview of the cohort registered since its foundation, March 2020.Uveite.pt is an electronic medical record platform developed by the Portuguese Ocular Inflammation Group (POIG), a scientific committee of the Portuguese Ophthalmology Society. This is a nationwide customized web-based platform for uveitis patients useful for both clinical practice and real-world-based research, working as a central repository and reporting tool for uveitis. This paper describes the technical principles, the design and the development of a web-based interoperable registry for uveitis in Portugal and provides an overview of more than 400 patients registered in the first 18 months since inception.In infrequent diseases, the existence of registries enables to gather evidence and increase research possibilities to clinicians. The adoption of this platform enables standardization and improvement of clinical practice in uveitis. It is useful to apprehend the repercussion of medical and surgical treatments in uveitis and scleritis, supporting clinicians in the strict monitoring of drug adverse reactions and surgical outcomes.
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Affiliation(s)
- Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vanda Nogueira
- Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
| | - Diogo Bernardo Matos
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Araújo
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Olga Berens
- Ophthalmology Department, Hospital do Espírito Santo, Évora, Portugal
| | - Margarida Ribeiro
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria João Furtado
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Marco Liverani
- Ophthalmology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Marta Inês Silva
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Marta Guedes
- Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Cordeiro
- Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Ribeiro
- Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Patrícia José
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Rafael Barão
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Rui Nunes Ferreira
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Fonseca
- Ophthalmology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sofia Mano
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Susana Pina
- Ophthalmology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Maria José Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Cristina Fonseca
- Ophthalmology Department, Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís Figueira
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP) of the University of Porto, Porto, Portugal
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Ng SMS, Low R, Pak C, Lai S, Lee B, McCluskey P, Symes R, Invernizzi A, Tsui E, Sitaula RK, Kharel M, Khatri A, Utami AN, La Distia Nora R, Putera I, Sen A, Agarwal M, Mahendradas P, Biswas J, Pavesio C, Cimino L, Sobrin L, Kempen JH, Gupta V, Agrawal R. The role of a multicentre data repository in ocular inflammation: The Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS). Eye (Lond) 2023; 37:3084-3096. [PMID: 36918629 PMCID: PMC10564879 DOI: 10.1038/s41433-023-02472-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
In the current literature, clinical registry cohorts related to ocular inflammation are few and far between, and there are none involving multi-continental international data. Many existing registries comprise administrative databases, data related to specific uveitic diseases, or are designed to address a particular clinical problem. The existing data, although useful and serving their intended purposes, are segmented and may not be sufficiently robust to design prognostication tools or draw epidemiological conclusions in the field of uveitis and ocular inflammation. To solve this, we have developed the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) Clinical Registry. OASIS collects prospective and retrospective data on patients with all types of ocular inflammatory conditions from centers all around the world. It is a primarily web-based platform with alternative offline modes of access. A comprehensive set of clinical data ranging from demographics, past medical history, clinical presentation, working diagnosis to visual outcomes are collected over a range of time points. Additionally, clinical images such as optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography studies may be uploaded. Through the capturing of diverse, well-structured, and clinically meaningful data in a simplified and consistent fashion, OASIS will deliver a comprehensive and well organized data set ripe for data analysis. The applications of the registry are numerous, and include performing epidemiological analysis, monitoring drug side effects, and studying treatment safety efficacy. Furthermore, the data compiled in OASIS will be used to develop new classification and diagnostic systems, as well as treatment and prognostication guidelines for uveitis.
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Affiliation(s)
- Sean Ming Sheng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Clara Pak
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - SerSei Lai
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Richard Symes
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Alessandro Invernizzi
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA
| | - Ranju Kharel Sitaula
- Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Muna Kharel
- Nepal Army Institute of Health Sciences, Kathmandu, Nepal
| | | | | | | | | | - Alok Sen
- Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff's Charity Eye Hospital Daryaganj, New Delhi, India
| | | | | | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, 42121, Reggio Emilia, Italy
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
- Department of Ophthalmology, Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
- Sight for Souls, Fort Myers, FL, USA
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
- Singapore Eye Research Institute, The Academia, Singapore, Singapore.
