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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Zur Bonsen L, Rübsam A, Knecht V, Pleyer U. [Vasculitis of the retina : Clinical aspects, diagnostics, management and treatment]. DIE OPHTHALMOLOGIE 2024; 121:509-524. [PMID: 38806792 DOI: 10.1007/s00347-024-02050-4] [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: 04/30/2024] [Indexed: 05/30/2024]
Abstract
Inflammatory changes in the retinal vessels can be attributed to a wide range of etiologies. These include infections, intraocular and systemic autoimmune processes, general diseases and iatrogenic factors. As the endothelium of the retinal capillaries forms the inner blood-retinal barrier, a disruption of this structure is directly associated with consequences for the fluid electrolyte balance of the retina. Clinical sequelae can include leakage of the retinal vessels and macular edema, which are often functionally threatening and significantly reduce the quality of life of patients. As the eye can be affected as an "index organ", a work-up of the patient by the ophthalmologist is of great importance. In the age of "precision medicine", efforts are being made to gain new insights into the pathogenetic mechanisms of vasculitis through "omics" in order to develop innovative treatment concepts.
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Affiliation(s)
- Lynn Zur Bonsen
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Anne Rübsam
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Vitus Knecht
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Uwe Pleyer
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland.
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Zhang H, Houadj L, Wu KY, Tran SD. Diagnosing and Managing Uveitis Associated with Immune Checkpoint Inhibitors: A Review. Diagnostics (Basel) 2024; 14:336. [PMID: 38337852 PMCID: PMC10855398 DOI: 10.3390/diagnostics14030336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
This review aims to provide an understanding of the diagnostic and therapeutic challenges of uveitis associated with immune checkpoint inhibitors (ICI). In the wake of these molecules being increasingly employed as a treatment against different cancers, cases of uveitis post-ICI therapy have also been increasingly reported in the literature, warranting an extensive exploration of the clinical presentations, risk factors, and pathophysiological mechanisms of ICI-induced uveitis. This review further provides an understanding of the association between ICIs and uveitis, and assesses the efficacy of current diagnostic tools, underscoring the need for advanced techniques to enable early detection and accurate assessment. Further, it investigates the therapeutic strategies for ICI-related uveitis, weighing the benefits and limitations of existing treatment regimens, and discussing current challenges and emerging therapies in the context of their potential efficacy and side effects. Through an overview of the short-term and long-term outcomes, this article suggests recommendations and emphasizes the importance of multidisciplinary collaboration between ophthalmologists and oncologists. Finally, the review highlights promising avenues for future research and development in the field, potentially informing transformative approaches in the ocular assessment of patients under immunotherapy and the management of uveitis following ICI therapy.
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Affiliation(s)
- Huixin Zhang
- Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada;
| | - Lysa Houadj
- Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada;
| | - Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Schauwvlieghe PP, Van Calster J, Herbort CP, Kestelyn PA, de Vlam K. Efficacy and safety of abatacept to treat active birdshot uveitis: a prospective open label interventional proof-of-concept trial. Br J Ophthalmol 2024; 108:244-252. [PMID: 36585127 PMCID: PMC10850705 DOI: 10.1136/bjo-2022-321585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS Birdshot uveitis (BU) is a chronic autoimmune posterior uveitis, mostly affecting middle-aged Caucasians. There is a strong association with HLA-A29 and T-cell activation. Safety and efficacy of abatacept, an inhibitor of T-cell costimulation, is tested in active BU. METHODS Fifteen patients with active BU were treated with monotherapy of weekly subcutaneous injections of abatacept 125 mg/mL. Time-to-treatment failure was evaluated as a primary outcome. The secondary objective was to evaluate the utility of different outcome measures to monitor disease activity. Safety was evaluated by adverse event reporting and serial blood analyses. RESULTS At the year-1 endpoint, there was significant improvement in vitreous haze grade (p=0.0014), central choroidal thickness (CCT) (p=0.0011), Fluorescein Angiography (FA) Score (p=0.0014), Indocyanine Green Angiography (ICGA) Score (p<0.001) and total dual FA-ICGA Score (p<0.001). Best corrected visual acuity (BCVA) (p=0.8354) and central retinal thickness (CRT) (p=0.3549) did not change significantly. There were no serious adverse events reported. In total, 4 out of 15 patients left the trial during year 1 of whom 2 experienced treatment failure. CONCLUSIONS Abatacept is very efficacious to treat both retinal vasculitis and choroiditis in patients with BU and is well tolerated. BCVA and CRT are inadequate to monitor disease activity. On the other hand, CCT is a promising non-invasive tool to detect treatment response in early active BU and dual FA-ICGA Score is very helpful to evaluate retinal vasculitis and choroiditis quantitatively. TRIAL REGISTRATION NUMBER NCT03871361.
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Affiliation(s)
- P P Schauwvlieghe
- Ophthalmology, University Hospitals Leuven, Leuven, Belgium
- Ophthalmology, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | | | - Carl Peter Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Montchoisi Teaching Centre, Lausanne, Switzerland
| | | | - Kurt de Vlam
- Rheumatology, University Hospitals Leuven, Leuven, Belgium
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5
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Baquet-Walscheid K, Heinz C. [Intermediate and Posterior Uveitis - Disease entities]. Klin Monbl Augenheilkd 2024; 241:119-135. [PMID: 37977201 DOI: 10.1055/a-2193-2568] [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: 11/19/2023]
Abstract
Intermediate and posterior uveitis can have multiple infectious and noninfectious causes, and posterior uveitis in particular is clinically multifaceted. Some entities require prompt initiation of therapy to ensure visual prognosis. This article presents typical characteristics of intermediate and posterior uveitides and explains special features of their treatment.
