1
|
Jacquot R, Jamilloux Y, Bert A, Gerfaud-Valentin M, Richard-Colmant G, Kodjikian L, Sève P. Etiological Diagnosis of Uveitis: Contribution of the of the Extra-Ophthalmological Clinical Examination. Ocul Immunol Inflamm 2024; 32:1655-1666. [PMID: 37948510 DOI: 10.1080/09273948.2023.2276304] [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: 08/22/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Determining uveitis etiology is a challenge. It is based primarily on demographic data and the characteristics of eye examination. It is not clear to what extent extraocular physical signs contribute to elucidating the etiology. This study aimed to establish the contribution of the clinical extra-ophthalmological features for the assessment of the underlying etiology of uveitis. METHODS We retrospectively reviewed 1307 patients with uveitis referred to our tertiary center between 2003 and 2021. Uveitis was classified according to the Standardization of Uveitis Nomenclature. Clinical features were collected at diagnosis by internists before the etiological diagnosis was made. The main outcome description was the contribution of clinical features. RESULTS Clinical extra-ophthalmological features contributed to the assessment of the underlying etiology of uveitis in 363 (27.8%) patients. The joint and the skin examinations were the most useful for etiological investigations, respectively in 12.3% and 11.8% of patients. Five etiologies of uveitis accounted for 80% of the cases: sarcoidosis, HLA-B27-related uveitis, Behçet's disease, multiple sclerosis, and Vogt-Koyanagi-Harada disease. Clinical extra-ophthalmological features were particularly important in the etiological diagnosis of acute bilateral anterior uveitis and panuveitis. CONCLUSION This study suggests that clinical extra-ophthalmological features are essential for the etiological diagnosis of uveitis in more than a quarter of patients. It demonstrates once again the value of collaboration between ophthalmologists and other specialists experienced in performing extra-ophthalmological clinical examinations, particularly in patients with acute bilateral anterior uveitis and panuveitis.
Collapse
Affiliation(s)
- Robin Jacquot
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- Immunopathology Department, Lyon Immunopathology FEderation (LIFE), Lyon, France
| | - Arthur Bert
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Gaëlle Richard-Colmant
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, University Claude Bernard Lyon 1, Villeurbanne, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
2
|
Park BH, Kwon HJ, Park SW, Lee JE, Byon I. A Case of Lyme Disease Presenting as Bilateral Panuveitis. Ocul Immunol Inflamm 2024; 32:1488-1493. [PMID: 37433086 DOI: 10.1080/09273948.2023.2231534] [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: 05/09/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Here, we describe a case of Lyme disease presenting as bilateral panuveitis. A 25-year-old woman presented to our clinic with decreased visual acuity of 20/320 and 20/160 in the right and left eye, respectively. An ophthalmic examination revealed the presence of anterior chamber cells 3+, vitreous cells 1+, vitreous haziness 2+/1+, and retinal infiltration in both eyes. She also had fever, headache, and difficulty in breathing. An initial blood analysis did not detect infection; however, high levels of erythrocyte sedimentation rate and C-reactive protein were noted. Pleural and pericardial effusions, and multiple reactive arthritis lesions were observed on chest computed tomography and bone scans, respectively. Oral steroids (30 mg/day) and steroid eye drops were initiated. Ten days later, she was diagnosed with Lyme disease, based on an indirect immunofluorescence antibody test. Ceftriaxone (2 g) was intravenously administered for 2 weeks followed by administration of oral trimethoprim-sulfamethoxazole (400 mg/80 mg/day) for 1 week. Thereafter, she received a 4-week course of doxycycline (100 mg) twice daily. Her symptoms and ocular findings improved; however, a gradually increasing dose of oral steroid was needed to control retinal lesions for some time, since multiple retinitis lesions developed in the peripheral retina after tapering the oral steroid dose to 5 mg/day. In conclusion, panuveitis can occur in patients with Lyme disease and can be treated with systemic antibiotics and steroids.