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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5
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Bui TT, Rosdahl JA. Systematic Review of MIGS and Non-Penetrating Glaucoma Procedures for Uveitic Glaucoma. Semin Ophthalmol 2022; 37:830-838. [PMID: 35894683 DOI: 10.1080/08820538.2022.2102927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Minimally invasive glaucoma surgeries (MIGS) and non-penetrating glaucoma procedures have changed the surgical management of glaucoma in recent years and are being explored in the management of uveitic glaucoma. Deep sclerectomy, Xen45 gel stent, gonioscopy-assisted transluminal trabeculotomy (GATT), trabectome, and canaloplasty are described in the literature as alternative surgeries that may work for uveitic glaucoma. While most of the published studies are retrospective case series, the results suggest success even in refractory cases and with less inflammation than more traditional surgeries.
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Affiliation(s)
- Trung Thanh Bui
- Philadelphia College of Osteopathic Medicine, Moultrie, GA, USA
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6
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Murthy SI, Das AV, Kammari P, Roy A, Basu S, Fernandes M, Rathi VM, Tyagi M. Patterns of Non-Infectious Scleritis across a Tertiary Eye Care Network Using the Indigenously Developed Electronic Medical Record System-eyeSmart. Ocul Immunol Inflamm 2022; 30:1733-1739. [PMID: 34255594 DOI: 10.1080/09273948.2021.1942497] [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: 01/01/2023]
Abstract
PURPOSE To report the pattern of noninfectious scleritis across a tertiary eye-care network. METHODS A three-year retrospective review of patients diagnosed with noninfectious scleritis was performed. Data were retrieved using diagnostic terms assigned to scleritis through the in-house eyeSmart-electronic medical record system. RESULTS 1103 patients, with a mean age of 44.33 ± 14.38 years and a median follow-up of 199.5 days (range 32-685) were enrolled. Unilateral disease was noted in 85%. Diffuse anterior scleritis (n = 542, 42.51%) and nodular scleritis (n = 482, 38.12%) were the commonest subtypes. Systemic immune disease association was present in 65 (5.89%). Treatment at onset was topical corticosteroids (n = 372, 36.54%) followed by oral non-steroidal anti-inflammatory drugs (n = 351, 34.45%), oral corticosteroids in 184 (19.04%), and immunomodulators in 32 patients (3.54%). CONCLUSIONS This study depicts the pattern of various noninfectious scleritis in a large cohort of patients. The present study helped to further customize the electronic medical records to minimize several data capture limitations.
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Affiliation(s)
- Somasheila I Murthy
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad, India
| | - Priyanka Kammari
- Department of eyeSmart EMR & AEye, L. V. Prasad Eye Institute, Hyderabad, India
| | - Aravind Roy
- Department of Cornea & Anterior Segment Services, L. V. Prasad Eye Institute, Vijayawada, India
| | - Soumyava Basu
- Uveitis Service and Smt Kannuri Santhamma Vitreo-retinal Service, L. V. Prasad Eye Institute, Hyderabad, India
| | - Merle Fernandes
- Department of Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Vishakhapatnam, India
| | - Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care (GPRICARE), LVPEI, Hyderabad, India
| | - Mudit Tyagi
- Uveitis Service and Smt Kannuri Santhamma Vitreo-retinal Service, L. V. Prasad Eye Institute, Hyderabad, India
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7
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Alli HD, Ally N, Mayet I, Dangor Z, Madhi SA. Global prevalence and clinical outcomes of tubercular uveitis: a systematic review and meta-analysis. Surv Ophthalmol 2021; 67:770-792. [PMID: 34626620 DOI: 10.1016/j.survophthal.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
Tubercular uveitis (TBU) is an inflammation/infection of the eye secondary to Mycobacterium tuberculosis infection. The difficulty in making the diagnosis has resulted in variable prevalence and clinical response rates. We aimed to determine the global prevalence of TBU in uveitis patients stratified by TB high-burden countries (HBCs) and non-HBCs and by geographic regions and the clinical response of TBU to antitubercular treatment We performed a systematic review and meta-analysis of TBU studies published in PubMed, Scopus and EMBASE, up to June 30, 2020. A random effects model was used for all meta-analyses. Of 5,018 articles identified, 70 prevalence studies (65,607 uveitis and 3,166 TBU cases) and 18 clinical outcome studies (1,570 TBU cases; 1,304 responded to anti-tubercular therapy [ATT]) were analyzed. The overall weighted prevalence of TBU was 4.0% (95% CI, 3-5); in TB HBCs it was 7.0% (95% CI, 5-11), non-HBCs 3.0% (95% CI, 2-4), and sub-Saharan Africa 11.0% (95% CI, 8-15). The overall weighted clinical response was 82.0% (95% CI, 75-89). Despite the difficulty in diagnosing TBU, the prevalence is expectantly higher in HBCs, and sub-Saharan Africa and the clinical outcome is poor. Standardization of diagnostic criteria and ATT is warranted in future cohort studies.