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Li A, Apivatthakakul A, Papaliodis GN, Sobrin L. High Positive Predictive Value of Fluorescein Angiography Contiguous, Perineural Retinal Vascular Leakage Pattern for Birdshot Chorioretinopathy. Ocul Immunol Inflamm 2024; 32:48-53. [PMID: 36521074 DOI: 10.1080/09273948.2022.2150228] [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: 06/28/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine the sensitivity and positive predictive value (PPV) of a contiguous, perineural retinal vascular leakage fluorescein angiography (FA) pattern in birdshot chorioretinopathy (BSCR) patients. METHODS Patients with BSCR and other posterior uveitis/retinal vasculitis and a FA were identified. Two graders reviewed the first FA for leakage primarily around the optic nerve and along the larger arcade vessels. We compared the rates of this pattern in BSCR and non-BSCR patients and calculated sensitivity and PPV. We compared clinical characteristics of BSCR patients with and without this pattern. RESULTS 64 BSCR and 98 non-BSCR patients were identified. The FA pattern's sensitivity, specificity, and PPV were 57.8%, 91.8%, and 82.2%. This pattern was significantly more common in BSCR patients earlier in their disease (p = .004). CONCLUSIONS A contiguous, perineural retinal vascular leakage FA pattern can help identify potential BSCR patients for further testing. This pattern is more common closer to symptom onset.
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Affiliation(s)
- Ashley Li
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Ophthalmology, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - George N Papaliodis
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Pham BH, Uludag G, Hien DL, Than NTT, Hwang JJ, Akhavanrezayat A, Matsumiya W, Lajevardi S, Regenold J, Halim MS, Nguyen QD. Birdshot Chorioretinopathy in Early Adulthood: Review of Current Literature and Case Report. Int Med Case Rep J 2023; 16:815-831. [PMID: 38107027 PMCID: PMC10723180 DOI: 10.2147/imcrj.s430981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/20/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose We describe the course of a patient diagnosed with birdshot chorioretinopathy (BSCR) in early adulthood and summarize clinical findings from similar BSCR patients reported in the literature. Observations A 37-year-old male presented to our tertiary uveitis facility with bilateral ocular discomfort, hazy vision, and floaters. Ocular examination was notable for vitritis, optic disc edema, and ovoid hypopigmented chorioretinal lesions, visible on indocyanine green chorioangiography as multiple hypocyanescent spots in the intermediate phase. Full-field electroretinography and visual evoked potential showed global retinal dysfunction and optic nerve dysfunction. Laboratory evaluations were notable only for human leukocyte antigen (HLA)-A29 positivity. The patient was diagnosed with BSCR and started on oral prednisone and eventually managed with infliximab. Conclusions and Importance BSCR can affect patients in early adulthood. Proper diagnostic work-up, including assessing HLA-A29 positivity, is needed to manage atypical cases.
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Affiliation(s)
| | - Gunay Uludag
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Doan Luong Hien
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Ngoc Trong Tuong Than
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Jaclyn Joyce Hwang
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
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Ramírez-Márquez E, Ayala Rodríguez SC, Santiago A, De Jesus E, Requejo Figueroa GA, Riskalla MM, Ryan ME, Koozekanani D, Oliver AL. Histocompatibility Leukocyte Antigen-A29-Associated Retinal Vasculitis without Choroidal Lesions: A Report of 4 Cases. J Clin Med 2023; 12:7023. [PMID: 38002637 PMCID: PMC10672558 DOI: 10.3390/jcm12227023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This study describes a cohort of patients presenting with histocompatibility leukocyte antigen (HLA)-A29-associated retinal vasculitis without choroidal lesions that may share clinical features with birdshot retinochoroiditis. The methods include a retrospective chart review of patients presenting with HLA-A29-associated retinal vasculitis without choroidal lesions. The data on the patients were entered retrospectively into a new database and analyzed. Four patients who had HLA-A29-associated retinal vasculitis without choroidal lesions were identified. The median age at presentation was 40 years (range: 14-71); 75% were female. At presentation, all four patients had a visual acuity of 20/50 or better in both eyes. All the eyes had mild vitritis, three eyes (37.5%) had cystoid macular edema, and two eyes (25%) had optic disc edema. All the patients required treatment with systemic steroids and immunosuppressive therapy. HLA-A29-associated retinal vasculitis without choroidal lesions appears to share many clinical features with birdshot chorioretinitis, including the need for systemic immunosuppressive therapy. Whether this entity represents an early form of birdshot retinochoroiditis or a more localized variant of the disease is a topic for additional studies.
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Affiliation(s)
- Estefanía Ramírez-Márquez
- Department of Ophthalmology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA
| | - Sofía C Ayala Rodríguez
- Department of Ophthalmology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA
| | - Alejandra Santiago
- Department of Ophthalmology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA
| | - Edgar De Jesus
- Department of Ophthalmology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA
| | - Guillermo A Requejo Figueroa
- Department of Ophthalmology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA
| | - Mona M Riskalla
- Division of Pediatric Rheumatology, Allergy, and Immunology, Department of Pediatrics, University of Minnesota Medical School Twin Cities, Minneapolis, MN 55455, USA
| | - Meghan E Ryan
- Division of Pediatric Rheumatology, Allergy, and Immunology, Department of Pediatrics, University of Minnesota Medical School Twin Cities, Minneapolis, MN 55455, USA
| | - Dara Koozekanani
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School Twin Cities, Minneapolis, MN 55455, USA
| | - Armando L Oliver
- Department of Ophthalmology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00936, USA
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Khalil R, Petrushkin H, Rees A, Westcott M. The incidence, presenting clinical findings and treatment patterns of Birdshot Retinochoroiditis in a high-prevalence region: findings from Northern Ireland, England and Wales. Eye (Lond) 2023; 37:2817-2825. [PMID: 36765269 PMCID: PMC10482920 DOI: 10.1038/s41433-023-02425-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Birdshot Retinochoroiditis (BSRC) is a rare, chronic posterior uveitis that is strongly associated with HLA-A*29.2 positivity. To date, no robust incidence studies of BSRC have been undertaken. We present the first epidemiological study of BSRC in a high-prevalence region. METHODS In collaboration with the British Ophthalmological Surveillance Unit, all new cases of BSRC between May 2017 and June 2019 were prospectively collected. Presenting demographics, symptoms, signs and treatment modalities were collected. A follow-up questionnaire twelve months later was also sent. RESULTS Thirty-seven confirmed cases meeting the reporting criteria were identified. Twenty-three cases had both baseline and follow-up data. The total population incidence of BSRC was 0.035 cases per 100,000 person-years [95% CI 0.025-0.048 cases per 100 000 people]. 97.3% were HLA-A*29 positive. The median age was 46 years, with females making up 78% of patients. There were no significant differences in the latitudinal incidence of BSRC. At presentation, floaters were the most common symptom. Optic disc swelling was the most common sign. Mean presenting visual acuity was independent of symptom duration. Combined systemic corticosteroids and immunomodulatory therapy were the most common treatments at baseline and follow-up. Intravitreal steroids were equally popular at follow-up. CONCLUSIONS This study provides the first nationwide estimate of the incidence of BSRC in a high-prevalence region. Cases were more common in females, with a broad range of presentation ages. No significant latitudinal effect of incidence was identified. Systemic therapy with steroids and IMT remain the most common treatments.