Collapse
Affiliation(s)
- Bo Hyun Park
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Han Jo Kwon
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Sung Who Park
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Jeong Eun Lee
- Division of Infectious Disease, Department Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Iksoo Byon
- Department of Ophthalmology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| |
Collapse
|
3
|
Bana G, Angioi-Duprez K, Conart JB, Moulinet T. When and which second-line workup to perform for uveitis: a tertiary care center experience. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00244-8. [PMID: 39142637 DOI: 10.1016/j.jcjo.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE Uveitis are inflammatory disorders of various etiologies. The first-line etiological workup is currently poorly codified, and some patients undergo sequential investigations. However, what leads the clinician to perform subsequent exams and the relevance of such exams remain to be determined. The main objective of the study was to evaluate the relevance and modalities of a second-line workup of patients with uveitis. MATERIALS AND METHODS We performed a monocentric retrospective study in Nancy University Hospital. All adult patients who underwent an etiological workup in the Internal Medicine Department between January 2014 and December 2021 were included. RESULTS Among the 247 patients included, 52 underwent a second-line workup, resulting in a modified diagnosis for 18 of them (34.6%), mainly sarcoidosis, intraocular lymphoma, and Crohn's disease. On multivariate analysis, a follow-up longer than 40 months and idiopathic uveitis were associated with the realization of a second-line workup (OR = 2.97 [1.58 - 5.61]; p = 0.001, and OR = 6.13 [2.3-16.1]; p < 0.01, respectively). The presence of synechia and ocular granuloma were associated with a modification of the diagnosis (OR = 8.03 [1.85-45.48]; p = 0.01, and OR = 5.14 [1.22-24.78]; p = 0.03, respectively). CONCLUSION The second-line workup is relevant in up to one-third of patients, mainly if presenting with a modification of ophthalmological examination, synechiae, and a granulomatous feature, and should focus on intraocular lymphoma, sarcoidosis, and Crohn's disease. Larger studies are needed to provide guidelines for second-line workup.
Collapse
Affiliation(s)
- Gaétan Bana
- Department of Ophthalmology, Nancy University Hospital, Nancy, France; Lorraine University, Nancy, France
| | - Kaine Angioi-Duprez
- Department of Ophthalmology, Nancy University Hospital, Nancy, France; Lorraine University, Nancy, France
| | - Jean-Baptiste Conart
- Department of Ophthalmology, Nancy University Hospital, Nancy, France; Lorraine University, Nancy, France
| | - Thomas Moulinet
- Department of Internal Medicine and Clinical Immunology, Nancy University Hospital, Nancy, France; UMR 7365, Ingénierie Moléculaire, Cellulaire et Physiopathologie, Lorraine University, Centre National de la Recherche Scientifique, Nancy, France.
| |
Collapse
|
4
|
Werkl P, Seidel G, Singer C, Tomasic H, Peschaut T, Heidinger A, Valentin K, Sommer M. [Bilateral fibrinous iridocyclitis with extensive myopization]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02087-5. [PMID: 39110214 DOI: 10.1007/s00347-024-02087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/31/2024] [Accepted: 07/10/2024] [Indexed: 09/11/2024]
Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036.
| | - Gerald Seidel
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036
| | - Christoph Singer
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036
| | - Hrvoje Tomasic
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036
| | - Tobias Peschaut
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036
| | - Astrid Heidinger
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036
| | - Katharina Valentin
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036
| | - Michael Sommer
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Graz, Österreich, Auenbruggerplatz 4, 8036
| |
Collapse
|
5
|
McEntire CRS, Chwalisz BK. Cranial nerve involvement, visual complications and headache syndromes in Lyme disease. Curr Opin Ophthalmol 2024; 35:265-271. [PMID: 38518069 DOI: 10.1097/icu.0000000000001031] [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: 03/24/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the visual manifestations and cranial neuropathies seen in Lyme disease. RECENT FINDINGS Lyme facial palsy remains the most common manifestation of Lyme neuroborreliosis. Recent investigations show likely evidence of vagal involvement in Lyme disease. SUMMARY The literature on Lyme neuroborreliosis continues to evolve. Lyme disease can affect nearly any cranial nerve in addition to causing various headache syndromes. The most common manifestation is Lyme disease facial palsy, occurring in up to 5-10% of patients with documented Lyme disease. Headache syndromes are common in the context of facial palsy but can occur in isolation, and more specific headache syndromes including trigeminal and geniculate neuralgias can occur rarely. Signs and symptoms indicative of vestibulocochlear nerve involvement are relatively common, although it could be that these represent other vestibular involvement rather than a specific cranial neuropathy. Optic neuritis is a controversial entity within Lyme disease and is likely overdiagnosed, but convincing cases do exist. Physicians who see any cranial neuropathy, including optic neuritis, in an endemic area can consider Lyme disease as a possible cause.