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Affiliation(s)
- Hassan D Alli
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Naseer Ally
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ismail Mayet
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ziyaad Dangor
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Shabir A Madhi
- Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (VIDA), Faculty of Health Sciences, University of the Witwatersrand, South Africa
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8
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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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9
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Ocular manifestations of HLA B 27 associated uveitis: a study of 255 cases from a tertiary eye care centre from South India. Int Ophthalmol 2021; 41:3743-3748. [PMID: 34313928 DOI: 10.1007/s10792-021-01943-6] [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: 10/14/2020] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the clinical profile of HLA B-27-associated uveitis in Indian population. METHOD We conducted a retrospective review of medical records of 431 eyes of 255 consecutive patients with HLA B-27-associated uveitis, presented to our institute between 2012 and 2017. RESULT The study observed a male preponderance (75.7%) and the mean age of patients was 35.6 ± 13.3 years. A total of 412 (95.3%) eyes had anterior uveitis, 17(3.9%) eyes had anterior and intermediate uveitis and 3 eyes (0.7%) had intermediate uveitis. Retinal vasculitis was detected in four eyes (0.9%). A total of 176 patients (69%) in the study had evidence of systemic disease and 85% patients developed recurrences. In addition to the treatment with topical and oral steroid, immunosuppressive was required in 39.6% patients and 4% patients received biological therapy. The majority of the eyes (78.4%) had a good visual outcome, while 61 (14.2%) eyes had moderate visual impairment and 32 (7.4%) eyes had severe visual impairment at the time of final follow-up. CONCLUSION HLA-B27-associated uveitis can be associated with higher number of posterior segment involvement than it is estimated and aggressive therapy in moderate-to-severe uveitis can prevent severe visual impairment in these patients.
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10
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Guo X, Chen Z, Xing Y. Immune-mediated uveitis and lifestyle factors: A review. Ophthalmic Res 2021; 64:687-695. [PMID: 34348329 DOI: 10.1159/000518496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Xiaoyu Guo
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China,
| | - Zhen Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yiqiao Xing
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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11
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Sonoda KH, Hasegawa E, Namba K, Okada AA, Ohguro N, Goto H. Epidemiology of uveitis in Japan: a 2016 retrospective nationwide survey. Jpn J Ophthalmol 2021; 65:184-190. [PMID: 33694024 DOI: 10.1007/s10384-020-00809-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the epidemiology of uveitis in Japan and assess its changes over time. STUDY DESIGN Retrospective multicenter study METHODS: Sixty-six hospitals in Japan with uveitis specialty clinics participated in this retrospective nationwide survey. A questionnaire was sent to each hospital to survey the total number of patients who made a first visit to the outpatient uveitis clinic of each hospital between 1 April 2016 and 31 March 2017. The diagnosis of uveitis was based on guidelines when available or on commonly used diagnostic criteria. RESULTS In 2016, new patients with uveitis accounted for 3.2% of the total number of new patients with ophthalmic diseases. A total of 5378 patients were enrolled in the survey; 3408 cases could be classified with a specific uveitis entity, and 1970 cases were described as unclassified intraocular inflammation. Among the classified cases, the most frequent disease was sarcoidosis (10.6%), followed by Vogt-Koyanagi-Harada disease (8.1%), herpetic iritis (6.5%), acute anterior uveitis (5.5%), sclerouveitis (4.4%), Behçet's disease (4.2%), malignant disease (2.6%), acute retinal necrosis (1.7%), Posner-Schlossman syndrome (1.7%), and diabetic iritis (1.4%). The rates of sarcoidosis, Vogt-Koyanagi-Harada disease, and Behçet's disease were similar; however, the rate of herpes iritis increased (4.2-6.5%) when compared with the 2009 survey. CONCLUSIONS Some changes were observed between the previous nationwide surveys (2002 and 2009) and the present survey. It must be valuable to continue such nationwide epidemiologic surveys at regular intervals.