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Affiliation(s)
- Rana Khalil
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, D02 YN77, Republic of Ireland.
| | - Harry Petrushkin
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, United Kingdom
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, United Kingdom
- UCL Institute of Ophthalmology, 11-43 Bath St, London, EC1V 9EL, United Kingdom
| | - Angela Rees
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, United Kingdom
| | - Mark Westcott
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, United Kingdom
- Queen Mary University of London, Mile End Rd, Bethnal Green, London, E1 4NS, United Kingdom
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10
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Thenappan A, Nanda A, Lee CS, Lee SY. Retinitis Pigmentosa Masquerades: Case Series and Review of the Literature. J Clin Med 2023; 12:5620. [PMID: 37685687 PMCID: PMC10489117 DOI: 10.3390/jcm12175620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Retinitis pigmentosa (RP) displays a broad range of phenotypic variations, often overlapping with acquired retinal diseases. Timely recognition and differentiation of RP masquerades is paramount due to the treatable nature of many such conditions. This review seeks to present examples of pseudo-RP cases and provide a comprehensive overview of RP masquerades. We first present two pseudo-RP cases, including comprehensive clinical histories and multimodal retinal imaging, to highlight the important role of accurate diagnoses that subsequently steered effective intervention. Subsequently, we conduct an in-depth review of RP masquerades to provide valuable insights into their key distinguishing features and management considerations. The recent approval of ocular gene therapy and the development of investigational gene-based treatments have brought genetic testing to the forefront for RP patients. However, it is important to note that genetic testing currently lacks utility as a screening tool for inherited retinal diseases (IRDs), including RP. The integrity of a precise clinical assessment remains indispensable for the diagnosis of both RP and RP masquerade conditions, thereby facilitating prompt intervention and appropriate management strategies.
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Affiliation(s)
- Abinaya Thenappan
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Arjun Nanda
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Chang Sup Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sun Young Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Ginsburg Institute for Biomedical Therapeutics and Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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Ferracci D, Mathis T, Gavoille A, Gerfaud-Valentin M, Bert A, Hafidi M, Denis P, Loria O, Kodjikian L, Sève P. Long-Term Outcomes of Birdshot Chorioretinopathy Treated with Corticosteroids: A Case Reports. J Clin Med 2023; 12:5288. [PMID: 37629330 PMCID: PMC10455668 DOI: 10.3390/jcm12165288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE To report the progression of patients diagnosed with birdshot chorioretinopathy (BSCR) initially treated with corticosteroids. METHODS We included 39 BSCR patients that were followed for ≥1 year. We analyzed their progression under treatment after 1, 3, 6 months, 1 year, and at the end of follow-up. In order to determine the efficiency of initial loading doses, patients were classified into two groups according to their initial treatment: methylprednisolone followed by prednisone (n = 28) and prednisone alone (n = 11). RESULTS At the end of follow-up, 31/39 (79.5%) patients had reached inflammation control. Thirteen out of 28 (46.4%) and 6/11 (54.5%) patients were treated exclusively with corticosteroids, and 18/19 (94.7%) of them had reached inflammation control at the end of follow-up; their mean (range) corticosteroid dose was 3.5 (0-10) mg/day. CONCLUSIONS We found that the prolonged corticosteroid therapy treatment strategy resulted in inflammation control in half of BSCR patients. This control was maintained with low doses of cortisone, usually <5 mg/day.
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Affiliation(s)
- Dino Ferracci
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100 Villeurbanne, France
| | - Antoine Gavoille
- Department of Biostatistics-Bioinformatics, Hospices Civils de Lyon, 69007 Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Arthur Bert
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Meriem Hafidi
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
| | - Philippe Denis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100 Villeurbanne, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100 Villeurbanne, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- Hospices Civils de Lyon, Pôle IMER, 69003 Lyon, France
- University Lyon, University Claude Bernard-Lyon 1, HESPER EA 7425, 69008 Lyon, France
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12
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Rodriguez L, Salomao DR, Dunn JP, Tufail A, Pulido JS. HISTOPATHOLOGIC CONFIRMATION OF LYMPHOCYTIC INFILTRATION OF THE OPTIC NERVE AND INNER RETINA IN BIRDSHOT CHORIORETINOPATHY. Retina 2023; 43:1425-1428. [PMID: 37257177 DOI: 10.1097/iae.0000000000003847] [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: 06/02/2023]
Abstract
PURPOSE To describe new histological findings involving the inner retina in birdshot chorioretinopathy. METHODS Evaluation of the inner retinal pathology of the eye of a patient with bilateral birdshot chorioretinopathy who underwent enucleation for a unilateral ciliochoroidal melanoma. RESULTS Histopathological sections showed focal perivascular lymphocytic infiltration at the optic nerve head that extended into the adjacent inner retina, mainly involving the ganglion and nerve fiber layers. CONCLUSION We have previously shown that birdshot chorioretinopathy has multiple foci of lymphocytes in the choroid. This is the first report that demonstrates lymphocytic infiltration of the inner retinal layers. This may lead to the bipolar and Müller cell dysfunction that ultimately results in an electronegative electroretinogram.