Collapse
Affiliation(s)
- Caleb R S McEntire
- Massachusetts General Hospital-Harvard Medical School
- Brigham and Women's Hospital-Harvard Medical School, Department of Neurology
| | - Bart K Chwalisz
- Massachusetts General Hospital-Harvard Medical School
- Massachusetts Eye and Ear-Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Silverstein M, Jordan CO, Aylward SC, Inger H. Yearly Occurrence and Seasonality of Neuro-ophthalmic Manifestations of Pediatric Lyme Disease. J Pediatr Ophthalmol Strabismus 2024; 61:179-182. [PMID: 37882186 DOI: 10.3928/01913913-20231005-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE To review the neuro-ophthalmic manifestations of Lyme disease at a central Ohio pediatric tertiary care center. METHODS A retrospective chart review of patients diagnosed as having Lyme disease from September 2015 to September 2020 was completed. Demographic information, diagnosis dates, and manifestations of Lyme disease were recorded. Patients were excluded for age older than 18 years or lack of corroborated Lyme disease diagnosis. Descriptive statistics were performed. RESULTS Of the 212 cases of pediatric Lyme disease reviewed, 50 patients had neuroborreliosis. The data showed an increase in Lyme disease and neuroborreliosis cases from 2018 to 2020, with a preponderance of diagnoses in the summer months. Twenty-four patients had meningitis, and 6 of these patients (25%) were diagnosed as having bilateral optic disc edema that was clinically consistent with intracranial hypertension. CONCLUSIONS Papilledema in the setting of Lyme meningitis may be more common than previously reported in central Ohio. If Lyme disease meningitis is suspected, an opening pressure should be recorded at the time of lumbar puncture and, if elevated, an ophthalmologic evaluation for optic nerve edema is indicated. [J Pediatr Ophthalmol Strabismus. 2024;61(3):179-182.].
Collapse
|
7
|
Mandal S, Tayyab H, Mandal SC, Sideeg A. Co-infectious Uveitis With Syphilis and Lyme Disease: A Case Report. Cureus 2024; 16:e58608. [PMID: 38765401 PMCID: PMC11102814 DOI: 10.7759/cureus.58608] [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] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Uveitis is the inflammation of the uveal tract (i.e., iris, ciliary body, and choroid). Uveitis is categorized into the following three types based on the anatomical location of inflammation: anterior, intermediate, and posterior uveitis. Severe cases may lead to panuveitis, where all three layers may become inflamed potentially resulting in permanent vision loss. Uveitis can arise from different underlying disorders, including infectious causes or autoimmune disorders. Syphilis and Lyme disease are uncommon causes of uveitis. Eye involvement can occur at any stage in Lyme disease, characterized by diverse manifestations such as conjunctivitis, episcleritis, keratitis, uveitis, neuroretinitis, and retinal vasculitis. Patients may present with symptoms of blurred vision, eye pain or discomfort, visual floaters, headache, or intolerance to light. Patients can risk vision loss if not diagnosed and treated promptly.
Collapse
Affiliation(s)
- Shobha Mandal
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Hamnah Tayyab
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Subhash C Mandal
- Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, NPL
| | | |
Collapse
|
8
|
Werkl P, Rademacher J, Pleyer U. HLA-B27-positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management, and treatment. DIE OPHTHALMOLOGIE 2024; 121:12-22. [PMID: 38085287 DOI: 10.1007/s00347-023-01960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/03/2024]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
Collapse
Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz-LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, 13355, Berlin, Germany.
| |
Collapse
|
9
|
Ferro Desideri L, Rosa R, Forte P, Manocchio R, Vagge A, Traverso CE, Nicolò M. Multimodal imaging for the management of Lyme-associated uveitis: A case report from an Italian tertiary center. Eur J Ophthalmol 2023; 33:NP58-NP64. [PMID: 36710514 DOI: 10.1177/11206721231154172] [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: 01/31/2023]
Abstract
INTRODUCTION Lyme borreliosis may present with different systemic manifestations and also the ocular involvement may be difficult to diagnose because of its multifaceted presentation. Considering the growing incidence of Lyme disease in European countries, ophthalmologist should be trained to distinguish ocular borreliosis. CASE REPORT Several clinical presentations have been previously described, including uveitis, unilateral or bilateral chorioretinitis, keratitis, episcleritis, papillitis and ischemic optic neuropathy, retinal vasculitis and acute posterior multifocal placoid pigment epitheliopathy (APMPPE); however our case report showed a rare presentation with the presence of unilateral uveitis with vitreitis and multiple, patchy, yellowish lesions, in association with retinal vasculitis. This clinical picture was to be considered in differential diagnosis with ocular Toxoplasmosis. CONCLUSIONS The appropriate management of this patient was made possible by the combination of multimodal imaging and appropriate laboratory tests, representing the optimal process in the diagnostic and therapeutic pathway in high-risk patients for ocular Lyme disease.
