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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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Dhirachaikulpanich D, Chanthongdee K, Zheng Y, Beare NAV. A systematic review of OCT and OCT angiography in retinal vasculitis. J Ophthalmic Inflamm Infect 2023; 13:1. [PMID: 36715778 PMCID: PMC9886715 DOI: 10.1186/s12348-023-00327-4] [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: 09/19/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Retinal vasculitis is a component of uveitis for which the Standardisation of Uveitis Nomenclature (SUN) working group has no standard diagnostic criteria or severity grading. Fluorescein angiography is the gold standard test to assess retinal vasculitis, but is invasive and time-consuming. Optical coherence tomography (OCT) provides non-invasive detailed imaging of retinal structures and abnormalities, including blood vessel architecture and flow with OCT angiography (OCT-A). However, use of OCT in retinal vasculitis beyond assessing macular oedema, is not well established. We conducted a systematic review to understand the features of retinal vasculitis in OCT, Enhanced-depth imaging OCT (OCT-EDI) and OCT-A imaging. METHODS The systematic search was done in March 2022 and updated in January 2023, through PubMed, EMBASE and the Web of Science database for studies related to OCT, OCT-EDI and OCT-A findings and retinal vasculitis. Bias assessment was assessed using JBI Critical Appraisal Checklist, and any findings associated with retinal vasculitis were extracted by qualitative analysis. RESULTS We identified 20 studies, including 8 articles on OCT, 6 on OCT-EDI and 6 on OCT-A. The studies included analytical retrospective studies, case-series, and a case-control study. Five OCT studies reported secondary complications could be detected, and four reported retinal thickness alteration in retinal vasculitis. Five studies explored choroidal thickness alteration in OCT-EDI, and four explored capillary density alterations in retinal vasculitis using OCT-A. The heterogeneity in the studies' analysis and design precluded a meta-analysis. DISCUSSION There were no clear OCT, OCT-EDI or OCT-A findings that demonstrated potential to supersede fluorescein angiography for assessing retinal vasculitis. Some signs of macular structural effects secondary to retinal vasculitis may help prognostication for vision. The OCT signs of inflamed retinal vessels and perivascular tissue is an unexplored area.
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Affiliation(s)
- Dhanach Dhirachaikulpanich
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.416009.aFaculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanat Chanthongdee
- grid.10223.320000 0004 1937 0490Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yalin Zheng
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.415992.20000 0004 0398 7066Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nicholas A. V. Beare
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.10025.360000 0004 1936 8470St Paul’s Eye Unit, Liverpool University Hospitals NHS Trust, Liverpool, UK
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3
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Miguel VM, Felipe RS, Claudia ZP, Anurag S, Kira L, Marlon GR, Veronica RM, Yolanda VG, Sonia CC. Retinal arterial occlusive vasculitis following IgA nephropathy: A case report. Eur J Ophthalmol 2022:11206721221111688. [PMID: 35791520 DOI: 10.1177/11206721221111688] [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: 11/15/2022]
Abstract
PURPOSE To discuss diagnosis and management in the case of a patient presenting with bilateral ischemic retinal vasculopathy associated with a previously undiagnosed IgA nephropathy. CASE REPORT In 2021, a 35-year-old male presented with a sudden onset asymmetric bilateral (OU) visual loss. Best-corrected visual acuity (BCVA) was 20/200 OD, and no light perception (NLP) OS with an associated relative afferent pupillary defect (RAPD). Slit-lamp examination (SLE) confirmed normal anterior segment anatomy OU. Indirect ophthalmoscopy and subsequent fluorescein angiography (FA) confirmed the presence of bilateral arterial attenuation, telangiectatic lesions, associated perivascular sheathing, and capillary leakage. Spectral domain optical coherence tomography (OCT) showed multiple areas of thinning of the inner retina. This constellation of diagnostic findings was highly suggestive of a bilateral ischemic retinal vasculopathy with an inflammatory vasculitis. Based on a high index of suspicion for a systemic etiology, nephrology was consulted, and a diagnosis of IgA nephropathy was confirmed by renal biopsy. Systemic immunomodulatory therapy was initiated. CONCLUSION Although it is among the most commonly occurring forms of glomerulonephritis leading to renal failure, IgA nephropathy rarely presents with a bilateral retinal vasculopathy. Schölein - Henoch purpura, the other primary disease associated with glomerular IgA deposition, may be indistinguishable from primary IgA nephropathy. A comprehensive retinal examination with multimodal functional and structural ophthalmic diagnostic testing in conjunction with renal biopsy was needed to confirm the diagnosis. It is critical to include primary renal pathology when formulating a differential diagnosis for cases of bilateral retinal vasculitis, particularly in young otherwise healthy patients.