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Affiliation(s)
| | - Diva R Salomao
- Departments of Ophthalmology and Pathology, Mayo Clinic, Rochester, Minnesota; and
| | - James P Dunn
- Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | - Jose S Pulido
- Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania
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13
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Shome A, Mugisho OO, Niederer RL, Rupenthal ID. Comprehensive Grading System for Experimental Autoimmune Uveitis in Mice. Biomedicines 2023; 11:2022. [PMID: 37509662 PMCID: PMC10377264 DOI: 10.3390/biomedicines11072022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Experimental autoimmune uveitis (EAU) is the most commonly used animal model to study the progression of chronic uveitis and to test various therapies to treat the disease. However, to accurately evaluate the effectiveness of such treatments, a grading system that combines the latest imaging techniques with definitive quantitative grading thresholds is required. This study aimed to develop a comprehensive grading system that objectively evaluates EAU progression in C57BL/6J mice. EAU was induced following immunisation with interphotoreceptor retinoid-binding protein (IRBP) and pertussis toxin. Weekly fundus and optical coherence tomography (OCT) images were acquired over 12 weeks using a Micron IV imaging system. Each mouse was graded (between 0 to 4) based on changes seen on both the fundus (optic disc, retinal blood vessels and retinal tissue) and OCT (vitreous and retinal layers) images. A total EAU response (with a maximum score of 48) was calculated for each mouse based on the sum of the individual scores each week. Analysis of the clinical scores depicted a gradual increase in inflammatory signs including optic disc and vascular swelling, leukocyte infiltration in the vitreous, lesions in the retina and formation of granulomas and hyper-reflective foci in the retinal layers in EAU mice, with most signs reaching a plateau towards the end of the study period. Development of these signs into sight-threatening complications such as optic disc atrophy, structural damage to the retina and subretinal oedema were noted in 80-90% of mice suggesting consistent disease induction. Overall, a comprehensive and objective grading system encompassing all pathologies occurring in EAU mice was developed to enhance the preclinical evaluation of novel uveitis treatments.
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Affiliation(s)
- Avik Shome
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, The New Zealand National Eye Centre, University of Auckland, Auckland 1142, New Zealand
| | - Odunayo O Mugisho
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, The New Zealand National Eye Centre, University of Auckland, Auckland 1142, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, The New Zealand National Eye Centre, University of Auckland, Auckland 1142, New Zealand
- Te Whatu Ora Te Toka Tumai, Auckland 1142, New Zealand
| | - Ilva D Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, The New Zealand National Eye Centre, University of Auckland, Auckland 1142, New Zealand
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14
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Maleki A, Look-Why S, Manhapra A, Asgari S, Philip AM, Chang PY, Anesi SD, Foster CS. Late recurrence in birdshot chorioretinopathy. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:77-81. [PMID: 34534507 DOI: 10.1016/j.jcjo.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the demographic, clinical, ancillary testing, and multimodal imaging characteristics of birdshot chorioretinopathy (BSCR) patients with late recurrence and birdshot patients with durable remission. PATIENTS AND METHODS This was a retrospective observational case series. The above-mentioned parameters were studied in BSCR patients with late recurrence (group 1) and BSCR patients with durable remission (group 2). RESULTS Fifty-five patients were included in this study. The average age of patients was 62.1 ± 11.1 years (range, 35-88 years). Groups 1 and 2 included 20 (36.4%) and 35 (63.6%) patients, respectively. In group 1, the average age of patients was 60.5 ± 10.39 years (range, 35-79 years). The female-to-male ratio was 16:4. In group 2, the average age of patients was 63.1 ± 11.6 years (range, 37-88 years). The female-to-male ratio was 22:13. None of the demographic, clinical, ancillary testing, and multimodal imaging parameters were statistically significantly different between the two groups. Using a receiver operating characteristics (ROC) curve, we found that the ideal duration of successful therapy to induce durable remission was 30 months with 70% sensitivity and 40% specificity (ideal point on the curve). A Kaplan-Meier survival curve demonstrated that late recurrence was seen within 30 months after stopping successful treatment of patients with BSCR. CONCLUSION There are no demographic, clinical, ancillary testing, or multimodal imaging characteristics that can predict late recurrence in BSCR patients. However, we found that 30 months of successful treatment may be ideal and recommended.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Soheila Asgari
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Andrew M Philip
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA; Ocular Immunology and Uveitis Foundation, Waltham, MA; Harvard Medical School, Boston, MA.
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15
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Pierron L, Tezenas du Montcel S, Heinzmann A, Coarelli G, Héron D, Heide S, Herson A, Hennessy J, Petit E, Gargiulo M, Durr A. Reproductive choices and intrafamilial communication in neurogenetic diseases with different self-estimated severities. J Med Genet 2023; 60:346-351. [PMID: 36270767 DOI: 10.1136/jmg-2022-108477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low uptake of presymptomatic testing and medically assisted reproduction in families impacted by neurogenetic diseases prompted us to investigate how reproductive options are considered and whether there is a relationship with perceived severity of the disease. We hypothesised that self-estimated severity would influence opinion on reproductive options and that prenatal/preimplantation diagnosis would be a motivation to inform relatives about their risk. METHODS We invited people impacted by neurogenetic diseases to evaluate the severity of their familial disease using analogic visual scales and to answer questionnaires about reproductive choices and intrafamilial communication. We compared answers between diseases and with the perceived severity of each disease. RESULTS We analysed 562 questionnaires. Participants were impacted by Huntington disease (n=307), spinocerebellar ataxias (n=114), Steinert myotonic dystrophy (n=82) and amyotrophic lateral sclerosis/frontotemporal dementia (n=59). Self-estimated severity differed between pathologies (p<0.0001). Overall, participants considered prenatal diagnosis (78.0±34.4 out of 100) and preimplantation diagnosis (75.2±36.1 out of 100) justified more than termination of pregnancy (68.6±38.5 out of 100). They were less in favour of gamete donation (48.3±39.8 out of 100) or pregnancy abstention (43.3±40.3 out of 100). The greater the perceived severity of the disease, the more reproductive options were considered justified, except for gamete donation. Prenatal/preimplantation diagnosis was a motivation to inform relatives for only 55.3% of participants (p=0.01). CONCLUSION Self-estimated severity minimally impacts opinions towards reproductive options. Medically assisted reproduction procedures are rarely sought and do not motivate familial communication.