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Affiliation(s)
- Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Eiichi Hasegawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Annabelle A Okada
- Department of Ophthalmology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Nobuyuki Ohguro
- Japan Community Health Care Organization Hospital, Osaka, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo, Japan
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12
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El Jammal T, Loria O, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Sève P. Uveitis as an Open Window to Systemic Inflammatory Diseases. J Clin Med 2021; 10:E281. [PMID: 33466638 PMCID: PMC7828680 DOI: 10.3390/jcm10020281] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Spondyloarthritis (Spa), Behçet's disease (BD) and sarcoidosis are major systemic inflammatory diseases worldwide. They are all multisystem pathologies and share a possible ocular involvement, especially uveitis. We hereby describe selected cases who were referred by ophthalmologists to our internal medicine department for unexplained uveitis. Physical examination and/or the use of laboratory and imaging investigations allowed to make a diagnosis of a systemic inflammatory disease in a large proportion of patients. In our tertiary referral center, 75 patients have been diagnosed with Spa (n = 20), BD (n = 9), or sarcoidosis (n = 46) in the last two years. There was a significant delay in the diagnosis of Spa-associated uveitis. Screening strategies using Human Leukocyte Antigen (HLA)-B27 determination and sacroiliac magnetic resonance imaging in patients suffering from chronic low back pain and/or psoriasis helped in the diagnosis. BD's uveitis affects young people from both sexes and all origins and usually presents with panuveitis and retinal vasculitis. The high proportion of sarcoidosis in our population is explained by the use of chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography CT that helped to identify smaller hilar or mediastinal involvement and allowed to further investigate those patients, especially in the elderly. Our results confirm how in these sight- and potentially life-threatening diseases a prompt diagnosis is mandatory and benefits from a multidisciplinary approach.
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Affiliation(s)
- Thomas El Jammal
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Olivier Loria
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
- IMER Department, Hospices Civils de Lyon, 69424 Lyon, France
- Department of Formation and Research in Human Biology, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France
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13
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Acute bilateral granulomatous anterior uveitis as an extra-hepatic manifestation of hepatitis A virus (HAV) infection: a case report. J Ophthalmic Inflamm Infect 2020; 10:18. [PMID: 32851489 PMCID: PMC7450014 DOI: 10.1186/s12348-020-00210-6] [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: 04/01/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
Anterior uveitis (AU) is the most common form of uveitis. The differential diagnosis of AU is broad, ranging from infectious etiologies to autoimmune causes. However, approximately half remain idiopathic. Infections are the vision-threatening causes of AU which should be ruled out by history taking and detailed physical examination combined with guided work up. We report a rare case of bilateral granulomatous AU following hepatitis A virus (HAV) infection in an immunocompetent patient. A 35-year-old male presented to our center with a chief complaint of pain and redness in both eyes 3 days prior to the presentation. The patient’s medical and drug history was unremarkable. He had a history of river water consumption 20 days prior to presentation. The patient was diagnosed with acute bilateral granulomatous AU. All routine work up to investigate the etiology of the disease was unremarkable, except for the serology of acute HAV infection, which was positive. The patient was managed with the topical steroid and cycloplegic for 2 weeks with no recurrence at one-year follow up. Extra-hepatic complications of HAV were reported in previous studies including arthritis, urticaria, myocarditis, nephritis, and myositis. The mechanism of extra-hepatic complication of hepatitis A is unknown; however, immune-complex deposition is most likely the etiological cause. Our report represents a rare case of sudden onset with limited duration granulomatous AU as a presenting manifestation of HAV infection. Previous studies do not provide a direct evidence of granulomatous AU associated with the HAV infection.
