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Ngo WK, Spaide RF. PRIMARY OCCLUSIVE PANVASCULITIS WITH SEGMENTAL PERIARTERIAL PLAQUES. Retin Cases Brief Rep 2024; 18:1-5. [PMID: 36007193 DOI: 10.1097/icb.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to describe a new clinical entity of bilateral occlusive panvasculitis with segmental periarterial plaques and its clinical course in two patients. METHODS This was a retrospective chart review. RESULTS Two patients with no medical history of any systemic inflammatory diseases presented with bilateral segmental periarterial plaques (Kyrieleis plaques), cotton wool spots, and microaneurysms. Segmental leakage, staining, and vascular occlusions involved the arterioles, venules, and capillaries. Leakage from the superficial capillary plexus in some areas bordering deep capillary plexus nonperfusion was observed. Both had recurrent episodes of vascular occlusions, normal brain MRI, and audiology tests. Complete workup including serology for infections, inflammatory markers, and antibody titers was unremarkable. They were started on with corticosteroids and immunosuppressant, and there were no further vascular occlusions. Both developed neovascularization adjacent to the areas of capillary nonperfusion. The second patient also developed vitreomacular traction and cystoid macular edema. He required intravitreal anti-VEGF injection, sector laser photocoagulation, and underwent a vitrectomy with membrane peeling. At the last visit, the visual acuity was 20/30 in both eyes for the first patient and 20/20 in the right eye and 20/40 in the left eye for the second patient, 12 and 6.5 years after initial presentation, respectively. CONCLUSION Both patients presented with findings of bilateral panvasculitis with prominent segmental periarterial plaques and had repeated episodes of vascular occlusions before corticosteroid and immunosuppressants treatment, after which no additional occlusions were observed. We propose that the constellation of findings constitutes a novel clinical entity, occlusive panvasculitis with segmental periarterial plaques.
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Affiliation(s)
- Wei Kiong Ngo
- Vitreous Retina Macula Consultants of New York, New York, New York
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Mahjoub A, Ben Abdesslem N, Zaafrane N, Sellem I, Sahraoui F, Nouri H, Hadj RB, Ben Alaya A, Krifa F, Hachemi M. Kyrieleis arteritis associated with toxoplasmic retinochoroiditis: A case report. Ann Med Surg (Lond) 2022; 78:103802. [PMID: 35734750 PMCID: PMC9206901 DOI: 10.1016/j.amsu.2022.103802] [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: 04/08/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 10/25/2022] Open
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Makri OE, Tsekouras IK, Leonidou L, Kagkelaris K, Kozobolis V, Georgakopoulos CD. Kyrieleis Arteriolitis Associated with Acute Retinal Necrosis due to Herpes Simplex Virus Type 1 Secondary to Herpetic Encephalitis. Vision (Basel) 2022; 6:vision6020027. [PMID: 35645381 PMCID: PMC9149933 DOI: 10.3390/vision6020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 52-year-old woman who presented to the emergency department with acute retinal necrosis in her left eye secondary to herpes simplex virus type 1 encephalitis for which she had been hospitalized four months before. Treatment with intravitreal foscarnet and intravenous acyclovir was promptly commenced followed by the addition of oral prednisolone. PCR analysis of aqueous humor detected HSV type 1 DNA. The condition responded to therapy with partial resolution of intraocular inflammation and improvement of visual acuity, but the presence of Kyrieleis plaques was observed two weeks after the initiation of treatment, when five intravitreal foscarnet injections had been administered. The patient was switched to oral therapy with valacyclovir, and 10 weeks after commencing treatment, the patient’s left eye was free of inflammation, having achieved a BCVA of 20/20. Oral steroid treatment was gradually tapered off, and the patient was instructed to remain on prophylactic antiviral therapy. Kyrieleis arteriolitis is an uncommon finding in the context of acute retinal necrosis. As far as we are aware, we report the first case of Kyrieleis arteriolitis in acute retinal necrosis secondary to viral encephalitis and the second one presenting Kyrieleis plaques in acute retinal necrosis caused by herpes simplex virus type 1. Prior reports of cases of Kyrieleis arteriolitis in acute retinal necrosis are also presented.