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Affiliation(s)
- Lucie Pierron
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Sophie Tezenas du Montcel
- Institut Pierre Louis de Santé Publique, Medical Information Unit, Sorbonne Université, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Anna Heinzmann
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Giulia Coarelli
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Delphine Héron
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Solveig Heide
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Ariane Herson
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
| | - Juliette Hennessy
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Elodie Petit
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
| | - Marcela Gargiulo
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Université Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Alexandra Durr
- Genetics Department, University Hospital Pitié Salpêtrière, Paris, France
- Sorbonne Université and Paris Brain Institute, Inserm, CNRS, AP-HP, Pitié- Salpêtrière Hospital, Paris, France
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16
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Fourcade L, Amatore F, Attia R, Berbis P, Gomes de Pinho Q, Granel B. [A typical triad]. Rev Med Interne 2023; 44:150-152. [PMID: 36863805 DOI: 10.1016/j.revmed.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/12/2022] [Indexed: 03/04/2023]
Affiliation(s)
- L Fourcade
- Service de dermatologie, CHU Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - F Amatore
- Service de dermatologie, CHU Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - R Attia
- Service d'ophtalmologie, Aix-Marseille université, CHU Nord, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - P Berbis
- Service de dermatologie, CHU Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - Q Gomes de Pinho
- Service de médecine interne, Aix-Marseille université, CHU Nord, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - B Granel
- Service de médecine interne, Aix-Marseille université, CHU Nord, Assistance publique-Hôpitaux de Marseille, Marseille, France.
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17
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Colman M, Syx D, de Wandele I, Rombaut L, Wilie D, Malfait Z, Meeus M, Malfait AM, Van Oosterwijck J, Malfait F. Sensory profiling in classical Ehlers-Danlos syndrome: a case-control study revealing pain characteristics, somatosensory changes, and impaired pain modulation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.24.23286404. [PMID: 36865307 PMCID: PMC9980260 DOI: 10.1101/2023.02.24.23286404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Pain is one of the most important, yet poorly understood complaints in heritable connective tissue disorders (HCTD) caused by monogenic defects in extracellular matrix molecules. This is particularly the case for Ehlers-Danlos syndromes (EDS), paradigm collagen-related disorders. This study aimed to identify the pain signature and somatosensory characteristics in the rare classical type of EDS (cEDS) caused by defects in type V or rarely type I collagen. We used static and dynamic quantitative sensory testing and validated questionnaires in 19 individuals with cEDS and 19 matched controls. Individuals with cEDS reported clinically relevant pain/discomfort (VAS ≥5/10 in 32% for average pain intensity the past month) and worse health -related quality of life. Altered sensory profile was found in the cEDS group with higher (p=0.04) detection thresholds for vibration stimuli at the lower limb indicating hypoesthesia, reduced thermal sensitivity with more (p<0.001) paradoxical thermal sensations, and hyperalgesia with lower pain thresholds to mechanical (p<0.001) stimuli at both the upper and lower limbs and to cold (p=0.005) stimulation at the lower limb. Using a parallel conditioned pain paradigm, the cEDS group showed significantly smaller antinociceptive responses (p-value between 0.005 and 0.046) suggestive of impaired endogenous central pain modulation. In conclusion, Individuals with cEDS report chronic pain and worse health-related quality of life, and present altered somatosensory perception. This study is the first to systematically investigate pain and somatosensory characteristics in a genetically defined HCTD and provides interesting insights on the possible role of the ECM in the development and persistence of pain.
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Affiliation(s)
- Marlies Colman
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Consortium
| | - Delfien Syx
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Inge de Wandele
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lies Rombaut
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Deborah Wilie
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Zoë Malfait
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Spine, Head and Pain SPINE Research Unit Ghent, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Consortium
| | - Anne-Marie Malfait
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica Van Oosterwijck
- Spine, Head and Pain SPINE Research Unit Ghent, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Consortium
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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18
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Martens A, Schauwvlieghe PP, Madoe A, Casteels I, Aspeslagh S. Ocular adverse events associated with immune checkpoint inhibitors, a scoping review. J Ophthalmic Inflamm Infect 2023; 13:5. [PMID: 36811715 PMCID: PMC9947214 DOI: 10.1186/s12348-022-00321-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/11/2022] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have become an important part of the treatment of multiple cancers, especially for advanced melanoma and non-small cell lung cancer. Some tumors are capable of escaping immunosurveillance by stimulating checkpoints on T-cells. ICIs prevent activation of these checkpoints and thereby stimulate the immune system and indirectly the anti-tumor response. However, the use of ICIs is associated with various adverse events. Ocular side effects are rare but may have a major impact on the quality of life of the patient. METHODS A comprehensive literature search of the medical databases Web of Science, Embase and PubMed was performed. Articles that provided a comprehensive description of a case report containing 1) cancer patient(s) treated with (a combination of) immune checkpoint inhibitors, and 2) assessed occurrence of ocular adverse events, were included. A total of 290 case reports were included. RESULTS Melanoma (n = 179; 61.7%) and lung cancer (n = 56; 19.3%) were the most frequent reported malignancies. The primary used ICIs were nivolumab (n = 123; 42.5%) and ipilimumab (n = 116; 40.0%). Uveitis was most the common adverse event (n = 134; 46.2%) and mainly related to melanoma. Neuro-ophthalmic disorders, including myasthenia gravis and cranial nerve disorders, were the second most common adverse events (n = 71; 24.5%), mainly related to lung cancer. Adverse events affecting the orbit and the cornea were reported in 33 (11.4%) and 30 cases (10.3%) respectively. Adverse events concerning the retina were reported in 26 cases (9.0%). CONCLUSION The aim of this paper is to provide an overview of all reported ocular adverse events related to the use of ICIs. The insights retrieved from this review might contribute to a better understanding of the underlying mechanisms of these ocular adverse events. Particularly, the difference between actual immune-related adverse events and paraneoplastic syndromes might be relevant. These findings might be of great value in establishing guidelines on how to manage ocular adverse events related to ICIs.