Collapse
Affiliation(s)
- Lorenzo Ferro Desideri
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Raffaella Rosa
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Paolo Forte
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Riccardo Manocchio
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Massimo Nicolò
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
- Macula Onlus Foundation, Genoa, Italy
| |
Collapse
|
10
|
Werkl P, Rademacher J, Pleyer U. [HLA-B27 positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management and treatment]. DIE OPHTHALMOLOGIE 2023; 120:108-122. [PMID: 36633629 DOI: 10.1007/s00347-022-01793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
Collapse
Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz - LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Deutschland.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Uwe Pleyer
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. .,Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, Berlin, Deutschland.
| |
Collapse
|
11
|
Koretz ZA, Apostolopoulou A, Chen E, Beale O, Veldkamp P, Viehman JA, Sahel JA, Chhablani J, Dansingani KK, Errera MH, Bonhomme GR. Clinical Features and Multimodal Imaging in Atypical Posterior Uveitis Secondary to Bartonella Henselae Infection. Ocul Immunol Inflamm 2022; 30:2047-2054. [PMID: 34402723 DOI: 10.1080/09273948.2021.1961812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To characterize an unusual presentation of infectious posterior uveitis using multimodal imaging, and discuss the clinical decision-making involved in diagnosis and treatment. METHODS Wide-field fundus photography, swept-source optical coherence tomography (OCT), swept-source OCT angiography, fluorescein angiography, and indocyanine green angiography. RESULTS This patient presented with cyclical fevers and blurry vision. Fundus examination revealed bilateral optic disc edema, macular intraretinal white spots and many scattered yellow-white chorioretinal lesions. Multimodal imaging characteristics suggested that many of these lesions represent choroidal granulomas. Extensive systemic workup was only notable for borderline elevated Bartonella henselae IgG titers (1:128), however convalescent IgG titers were elevated at 38 days (1:512) supporting the diagnosis of Bartonella chorioretinitis. CONCLUSION Ocular manifestations of Bartonella henselae infection are varied and may include choroidal granulomas. Multimodal imaging characteristics may help identify etiologies of infectious uveitis. Convalescent titers are important when evaluating patients with suspected Bartonellosis, especially patients with atypical presentations.
Collapse
Affiliation(s)
- Zachary A Koretz
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anna Apostolopoulou
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edwin Chen
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Oliver Beale
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter Veldkamp
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John Alex Viehman
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle R Bonhomme
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
12
|
Teo AYT, Betzler BK, Hua KLQ, Chen EJ, Gupta V, Agrawal R. Intermediate Uveitis: A Review. Ocul Immunol Inflamm 2022:1-20. [PMID: 35759636 DOI: 10.1080/09273948.2022.2070503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU). METHODS Narrative literature review. RESULTS IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice. CONCLUSIONS IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.
Collapse
Affiliation(s)
| | | | - Keith Low Qie Hua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Singapore Eye Research Institute, Singapore.,Duke NUS Medical School, Singapore
| |
Collapse
|
13
|
Shivpuri A, Turtsevich I, Solebo AL, Compeyrot-Lacassagne S. Pediatric uveitis: Role of the pediatrician. Front Pediatr 2022; 10:874711. [PMID: 35979409 PMCID: PMC9376387 DOI: 10.3389/fped.2022.874711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
The challenges of childhood uveitis lie in the varied spectrum of its clinical presentation, the often asymptomatic nature of disease, and the evolving nature of the phenotype alongside normal physiological development. These issues can lead to delayed diagnosis which can cause significant morbidity and severe visual impairment. The most common ocular complications include cataracts, band keratopathy, glaucoma, and macular oedema, and the various associated systemic disorders can also result in extra-ophthalmic morbidity. Pediatricians have an important role to play. Their awareness of the various presentations and etiologies of uveitis in children afford the opportunity of prompt diagnosis before complications arise. Juvenile Idiopathic Arthritis (JIA) is one of the most common associated disorders seen in childhood uveitis, but there is a need to recognize other causes. In this review, different causes of uveitis are explored, including infections, autoimmune and autoinflammatory disease. As treatment is often informed by etiology, pediatricians can ensure early ophthalmological referral for children with inflammatory disease at risk of uveitis and can support management decisions for children with uveitis and possible underling multi-system inflammatory disease, thus reducing the risk of the development of irreversible sequelae.