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Affiliation(s)
- Olga E. Makri
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Iasonas K. Tsekouras
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Leonidia Leonidou
- Internal Medicine, Department of Internal Medicine, Patras University Hospital, 265 04 Patras, Greece;
| | - Konstantinos Kagkelaris
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Vassilios Kozobolis
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Constantinos D. Georgakopoulos
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
- Correspondence:
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Cicinelli MV, Sadiq SA, Mishra S, Jampol LM, Mirza RG. Multimodal Imaging Characterization of Arteriolosclerotic Plaques in Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2021; 52:650-657. [PMID: 34908486 DOI: 10.3928/23258160-20211118-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the multimodal imaging features and the clinical associations of arteriolosclerotic plaques in patients with retinal vein occlusion (RVO). MATERIALS AND METHODS This was a retrospective case series of patients with RVO. Demographic and clinical characteristics were recorded at the time of RVO for each participant. Best-corrected visual acuity and central macular thickness were collected at baseline and observed for 1 year. Arteriolosclerotic plaques were identified on multimodal imaging, and their imaging features were summarized. Differences in demographic and clinical characteristics between eyes with arteriolosclerotic plaques and those with no arteriolosclerotic plaques were reported. RESULTS Seventy-five eyes of 75 patients (39 males; mean age, 72.5 years) were included. Arteriolosclerotic plaques were identified in nine eyes (12%) as segmental, yellow, ill-defined creamy lesions in the arterioles' walls. Baseline macular edema was worse in eyes with arteriolosclerotic plaques than in eyes with no plaques (716.5 μm vs 539.7 μm). Arteriolosclerotic plaques did not interfere with blood flow and regressed in three eyes (33%). Eyes with plaques had worse best-corrected visual acuity (P < .001) and lower central macular thickness (P = .02) at 12 months than did eyes with RVO and no plaques. CONCLUSIONS Arteriolosclerotic plaques suggest an ischemic or inflammatory involvement of the arteriolar branches in eyes with RVO and are associated with severe macular damage. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:650-657.].
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EVALUATION OF SEGMENTAL RETINAL ARTERITIS WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retin Cases Brief Rep 2021; 15:688-693. [PMID: 31313702 DOI: 10.1097/icb.0000000000000900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the vascular anatomy and intraluminal flow characteristics of segmental retinal arteritis (SRA) using structural and angiographic optical coherence tomography (OCT). METHODS Retrospective case series of consecutive patients presenting with SRA. All patients were evaluated at presentation with fundus photography, spectral domain OCT, and OCT angiography. One patient was imaged with dense B-scan OCT angiography. RESULTS Three eyes of three male patients were evaluated. All examinations were consistent with reactivation of ocular toxoplasmosis with an area of active retinochoroiditis adjacent to a focal chorioretinal scar. Spectral domain OCT through areas of SRA noted on clinical examination demonstrated areas of hyperreflectivity circumscribing the affected vessel with a normoreflective lumen. Optical coherence tomography angiography and dense B-scan OCT angiography demonstrated narrowing of the intraluminal flow signal that correlated with areas of segmental hyperreflectivity on spectral domain OCT. Vascular sections proximal and distal to areas of SRA showed normal flow signal. CONCLUSION Vessels with SRA demonstrated hyperreflectivity highlighting the vessel wall on spectral domain OCT. Optical coherence tomography angiography showed narrowing of the flow signal within these segments suggesting reduced lumen diameter. Coupling these finding with previous indocyanine green imaging findings in SRA, the collective data suggest the plaques are localized within the vessel wall to either the endothelium or the muscular tunica media without occlusion of the vessel lumen.