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Affiliation(s)
- A. Martens
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - P. P. Schauwvlieghe
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - A. Madoe
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - I. Casteels
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - S. Aspeslagh
- grid.411326.30000 0004 0626 3362Department of Medical Oncology, University Hospital Brussels, Brussels, Belgium
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19
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Agrawal R, Weng RC, Fonollosa A, Giralt L, Artaraz J, Yang P, Huang F, Tan B, Schmetterer L, Sen A, Gupta V, Xin W. Outcome Measures for Disease Monitoring in Intraocular Inflammatory and Infectious Diseases (OCTOMERIA): Understanding the Choroid in Uveitis with Optical Coherence Tomography (OCT). Ocul Immunol Inflamm 2023; 31:374-392. [PMID: 35201909 DOI: 10.1080/09273948.2022.2026414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare imaging modalities for the choroid of the eye, and evaluate various choroidal changes in uveitides entities. METHODS A comprehensive systematic literature review was conducted looking at current imaging modalities available to assess choroid architecture and commonly used parameters available to qualify and quantify choroidal changes, before looking at specific uveitides entities with choroidal involvement which have been broadly separated into non-infectious and infectious in etiology. RESULTS We describe the various modalities currently available to evaluate the choroid of the eye such as Ultrasound B Scan, ICGA, and OCT. Choroidal changes in various ocular and systemic diseases such as Behcet's Disease, Sarcoidosis, Syphillis, Tuberculosis, and many more have been reported and published. CONCLUSION Multiple choroidal tomographic and angiotomographic findings have been demonstrated for evaluation in uveitis. These findings can manifest in multiple ocular and systemic diseases, and can be illustrated using the various imaging modalities at present. Future advancements in choroidal imaging would help to adapt these findings into parameters for clinical practice to properly evaluate these ocular and systemic diseases.
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Affiliation(s)
- Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke NUS Medical School, Singapore, Singapore
| | - Rei Chern Weng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain.,Retina Department, Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - Lena Giralt
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Fanfan Huang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ocular Imaging Department, Singapore Eye Research Institute, Institute of Molecular and Clinical Ophthalmology Basel Switzerland
| | - Alok Sen
- Department of Vitreo-Retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, India.,The Bodhya Eye Consortium, India
| | - Vishali Gupta
- Department of Vitreoretina, Post Graduate Institute of Medical Education and Research, Chitrakoot, India
| | - Wei Xin
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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20
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Agarwal A, Pichi F, Invernizzi A, Grewal DS, Singh RB, Upadhyay A. Stepwise approach for fundus imaging in the diagnosis and management of posterior uveitis. Surv Ophthalmol 2023; 68:446-480. [PMID: 36724831 DOI: 10.1016/j.survophthal.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
An array of retinochoroid imaging modalities aid in comprehensive evaluation of the immunopathological changes in the retina and choroid, forming the core component for the diagnosis and management of inflammatory disorders such as uveitis. The recent technological breakthroughs have led to the development of imaging platforms that can evaluate the layers of retina and choroid and the structural and functional alteration in these tissues. Ophthalmologists heavily rely on imaging modalities such as dye-based angiographies (fluorescein angiography and indocyanine green angiography), optical coherence tomography, fundus autofluorescence, as well as dye-less angiography such as optical coherence tomography angiograph,y for establishing a precise diagnosis and understanding the pathophysiology of the diseases. Furthermore, these tools are now being deployed with a 'multimodal' approach for swift and accurate diagnosis. In this comprehensive review, we outline the imaging platforms used for evaluation of posterior uveitis and discuss the organized, algorithmic approach for the assessment of the disorders. Additionally, we provide an insight into disease-specific characteristic pathological changes and the established strategies to rule out disorders with overlapping features on imaging.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, New South Wales, Australia
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Awaneesh Upadhyay
- Department of Ophthalmology, EyeQ Super-specialty Hospitals, Noida, Uttar Pradesh, India
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Regenold J, Ghoraba H, Akhavanrezayat A, Ongpalakorn P, Bazojoo V, Do DV, Nguyen QD, Or C. Birdshot chorioretinopathy in an HLA-A29 positive Asian patient. Am J Ophthalmol Case Rep 2023; 29:101802. [PMID: 36741421 PMCID: PMC9894781 DOI: 10.1016/j.ajoc.2023.101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/28/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Purpose To present a case of birdshot chorioretinopathy (BCR) in a Chinese patient with HLA-A29 positivity. Observations A 45-year-old Chinese female presented at a tertiary Ophthalmology Clinic with complaints of frequent headaches as well as blurred vision, photophobia, and pressure in the left eye (OS). The patient had a significant ocular history of left orbital cavernous hemangioma status post lateral orbitotomy and resection. Uncorrected visual acuity was 20/20 in the right eye (OD) and 20/40 in OS (pinhole 20/30). Funduscopic examination demonstrated optic disc edema, left eye worse than right eye, and vascular tortuosity in both eyes (OU). Late phase fluorescein angiography (FA) showed extensive perivascular and optic disc leakage and peripheral capillary leakage in OU. Laboratory evaluations were positive for human leukocyte antigen-A29 (HLA-A29). The patient was started on 40 mg prednisone daily; mycophenolate mofetil 500 mg twice daily was subsequently added.At the 3-month consultation visit to the Uveitis Clinic, dilated funduscopic examination revealed 1+ vitreous cells and improved optic disc edema in OU. FA showed improved vascular and optic disc leakage in OS but worsened leakage in OD. At this point, indocyanine green angiography (ICGA) was ordered which revealed hypocyanescent lesions throughout the choroid that were centered on the optic disc, supporting and confirming the diagnosis of BCR. Conclusions and Importance The index patient is the first reported case of BCR in an HLA-A29 positive Asian patient.