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Affiliation(s)
| | - Ramírez-Solís Felipe
- Retina and Vitreous Department, Instituto Mexicano de Oftalmologia (IMO), Queretaro, Mexico
| | - Zepeda-Palacio Claudia
- Retina and Vitreous Department, Instituto Mexicano de Oftalmologia (IMO), Queretaro, Mexico
| | - Shrivastava Anurag
- Department of Ophthalmology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lin Kira
- Department of Ophthalmology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garcia-Roa Marlon
- Retina and Vitreous Department, Instituto Mexicano de Oftalmologia (IMO), Queretaro, Mexico
| | | | | | - Corredor-Casas Sonia
- Head of Pathology Department, Instituto Mexicano de Oftalmologia (IMO), Queretaro, Mexico
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Affiliation(s)
- Emmett T. Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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Shanmugam VK, Phillpotts M, Brady T, Dalal M, Haji-Momenian S, Akin E, Nataranjan K, McNish S, Karcher DS. Retinal vasculitis with Chronic Recurrent Multifocal Osteomyelitis: a case report and review of the literature. BMC Rheumatol 2019; 3:29. [PMID: 31388650 PMCID: PMC6676622 DOI: 10.1186/s41927-019-0076-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background Concurrent presentation of retinal vasculitis with mixed sclerotic and lytic bone lesions is rare. Case presentation We present the case of a 37-year old woman with a several year history of episodic sternoclavicular pain who presented for rheumatologic evaluation due to a recent diagnosis of retinal vasculitis. We review the differential diagnosis of retinal vasculitis, along with the differential diagnosis of mixed sclerotic and lytic bone lesions. Ultimately, bone marrow biopsy confirmed diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). Concurrent presentation of CRMO with retinal vasculitis is extremely rare but important to recognize. The patient demonstrated clinical response to prednisone and tumor necrosis factor-alpha inhibition (TNF-i). Conclusion This case reports and unusual presentation of CRMO spectrum disease involving the sternum and sternoclavicular joint with concurrent retinal vasculitis.
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Affiliation(s)
- Victoria K Shanmugam
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Marc Phillpotts
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Timothy Brady
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Monica Dalal
- 2Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Shawn Haji-Momenian
- 3Department of Radiology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Esma Akin
- 3Department of Radiology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Kavita Nataranjan
- 4Department of Hematology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Sean McNish
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Donald S Karcher
- 5Department of Pathology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
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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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Matet A, Paris L, Fardeau C, Terrada C, Champion E, Fekkar A, Cassoux N, Touitou V, LeHoang P, Bodaghi B. Clinical and Biological Factors Associated With Recurrences of Severe Toxoplasmic Retinochoroiditis Confirmed by Aqueous Humor Analysis. Am J Ophthalmol 2019; 199:82-93. [PMID: 30502335 DOI: 10.1016/j.ajo.2018.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate clinical and biological factors influencing recurrences of severe toxoplasmic retinochoroiditis (TRC) confirmed by aqueous humor analysis. DESIGN Retrospective case series. METHODS Retrospective analysis of 87 subjects with severe TRC, proven by positive Goldmann-Witmer coefficient (GWC), Toxoplasma gondii (T. gondii) immunoblot, or T. gondii-specific polymerase chain reaction (PCR) in aqueous humor. Cases with immunosuppression or retinal scars without previous recorded episode were excluded. Time-dependent, clinical, treatment-related, and biological factors were explored by univariate and multivariate shared frailty survival analyses. RESULTS Among 44 included subjects (age, 40.4 ± 17.6 years; follow-up, 8.3 ± 2.7 years), 22 presented recurrences. There was 0.11 recurrence/patient/year and mean disease-free interval was 5.0 ± 2.9 years. The risk of recurrence was higher immediately after an episode (P < .0001). Among recurrent cases, the risk of multiple recurrences was higher when the first recurrence occurred after longer disease-free intervals (P = .046). In univariate analysis, the recurrence risk declined with higher number of intense bands on aqueous T. gondii immunoblot (P = .006), and increased when venous vasculitis was present initially (P = .019). Multivariate analysis confirmed that eyes with more intense bands on immunoblot had fewer recurrences (P = .041). There was a near-significant risk elevation after pyrimethamine/azithromycin treatment (P = .078 and P = .054, univariate and multivariate). Intravenous corticosteroid administration, oral corticosteroid administration, aqueous GWC, and T. gondii PCR did not influence recurrences (P = .12, P = .10, P = .39, and P = .96, respectively). CONCLUSIONS Recurrences of severe TRC are not random and may be influenced by clinical and biological factors possibly related to blood-retinal barrier alterations. These results may contribute to identifying biomarkers for TRC reactivation.