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Pichi F, Veronese C, Lembo A, Invernizzi A, Mantovani A, Herbort CP, Cunningham ET, Morara M, Ricci F, Neri P, Nucci P, Ciardella AP, Staurenghi G, Lowder CY, Srivastava SK. New appraisals of Kyrieleis plaques: a multimodal imaging study. Br J Ophthalmol 2016; 101:316-321. [PMID: 27267451 DOI: 10.1136/bjophthalmol-2015-308246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/16/2016] [Accepted: 05/11/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE Kyrieleis retinal periarteritis reflects the severe intraocular inflammation experienced by the eye. Its aetiology has not been well established, since only nine cases have been reported and there is no pathological study available in the literature. We determine the pathogenesis of Kyrieleis periarteritis based on interpretation of multimodal imaging findings. METHODS Charts of patients with Kyrieleis arteritis seen between 2006 and 2014 were retrieved from eight uveitis referral centres throughout the world. Follow-up ranged from 5 to 12 months. RESULTS Twenty-five eyes with Kyrieleis arteritis from 25 patients were included in the study. Nineteen patients (72%) were male and six (28%) were female. Twenty-three patients were diagnosed with toxoplasmosis retinochoroiditis and two patients had cytomegalovirus retinitis. Fluorescein angiography, fundus autofluorescence and indocyanine green angiography were performed on 25/25 (100%) eyes. In eight eyes (32%), baseline spectral domain optical coherence tomography (SD-OCT) scans were performed along the segmental Kyrieleis arteritis. Fluorescein angiography showed early hypofluorescence and intermediate hyperfluorescence associated with the areas of focal arteritis, whereas indocyanine green angiography of these accumulations showed early hypofluorescence and late hyperfluorescence. Fundus autofluorescence revealed an increased autofluorescence of the vessels corresponding to the Kyrieleis plaques, while SD-OCT scans along the segmental Kyrieleis arteritis showed hyperreflectivity of the vessel wall. CONCLUSIONS These imaging modalities provide in vivo, quasi-histologic images demonstrating that Kyrieleis plaques are characterised by an inflammatory involvement within the vessels' endothelium.
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Affiliation(s)
- Francesco Pichi
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Chiara Veronese
- Ophthalmology Unit, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Lembo
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science, Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Carl P Herbort
- Department of Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialized Care, Lausanne, Switzerland
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Federico Ricci
- Retinal Pathologies Unit, University of Rome "Tor Vergata"-"Tor Vergata" Foundation, Rome, Italy
| | - Piergiorgio Neri
- The Ocular Immunology Service, The Eye Clinic, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Nucci
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science, Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
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Goel N, Sawhney A. Kyrieleis plaques associated with Herpes Simplex Virus type 1 acute retinal necrosis. Saudi J Ophthalmol 2016; 30:144-7. [PMID: 27330396 PMCID: PMC4908145 DOI: 10.1016/j.sjopt.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 01/20/2016] [Accepted: 02/11/2016] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 55-year-old immunocompetent male who presented with features typical of acute retinal necrosis (ARN). Polymerase chain reaction of the aqueous tap was positive for Herpes Simplex Virus (HSV) – 1. Following therapy with intravenous Acyclovir, followed by oral Acyclovir and steroids, there was marked improvement in the visual acuity and clinical picture. At one week after initiation of treatment, Kyrieleis plaques were observed in the retinal arteries. They became more prominent despite resolution of the vitritis, retinal necrosis and vasculitis and persisted till six weeks of follow-up, when fluorescein angiography was performed. The appearance of this segmental retinal periarteritis also known as Kyrieleis plaques has not been described in ARN due to HSV-1 earlier.
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Affiliation(s)
- Neha Goel
- ICARE Eye Hospital and Postgraduate Institute, Noida, U.P., India
| | - Amrita Sawhney
- ICARE Eye Hospital and Postgraduate Institute, Noida, U.P., India
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Dokey AT, Haug SJ, McDonald HR, Cunningham ET, Lujan BJ, Fu AD, Jumper JM. Acute retinal necrosis secondary to multidrug-resistant herpes simplex virus 2 in an immunocompetent adolescent. Retin Cases Brief Rep 2014; 8:260-264. [PMID: 25372523 DOI: 10.1097/icb.0000000000000096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report the clinical course of a patient with acute retinal necrosis resulting from a multidrug-resistant strain of herpes simplex virus 2. METHODS Observational case report. RESULTS A 17-year-old man with no identifiable immune deficiency presented with pain and decreased vision in his left eye. He had dense anterior and posterior segment inflammation with retinal whitening suggestive of acute retinal necrosis, which progressed despite treatment with intravenous acyclovir, methylprednisolone, and ganciclovir. A transition to intravitreal and intravenous foscarnet led to clinical improvement. Genetic analysis revealed the etiology to be a multidrug-resistant strain of herpes simplex virus 2. CONCLUSION Antiviral resistance is an uncommon finding among viruses causing acute retinal necrosis in immunocompetent patients. Patients with these infections may be adequately treated with prompt recognition and a change in therapy to alternative antiviral agents such as foscarnet.
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Affiliation(s)
- Adrian T Dokey
- *Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; †West Coast Retina Medical Group, San Francisco, California; ‡Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California; and §Department of Vision Science, Berkeley School of Optometry, University of California, Berkeley, California
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