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Affiliation(s)
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Prapatsorn Ongpalakorn
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Vahid Bazojoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana V. Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA,Corresponding author. Spencer Center for Vision Research at the Byers Eye Institute Stanford University, 2370 Watson Court Suite 200, Palo Alto, CA, 94303, USA.
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22
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Alafaleq M, Freund R, Penet MA, Fardeau C, Isnard-Bagnis C, Tezenas du Montcel S, Deray G, LE Hoang P, Bodaghi B, Tostivint I. Ciclosporin A in bilateral auto-immune chronic posterior uveitis associated with macular oedema: a Long-term Observational Safety and Efficacy Study. Eye (Lond) 2022; 36:2144-2150. [PMID: 34718340 PMCID: PMC9581979 DOI: 10.1038/s41433-021-01829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE A non-interventional, longitudinal, retrospective follow-up study to assess CsA-induced nephrotoxicity (IN) and its reversibility after withdrawal in patients exhibiting a bilateral chronic posterior uveitis (CPU) associated with cystoid macular oedema (CMO) in at least one eye. Data from medical records between 1986 and 2013. METHODS Primary outcome was the renal tolerance during and after CsA treatment assessed by plasma creatinine concentration and glomerular filtration rate (GFR) estimated by Chronic Kidney Disease Epidemiology (CKD-Epi) formula. Secondary outcomes were CsA through concentration, occurrence of cancers and ophthalmologic efficacy assessed by three parameters including CMO, vitreous inflammation, and best-corrected visual acuity BVCA changes. RESULTS One hundred forty-three patients were followed for renal tolerance. Underlying diseases were Birdshot retinochoroiditis (n = 67), Behçet disease (n = 9), probable sarcoidosis (n = 23), sympathetic ophthalmia (n = 3), idiopathic (n = 41). After CsA discontinuation in 115 patients (mean treatment duration of 5.9 ± 3.8 years) mean plasma creatinine concentration was 82.2 ± 14.2 µmol/L versus 82.1 ± 14.1 µmol/L at baseline, mean GFR was 79.4 ± 13.9 mL/min versus 82.5 ± 14.3 mL/min at baseline, with no significant difference (respectively p = 0.91 and p = 0.09). Blood pressure did not significantly change during follow-up. CMO was completely resorbed in at least one eye, in 70.8% patients (n = 72) at 6 months, in 71.4% patients (n = 49) at 10 years and in 54.2% patients (n = 24) at 20 years. BCVA did not statistically change over time. CONCLUSION Early and long-term monitoring of renal tolerance and dual adjustment of CsA doses in inflammatory stages of CPU were associated with reversible CsA IN. CsA could be effective in the treatment of CMO in CPU patients.
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Affiliation(s)
- Munirah Alafaleq
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France.
- Ophthalmology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Romain Freund
- Department of Biostatistics, Public Health and Medical Information, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Marie-Aude Penet
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Christine Fardeau
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France
| | - Corinne Isnard-Bagnis
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Sophie Tezenas du Montcel
- INSERM, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Gilbert Deray
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Phuc LE Hoang
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France
| | - Isabelle Tostivint
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France.
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23
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Hang C, Yan Y. Case report: Visual snow as the presenting symptom in multiple evanescent white dot syndrome. Two case reports and literature review. Front Neurol 2022; 13:972943. [PMID: 36277919 PMCID: PMC9582439 DOI: 10.3389/fneur.2022.972943] [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: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Multiple evanescent white dot syndrome (MEWDS) usually manifests as photopsia, enlarged blind spots, scotomas, and blurred vision, which can be classified into positive and negative visual phenomena. Visual snow and chromatopsia were rarely reported in these patients. Herein, we described two Chinese female patients with MEWDS who initially presented with visual snow, and one of them also had yellow-tinged vision. Methods First, we performed the chart review of two patients. Second, we reviewed the English literature for all cases of MEWDS through PubMed until December 2021, using the terms “MEWDS” or “multiple evanescent white dot syndrome.” We concluded on all the reported patients' demographic features and symptoms. The visual acuity of patients with/without positive or negative visual phenomena was compared through one-way ANOVA. Results Patient 1: A 27-year-old Chinese woman experienced continuous visual snow and yellow-tinged vision in the right eye for a week. She noticed tiny white and black dots involving the entire visual field and shimmering light inferiorly. Patient 2: A 22-year-old Chinese woman complained of a gray area with continuous visual snow in the temporal visual field of the left eye for 5 days. The ocular examinations, including fundus autofluorescence (FAF), optical coherence tomography (OCT), and indocyanine green angiography (ICGA), confirmed the diagnosis of MEWDS. Their symptoms resolved spontaneously without treatment. We found 60 MEWDS case reports (147 cases) in PubMed. The mean age was 31.2 years old. The mean LogMAR best-corrected visual acuity was 0.35 ± 0.39 at the first visit and 0.01 ± 0.16 at the last visit. The most common symptoms included blurred vision (72.8%), enlarged blind spot (42.2%), photopsia (37.4%), and scotoma (33.3%). We found the patients with only positive visual phenomena had significantly worse visual acuity at the first and last visit than patients with only negative visual phenomena (p = 0.008) or the patients with both positive and negative visual phenomena (p = 0.026). Four cases similar to visual snow were discovered. Compared to the MEWDS patients without visual snow, the patients with visual snow tend to have a larger proportion of females (p = 0.005) and a better visual acuity at the first visit (p = 0.007). Conclusion Herein, we expand upon the clinical manifestations of MEWDS with visual snow, and the symptoms attributable to visual snow could precede the onset of MEWDS. Neurologists and ophthalmologists should carefully rule out occult chorioretinopathy before diagnosing visual snow syndrome.