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Ali S, Oo HH, Agarwal R, Khee PK. Concurrent presence of retinal hemorrhages in the setting of acute Vogt-Koyanagi-Harada syndrome - an unusual presentation. J Ophthalmic Inflamm Infect 2020; 10:12. [PMID: 32297038 PMCID: PMC7158964 DOI: 10.1186/s12348-020-00203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sowkath Ali
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Hnin Hnin Oo
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Rupesh Agarwal
- Department of Ophthalmology, Tan Tock Seng Hospital, Novena, Singapore
| | - Peh Khaik Khee
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Yishun, Singapore
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15
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Anquetil C, Salem JE, Lebrun-Vignes B, Touhami S, Desbois AC, Maalouf G, Domont F, Allenbach Y, Cacoub P, Bodaghi B, Saadoun D. Evolving spectrum of drug-induced uveitis at the era of immune checkpoint inhibitors results from the WHO's pharmacovigilance database. J Autoimmun 2020; 111:102454. [PMID: 32303423 DOI: 10.1016/j.jaut.2020.102454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Drug-induced uveitis is a rare but sight-threatening condition. We seek to determine the spectrum of drug-induced uveitis at the era of immune checkpoint inhibitors (ICI). METHODS Retrospective pharmacovigilance study based on adverse drug reactions reported within VigiBase, the WHO international pharmacovigilance database. We included deduplicated individual case safety reports (ICSRs) reported as 'uveitis' at Preferred Term level according to the Medical Dictionary for Drug Regulatory Activities between 1967 and 04/28/2019. We performed a case/non-case analysis to study if suspected drug-induced uveitis were differentially reported for each suspected treatment compared to the full database. We excluded drugs with potential indication bias. RESULTS 1404 ICSRs corresponding to 37 drugs had a significant over-reporting signal with a median age of 57 [42-68] years and 45.7% of males. We identified five major groups of treatments: bisphosphonates (26.9%), non-antiviral anti-infectious drugs (25.4%), protein kinase inhibitors (15.5%), ICI (15.0%), and antiviral drugs (11.1%). Severe visual loss was reported in 12.1% of cases. ICI and protein kinase inhibitors were the most recently emerging signals. The time to onset between first infusion and uveitis was significantly different between groups ranging from 5 days [2-19] in the bisphosphonate group to 138.5 [47.25-263.75] in protein kinase inhibitors group (p < 0.0001). Anti-Programmed Cell death 1 represented more than 70% of ICI-induced uveitis. We identified Vogt-Koyanagi-Harada (VKH)-like syndrome as being associated with ICI use. CONCLUSIONS The spectrum of drug-induced uveitis has changed with the evolution of pharmacopeia and the recent emergence of ICIs. VKH-like syndrome has been reported with ICI and protein kinase inhibitors therapy.
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Affiliation(s)
- Céline Anquetil
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS974, Paris, France
| | - Joe-Elie Salem
- Regional Pharmacovigilance Centre, Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Bénédicte Lebrun-Vignes
- Regional Pharmacovigilance Centre, Department of Pharmacology, Sorbonne Université, INSERM CIC Paris-Est, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Sara Touhami
- Department of Ophtalmology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Anne-Claire Desbois
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Georgina Maalouf
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre national de référence maladies auto-immunes systémiques rares, Centre national de référence maladies auto-inflammatoires et amylose, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunothérapie, i3, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS974, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre national de référence maladies auto-immunes systémiques rares, Centre national de référence maladies auto-inflammatoires et amylose, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunothérapie, i3, France
| | - Bahram Bodaghi
- Department of Ophtalmology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre national de référence maladies auto-immunes systémiques rares, Centre national de référence maladies auto-inflammatoires et amylose, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunothérapie, i3, France.