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MESH Headings
- Administration, Oral
- Adolescent
- Adult
- Aged
- Antibodies, Protozoan/immunology
- Aqueous Humor/parasitology
- Biological Factors
- Chorioretinitis/diagnosis
- Chorioretinitis/genetics
- Chorioretinitis/immunology
- Chorioretinitis/parasitology
- DNA, Protozoan/genetics
- Eye Infections, Parasitic/diagnosis
- Eye Infections, Parasitic/genetics
- Eye Infections, Parasitic/immunology
- Eye Infections, Parasitic/parasitology
- Female
- Follow-Up Studies
- Glucocorticoids/administration & dosage
- Humans
- Immunoblotting
- Infusions, Intravenous
- Male
- Middle Aged
- Polymerase Chain Reaction
- Recurrence
- Retrospective Studies
- Toxoplasma/genetics
- Toxoplasma/immunology
- Toxoplasmosis, Ocular/diagnosis
- Toxoplasmosis, Ocular/genetics
- Toxoplasmosis, Ocular/immunology
- Toxoplasmosis, Ocular/parasitology
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Affiliation(s)
- Alexandre Matet
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France.
| | - Luc Paris
- Parasitology Department, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Christine Fardeau
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Céline Terrada
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Emmanuelle Champion
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Arnaud Fekkar
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Nathalie Cassoux
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Valérie Touitou
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Phuc LeHoang
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
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Gao Y, Lyu S, Bao L, Zhang M. Sudden unilateral vision loss in an adult with Behcet disease: A case report. Medicine (Baltimore) 2018; 97:e13594. [PMID: 30558031 PMCID: PMC6320199 DOI: 10.1097/md.0000000000013594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Behcet disease is an autoimmune vasculitis, involving multiple systems and organs. It is often chronic and recurrent, and involves all levels of arteries and veins. PATIENT CONCERNS A 40-year-old Chinese male with sudden vision loss in his right eye for 3 days was reported. DIAGNOSES The patient was diagnosed as bilateral uveitis (obstructive retinal vasculitis in the right eye) and Behcet disease. INTERVENTIONS The patient was given topical corticosteroids and compound tropicamide eye drops in our department. In addition, he was also hospitalized in the Rheumatology Department, and received systemic infusion of methylprednisolone and cyclophosphamide. OUTCOMES Best corrected visual acuity vision acuity of the left eye was 20/20 and that of the right eye was no light perception after 2 weeks. During the telephonic follow-up after 1 year, the patient reported 2 recurrent episodes of uveitis in the left eye, which improved after treatment at the local hospital. LESSONS It cautions ophthalmologists of the high possibility of vasculitis in young and middle-aged patients with retinal vascular occlusion. It also reminds the ophthalmologists investigate systemic diseases, and obtain detailed medical history, not just depending on specific laboratory findings. This case further suggests that Behcet disease has diverse manifestations, complex diagnosis, and severe lesions, and the recurrence rate must be controlled to minimize irreversible consequences such as sudden vision loss during recurrence.