Collapse
Affiliation(s)
- Abhay Shivpuri
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Inga Turtsevich
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ameenat Lola Solebo
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom.,University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sandrine Compeyrot-Lacassagne
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom
| |
Collapse
|
14
|
Update on the Management of Uveitic Macular Edema. J Clin Med 2021; 10:jcm10184133. [PMID: 34575244 PMCID: PMC8470573 DOI: 10.3390/jcm10184133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022] Open
Abstract
Uveitic macular edema (ME) is a frequent complication in 8.3% of uveitis patients and is a leading cause of serious visual impairment in about 40% of cases. Despite the numerous available drugs for its treatment, at least a third of patients fail to achieve satisfactory improvement in visual acuity. First-line drugs are steroids administered by various routes, but drug intolerance or ineffectiveness occur frequently, requiring the addition of other groups of therapeutic drugs. Immunomodulatory and biological drugs can have positive effects on inflammation and often on the accompanying ME, but most uveitic randomized clinical trials to date have not aimed to reduce ME; hence, there is no clear scientific evidence of their effectiveness in this regard. Before starting therapy to reduce general or local immunity, infectious causes of inflammation should be ruled out. This paper discusses local and systemic drugs, including steroids, biological drugs, immunomodulators, VEGF inhibitors, and anti-infection medication.
Collapse
|
15
|
ARICAN N. Pediatric Patient with Pars Planitis Associated with Lyme Disease: A Rare Presentation: Case Report. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2021. [DOI: 10.33631/duzcesbed.913303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
16
|
Touhami S, Leclercq M, Stanescu-Segall D, Touitou V, Bodaghi B. Differential Diagnosis of Vitritis in Adult Patients. Ocul Immunol Inflamm 2021; 29:786-795. [PMID: 34003716 DOI: 10.1080/09273948.2021.1898001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The term "vitritis" refers to the presence of a cellular infiltration of the vitreous body, usually in the context of an intraocular inflammation, but not exclusively. Intermediate uveitis is the most prominent cause of vitritis, including infectious and auto-immune/auto-inflammatory etiologies. Corticosteroids and immunosuppressive therapies should not be started before ruling out the infectious causes of vitritis, especially in immunosuppressed individuals. Other situations can mimic intermediate uveitis such as amyloidosis and ocular tumors. Primary intraocular lymphoma should always be suspected in case of vitreous infiltrations in individuals aged over 50 years.
Collapse
Affiliation(s)
- Sarah Touhami
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Mathilde Leclercq
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Dinu Stanescu-Segall
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.,Centre Nord Exploration Ophtalmologique, Lille, France
| | - Valérie Touitou
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| |
Collapse
|
17
|
Issa R, DeSouza SAM. Recurrent bilateral chorioretinitis with positive Lyme serology: a case report. J Med Case Rep 2021; 15:253. [PMID: 33941242 PMCID: PMC8094503 DOI: 10.1186/s13256-021-02804-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background It has been disputed whether Lyme is a true causative agent in posterior uveitis or an incidental finding. Case presentation This report presents a case of a 33-year-old Caucasian female with a remote history of Lyme disease who presented with blurry vision in the right eye. Exam and imaging revealed a right active chorioretinitis and positive Lyme serology. The patient was systemically treated with prednisone and antibiotics. Symptoms initially improved, but she later developed a localized choriocapillaritis in the left eye. Steroids and antibiotics were restarted many times with fluctuating course of the disease. The patient was then started on chronic steroid-sparing immunosuppression, which has controlled the condition without recurrence. Conclusions The current report presents a unique case of recurrent bilateral chorioretinitis with positive Lyme serology and raises the question of the existence of true Lyme-associated uveitis.