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16
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Zhao L, Huang X, Peng M, Tan Q, Lin W, Khan MA, Tang Q, Lin D. Sub-Tenon Sustained Controllable Delivery of Dexamethasone for Treating Severe Acute Experimental Uveitis. Ocul Immunol Inflamm 2019; 28:984-993. [PMID: 31429619 DOI: 10.1080/09273948.2019.1643027] [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: 10/26/2022]
Abstract
PURPOSE To evaluate the efficacy of dexamethasone (DXM) through sub-tenon sustained controllable drug delivery system (SSCDDS) for treating severe acute experimental uveitis. METHODS Rabbits were treated with either DXM (treated group) or normal saline (control group) through SSCDDS. Clinical signs of uveitis were assessed at days 1, 3, 5, 7, and 14 after treatment. Histopathologic examinations were performed to evaluate inflammatory cell infiltration on posttreatment days 7 and 14. RESULTS All signs of experimental uveitis were reduced by SSCDDS of DXM according to clinical criteria, and the treated group had significantly less inflammation than the control group (p<0.05). Histopathologic examinations showed severe inflammation and marked inflammatory cell infiltration in the control group, but minimal inflammation in the treated group. CONCLUSIONS Sub-tenon sustained controllable delivery of DXM effectively suppresses severe acute inflammation in a rabbit model of uveitis. The proposed minimal invasive system might be a promising candidate for managing severe ocular diseases.
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Affiliation(s)
- Libei Zhao
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Xuetao Huang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Manqiang Peng
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Qian Tan
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Wenxiang Lin
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Muhammad Ahmad Khan
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Qiongyan Tang
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Ding Lin
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
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17
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Low R, Chen EJ, Bin Ismail MA, Mi H, Ling HS, Lim WK, Teoh SC, Agrawal R. Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) - Report 2: Pattern of Uveitis Investigations in Singapore. Ocul Immunol Inflamm 2018; 28:92-99. [PMID: 30335550 DOI: 10.1080/09273948.2018.1535080] [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: 10/28/2022]
Abstract
Purpose: To analyze the pattern of laboratory investigations of uveitis at a tertiary referral eye care center in Singapore.Methods: Retrospective analysis of 2040 uveitis cases from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database over a 12-year period (2004 - 2015).Results: Patients with retinal vasculitis (RV) had the most tests utilized per patient (6.79), followed by intermediate uveitis (IU) (5.25), panuveitis (Pan) (5.12), posterior uveitis (PU) (4.17), anterior uveitis (AU) (2.75), and keratouveitis (KU) (1.10). The most frequently utilized test for infective etiology were the VDRL (41.3%), Syphilis IgG (29.5%), and T-SPOT.TB (24.6%). For autoimmune tests, ANA was most utilized (18.2%), followed by anti-dsDNA (14.8%), and HLA-B27 (12.4%).Conclusion: There was high utilization of autoimmune tests such as ANA, anti-dsDNA, RF, and ANCA, despite its limited yield. Rationalization of investigations in patients with ocular inflammation via a stepladder approach may help optimize the use of limited resources.