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Affiliation(s)
- Yunxia Gao
- Department of Ophthalmology, Sichuan University West China Hospital, Sichuan, China
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Sheemar A, Temkar S, Takkar B, Sood R, Sinha S, Chawla R, Vohra R, Venkatesh P. Ultra-Wide Field Imaging Characteristics of Primary Retinal Vasculitis: Risk Factors for Retinal Neovascularization. Ocul Immunol Inflamm 2018; 27:383-388. [PMID: 30207804 DOI: 10.1080/09273948.2018.1508729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: To evaluate patterns of retinal vasculitis with ultra-wide field imaging (UWF) and ascertain the risk factors for retinal neovascularization. Methods: Consecutive patients of retinal vasculitis were included prospectively. Patients with retinal vasculitis secondary to uveitis were excluded. UWF was done for all the patients. Retinal involvement was classified into three zones and area of capillary non-perfusion was stratified into clock hours. Results: Two hundred patients were included, 85% (n = 170) were male. Mean age was 28.99 ± 10.56 years. Clinical examination revealed 65% cases (n = 130) to be bilateral, while UWF angiography detected 72.5% (n = 145) to have bilateral involvement. Retinal neovascularization was present in 47% (n = 188).Presence of posterior disease had very high odds ratio for development of retinal neovascularization as compared to cases restricted to retinal periphery (OR = 45.03, CI = 6.10-332.30, p = < 0.001). Conclusion: UWF imaging is useful in detecting retinal vasculitis, which is otherwise obscure to clinical examination and assessing risk factors for retinal neovascularization.
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Affiliation(s)
- Abhishek Sheemar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Shreyas Temkar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Brijesh Takkar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rita Sood
- b Department of Medicine , All India Institute of Medical Sciences , New Delhi , India
| | - Sanjeev Sinha
- b Department of Medicine , All India Institute of Medical Sciences , New Delhi , India
| | - Rohan Chawla
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rajpal Vohra
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Pradeep Venkatesh
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
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Abstract
Retinal vasculitis (RV) is an inflammation of retinal blood vessels that can be associated with uveitis or be isolated, and can induce vascular occlusion and retinal ischemia. Visual acuity can be severely affected in case of macular involvement or neovessel formation. The diagnosis relies on fundoscopy and fluorescein angiography. Systemic diseases may be associated with RV, the most frequently encountered are Behçet's disease, sarcoidosis or multiple sclerosis, all predominantly associated with venous involvement, whereas systemic lupus erythematosus and necrotizing vasculitis are less frequently observed and predominantly associated with arterial or mixed vasculitis. Treatments are usually aggressive in order to preserve a good visual acuity and to reduce retinal inflammation and chronic ischemia. Steroids, immunosuppressive drugs, retinal laser photocoagulation, intravitreal anti-VEGF injections are usual treatments and more recently, anti-TNFalpha monoclonal therapeutic antibodies have been shown to be very successful.
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12
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New imaging techniques in retinal vasculitis. Med Clin (Barc) 2017; 149:261-266. [PMID: 28687121 DOI: 10.1016/j.medcli.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 11/21/2022]
Abstract
The term retinal vasculitis (RV) encompasses a heterogeneous group of sight-threatening conditions that are included in the intraocular inflammatory diseases that affect the posterior segment of the eye. Based on the nature of the inflammatory process, RV are classified into predominantly inflammatory or ischaemic (occlusive RV). The diagnosis is clinical and the aetiology can be infectious or non-infectious (immune-mediated). RV can be an isolated ocular syndrome or be associated with a systemic disease, of which they can represent the first manifestation. New retinal imaging techniques such as ultra-wide field fluorescein angiography and optical coherence tomography angiography will help us classify the RV and aid the diagnostic process, which can be challenging and require a multidisciplinary approach. Therefore, clinical knowledge of RV is essential for prompt diagnosis and to establish the appropriate treatment.