Collapse
Affiliation(s)
- Reda Issa
- Associated Retina Consultants, 1750 E. Glendale Ave, Phoenix, AZ, USA. .,Department of Ophthalmology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
| | - Stephen A M DeSouza
- Associated Retina Consultants, 1750 E. Glendale Ave, Phoenix, AZ, USA.,Department of Ophthalmology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| |
Collapse
|
18
|
Cuevas-Peláez M, Correa-García A, López-Mahecha JM. Respuesta a: panuveítis no granulomatosa en un paciente colombiano:. IATREIA 2020. [DOI: 10.17533/udea.iatreia.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
19
|
Pleyer U, Pohlmann D, Rademacher J. [Anterior Uveitis: Clinic, Diagnostic Procedure and Treatment Options]. Klin Monbl Augenheilkd 2020; 237:1005-1019. [PMID: 32303071 DOI: 10.1055/a-1148-2875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Anterior uveitis involves inflammation of the iris and/or ciliary body and is the most common intraocular inflammation in ophthalmological practice. It can be attributed to an infectious or immune-mediated genesis or be associated with systemic diseases. Anamnesis and (guiding) findings during the slit lamp examination often already provide important information on pathogenesis and thus on further diagnostic clarification and therapy. This includes the assessment of laterality, acute or chronic course of the disease and morphological criteria (granulomatous/non-granulomatous). The guideline-compliant procedure recommends further diagnosis with targeted laboratory diagnostics and, if necessary, consultative examinations if the disease recurs. This is important in order to pursue a targeted treatment approach and to recognize comorbidities.
Collapse
|
20
|
Livingston ET, Mursalin MH, Callegan MC. A Pyrrhic Victory: The PMN Response to Ocular Bacterial Infections. Microorganisms 2019; 7:E537. [PMID: 31703354 PMCID: PMC6920826 DOI: 10.3390/microorganisms7110537] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/03/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022] Open
Abstract
Some tissues of the eye are susceptible to damage due to their exposure to the outside environment and inability to regenerate. Immune privilege, although beneficial to the eye in terms of homeostasis and protection, can be harmful when breached or when an aberrant response occurs in the face of challenge. In this review, we highlight the role of the PMN (polymorphonuclear leukocyte) in different bacterial ocular infections that invade the immune privileged eye at the anterior and posterior segments: keratitis, conjunctivitis, uveitis, and endophthalmitis. Interestingly, the PMN response from the host seems to be necessary for pathogen clearance in ocular disease, but the inflammatory response can also be detrimental to vision retention. This "Pyrrhic Victory" scenario is explored in each type of ocular infection, with details on PMN recruitment and response at the site of ocular infection. In addition, we emphasize the differences in PMN responses between each ocular disease and its most common corresponding bacterial pathogen. The in vitro and animal models used to identify PMN responses, such as recruitment, phagocytosis, degranulation, and NETosis, are also outlined in each ocular infection. This detailed study of the ocular acute immune response to infection could provide novel therapeutic strategies for blinding diseases, provide more general information on ocular PMN responses, and reveal areas of bacterial ocular infection research that lack PMN response studies.
Collapse
Affiliation(s)
- Erin T. Livingston
- Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (E.T.L.); (M.H.M.)
| | - Md Huzzatul Mursalin
- Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (E.T.L.); (M.H.M.)
| | - Michelle C. Callegan
- Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (E.T.L.); (M.H.M.)
- Department of Ophthalmology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Oklahoma Center for Neuroscience, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Dean McGee Eye Institute, Oklahoma City, OK 73104, USA
| |
Collapse
|
21
|
Rifkin LM, Vadboncoeur J, Minkus CC, Dunn EN, Moorthy RS, Bhatt N, Sen HN, Taggart MG, Vitale AT, Goldstein DA. The Utility of Lyme Testing in the Workup of Ocular Inflammation. Ocul Immunol Inflamm 2019; 29:149-153. [PMID: 31577476 DOI: 10.1080/09273948.2019.1657904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Lana M Rifkin
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Julie Vadboncoeur
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Caroline C Minkus
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Evan N Dunn
- Department of Ophthalmology, Associated Vitreoretinal and Uveitis Consultants, Indiana University, Indianapolis, IN, USA
| | - Ramana S Moorthy
- Department of Ophthalmology, Associated Vitreoretinal and Uveitis Consultants, Indiana University, Indianapolis, IN, USA
| | - Nirali Bhatt
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael G Taggart
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Albert T Vitale
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| |
Collapse
|