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Affiliation(s)
- Rebecca Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elizabeth J Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Helen Mi
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ho Su Ling
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Kiak Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Eagle Eye Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Stephen C Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Eagle Eye Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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18
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Todokoro D, Mochizuki K, Nishida T, Eguchi H, Miyamoto T, Hattori T, Suzuki T, Inoue T, Nejima R, Hoshi S, Akiyama H. Isolates and antibiotic susceptibilities of endogenous bacterial endophthalmitis: A retrospective multicenter study in Japan. J Infect Chemother 2018; 24:458-462. [PMID: 29487034 DOI: 10.1016/j.jiac.2018.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/16/2017] [Accepted: 01/25/2018] [Indexed: 01/05/2023]
Abstract
Endogenous bacterial endophthalmitis, also called metastatic endophthalmitis, is a rare bacterial endophthalmitis derived from distant infectious foci via the bloodstream. This infection can potentially cause not only severe visual disturbance, but also loss of the eyeball or death, as most patients are immunocompromised. This retrospective Japanese multicenter study analyzed 32 eyes in 25 definitive cases. Twelve patients (48.0%) had diabetes mellitus. Typical ocular findings were vitreous haze (87.5%), cells in the anterior chambers (62.5%) and retinal infiltrates (50.0%). Elevated body temperature (64.0%), high serum C-reactive protein (96.0%) and leukocytosis (52.0%) were also frequently observed. Culture positivity rates for intraocular fluid were higher in the vitreous (62.5%) versus aqueous humor (28.6%). High positivity rates were also observed for blood (57.1%) and central venous catheters (100%). The most common pathogen was Staphylococcus aureus (10 cases), including methicillin-resistant S. aureus (4 cases). The next most common pathogen was Klebsiella pneumoniae (7 cases), which was highly associated with liver abscess. Compared to a previous 1991 national multicenter study, there has been a fourfold increase in the ratio of S. aureus. Antibiotic susceptibility tests revealed that all Gram-positives were susceptible to vancomycin and all Gram-negatives were susceptible to third-generation cephalosporins, imipenem/cilastatin, gentamycin and levofloxacin. Prognostic factors influencing poor visual outcome included poor initial visual acuity (p < 0.01), K. pneumoniae (p = 0.027) and gram-negative bacteria (p = 0.014) as the causative bacteria. Intravitreal antibiotic injection in combination with vancomycin and ceftazidime may be applicable for use as part of the standard treatment regimen for EBE.
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Affiliation(s)
- Daisuke Todokoro
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Takashi Nishida
- Department of Ophthalmology, Gifu University School of Medicine, Japan
| | - Hiroshi Eguchi
- Department of Ophthalmology, Sakai Hospital Kindai University, Japan
| | - Tatsuro Miyamoto
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Takaaki Hattori
- Hattori Clinic, Japan; Department of Ophthalmology, Tokyo Medical University, Japan
| | - Takashi Suzuki
- Ishizuchi Eye Clinic, Japan; Department of Ophthalmology, Toho University Omori Medical Center, Japan
| | | | | | | | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan
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Lee JH, Mi H, Lim R, Ho SL, Lim WK, Teoh SC, Agrawal R. Ocular Autoimmune Systemic Inflammatory Infectious Study - Report 3: Posterior and Panuveitis. Ocul Immunol Inflamm 2017; 27:89-98. [PMID: 28991501 DOI: 10.1080/09273948.2017.1358377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To report the pattern of posterior and panuveitis at a tertiary referral center in Singapore. METHODS Subgroup retrospective analysis of 334 new posterior and panuveitis cases, from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database. Descriptive analysis was performed and visual outcome and complications were reported. RESULTS The etiology for posterior uveitis and panuveitis was infectious in 162 patients (48.5%), non-infectious in 144 patients (43.1%), and idiopathic in 28 patients (8.4%). More patients with bilateral disease had a non-infectious etiology (n = 82, 50.9%) (p = 0.012). The most common complication was epiretinal membrane (n = 20, 12.3%) for the infectious group and cystoid macular edema (n = 12, 8.3%) for the non-infectious group. CONCLUSIONS The proportion of etiologies in our cohort varies from other studies. Understanding the variations and demographic associations allows the diagnosis and management of posterior and panuveitis to be further improved.
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Affiliation(s)
- Joanne H Lee
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore
| | - Helen Mi
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| | - Rachel Lim
- c Singapore National Eye Centre , Singapore , Singapore
| | - Su Ling Ho
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| | - Wee Kiak Lim
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore.,d Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore , Singapore
| | - Stephen C Teoh
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore.,d Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore , Singapore
| | - Rupesh Agrawal
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore.,b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
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