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Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, Thorne JE. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol 2017; 179:171-178. [PMID: 28501390 DOI: 10.1016/j.ajo.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the incidence rates of visual loss and ocular complications in patients with retinal vasculitis (RV). DESIGN Retrospective cohort study. METHODS Clinical data were collected for 96 patients (175 eyes) diagnosed with RV from 2003 to 2013. Main outcome measures included rates of visual loss and ocular complications. Comparison of outcomes in patients with a relapsing vs nonrelapsing disease also were analyzed. RESULTS Over a median follow-up of 44 months (range: 1-153 months), the rate of visual loss to 20/50 or worse was 0.13 per eye-year (/EY, 95% confidence interval [CI], 0.09/EY to 0.18/EY) and to 20/200 or worse was 0.06/EY (95% CI, 0.04/EY to 0.08/EY). The most common complications were cataract (0.31/EY), epiretinal membrane (0.16/EY), and recurrent macular edema (0.09/EY). Patients with a relapsing course (median number of relapses = 1, range: 1-6) appeared to have greater risk for visual loss to 20/50 (odds ratio [OR] = 2.07; 95% CI, 0.88-4.90, P = .09) and 20/200 or worse (OR = 2.49; 95% CI, 0.98-6.30, P = .05). Immunosuppressive drug therapy lowered the risk of visual loss, independent of relapsing disease course (OR = 0.79; 95% CI, 0.66-0.94, P = .01 and OR = 0.73; 95% CI, 0.57-0.93, P = .01 for the 20/50 or worse and 20/200 or worse thresholds, respectively). CONCLUSIONS Rates of visual loss and complications among patients with RV were similar to reported rates in noninfectious uveitides. Treatment with immunosuppressive drugs lowered the risk of visual loss. A relapsing course suggested an increased risk for visual loss but was not statistically significant, perhaps owing to low numbers of recurrences.
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14
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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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Abstract
PURPOSE OF REVIEW Ophthalmologists and rheumatologists frequently have a miscommunication among themselves, and as a result differ in their opinion for patients consulting them with retinal vasculitis. This report seeks to establish a common understanding of the term, retinal vasculitis, and to review recent studies on this diagnosis. RECENT FINDINGS The genetic basis of some rare forms of retinal vascular disease has recently been described. Identified genes include CAPN5, TREX1, and TNFAIP3; Behçet's disease is a systemic illness that is very commonly associated with occlusive retinal vasculitis; retinal imaging, including fluorescein angiography and other newer imaging modalities, has proven crucial to the identification and characterization of retinal vasculitis and its complications; although monoclonal antibodies to interleukin-17A or interleukin-1 beta failed in trials for Behçet's disease, antibodies to TNF-alpha, either infliximab or adalimumab, have demonstrated consistent benefit in managing this disease. Interferon treatment and B-cell depletion therapy via rituximab may be beneficial in certain types of retinal vasculitis. SUMMARY Retinal vasculitis is an important entity for rheumatologists to understand. Retinal vasculitis associated with Behçet's disease responds to monoclonal antibodies that neutralize TNF, but the many other forms of noninfectious retinal vasculitis may require alternate therapeutic management.
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16
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Bazvand F, Zarei M, Ebrahimiadib N, Karkhaneh R, Davoudi S, Soleimanzadeh M, Sharifian E, Roohipoor R, Modjtahedi BS. Ocular Manifestations, Conventional Fundus Fluorescein Angiographic Findings, and Relationship Between Angiographic Findings and Visual Acuity in Behçet's Disease. Semin Ophthalmol 2016; 32:764-771. [PMID: 27715380 DOI: 10.1080/08820538.2016.1178310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Evaluating the ocular manifestation and fundus fluorescein angiography (FA) findings of patients with Behçet's disease as well as the relationship between visual acuity and angiographic findings. METHODS Retrospective chart review of patients with Behçet's disease seen at the Farabi Eye Hospital. RESULTS Forty-six patients (92 eyes) with mean age of 33.41 ± 10.67 were included. The most frequent presenting symptom and sign were reduced vision (76%) and uveitis (87%), respectively. Panuveitis was the most frequent type of uveitis (76%). Among patients with FA, vasculitis was the most common finding (87%) and it was significantly more severe among patients with visual acuity less than 20/200. Macular leakage (P = 0.001), arterial narrowing (P = 0.000), and posterior retinal vasculitis (P = 0.002) on FA were all associated with worsening final visual acuity. CONCLUSION The most common ocular findings in Behçet's disease were panuveitis and vasculitis. Location of vasculitis, arterial narrowing, and macular leakage on initial FA may predict visual prognosis.
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Affiliation(s)
- Fatemeh Bazvand
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Zarei
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Nazanin Ebrahimiadib
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Reza Karkhaneh
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Samaneh Davoudi
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Mahyar Soleimanzadeh
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Elaheh Sharifian
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Ramak Roohipoor
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Bobeck S Modjtahedi
- b Retina Service, Department of Ophthalmology , Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
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