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Affiliation(s)
- Chenyue Hang
- Ottawa-Shanghai Joint School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Yan
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yan Yan
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24
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Management of Non-Infectious Uveitis, a Selection of Topical Items Updating. J Clin Med 2022; 11:jcm11195558. [PMID: 36233426 PMCID: PMC9572930 DOI: 10.3390/jcm11195558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
First of all, we would like to thank all of the authors for their contributions and the editorial staff who enabled the achievement of this «Diagnosis and Management of Non-infectious Uveitis: Old and New Challenges» Special Issue [...]
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25
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Huang N, Kim I, Rutledge B, Hunter DD, Swan RT. Observing the initial onset of retinal vasculitis as unilateral Birdshot Retinochoroiditis becomes bilateral: A case report. Am J Ophthalmol Case Rep 2022; 27:101593. [PMID: 35664450 PMCID: PMC9160671 DOI: 10.1016/j.ajoc.2022.101593] [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: 03/27/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Birdshot Retinochoroiditis (BRC) is an uncommon but distinct form of bilateral posterior uveitis. It is generally of indolent onset, making early natural history difficult to study. Our report seeks to expand knowledge on the natural history of the onset of BRC. Observations Our patient presented with clinical features that were consistent with unilateral BRC, despite it being defined as a bilateral condition. Over the course of one year he developed retinal vasculitis, vitritis and fundus features of BRC in the second eye. Conclusions and Importance Although BRC is a bilateral disease, our case demonstrates that the onset may sometimes be sequential instead of simultaneous. Unilateral disease that is characteristic of BRC should be monitored for second-eye involvement with multi-modal imaging including fundus photography, angiography, perimetry, electroretinography, and optical coherence tomography of the macula with emphasis on the choroidal thickness. Birdshot Retinochoroiditis has an indolent onset making it difficult to study early disease. Our case suggests onset of Birdshot retinochoroiditis may be unilateral with later involvement of the second eye. Diagnostic criteria of Birdshot Retinochoroiditis require inflammation of both eyes. Optic nerve hyperfluorescence and retinal vasculitis was our patient's most prominent feature of second eye involvement. Intravitreal steroid implants improved the retinal vasculitis.
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26
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Singh RB, Perepelkina T, Testi I, Young BK, Mirza T, Invernizzi A, Biswas J, Agarwal A. Imaging-based Assessment of Choriocapillaris: A Comprehensive Review. Semin Ophthalmol 2022:1-22. [PMID: 35982638 DOI: 10.1080/08820538.2022.2109939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium. METHODS A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid. RESULTS The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed. CONCLUSION The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Tatiana Perepelkina
- Department of Ophthalmology, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Benjamin K Young
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Tuba Mirza
- Department of Ophthalmology, Ascension Macomb Oakland Eye Institute, Warren, MI, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
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27
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Birdshot Chorioretinopathy: A Review. J Clin Med 2022; 11:jcm11164772. [PMID: 36013011 PMCID: PMC9410532 DOI: 10.3390/jcm11164772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 01/26/2023] Open
Abstract
Birdshot chorioretinopathy (BSCR) is a bilateral chronic inflammation of the eye with no extraocular manifestations. BSCR affects middle-aged individuals from European descent and is strongly associated with the human leucocyte antigen (HLA)-A29 allele. The immune mechanisms involved are not fully understood, but recent advances have shown the role of Endoplasmic Reticulum Aminopeptidase 2 (ERAP2) in disease pathogenesis. Multimodal imaging, including fluorescein angiography, indocyanine angiography, fundus autofluorescence, and optical coherence tomography, are useful in confirming the diagnosis and monitoring disease activity. Visual field testing is also important to assess the disease progression. To date, there is no consensus for optimal treatment regimen and duration. Local and systemic corticosteroids can be used for short periods, but immunosuppressive or biological therapies are usually needed for the long-term management of the disease. Here, we will review publications focused on birdshot chorioretinopathy to give an update on the pathophysiology, the multimodal imaging, and the treatment of the disease.
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28
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Liu S, Cui X, Xia K, Duan Y, Xiong M, Li G. Efficacy and safety of whole-lung lavage for pulmonary alveolar proteinosis: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e057671. [PMID: 35443958 PMCID: PMC9021772 DOI: 10.1136/bmjopen-2021-057671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Pulmonary alveolar proteinosis (PAP) is an ultrarare disorder characterised by the accumulation of alveolar surfactant and the dysfunction of alveolar macrophages that results in hypoxemic respiratory failure. Whole-lung lavage (WLL) is currently the primary therapy for PAP. However, systematic evaluation of the clinical efficacy of WLL is lacking. We aim to perform a systematic review and meta-analysis of existing evidence to support WLL for the clinical treatment of PAP. METHODS AND ANALYSIS We will search the PubMed (MEDLINE), Cochrane Library, Embase, Web of Science and Google Scholar databases from inception to December 2021 for observational studies using WLL for the treatment of PAP. Two authors will independently screen the eligible studies, assess the quality of the included papers and extract the required information. Review Manager V.5.4 will be used to perform the meta-analysis. We will evaluate the overall quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. All steps of this protocol will be performed using the Cochrane Handbook for Preferred Reporting Items for Systematic Review and Meta-analysis statement. ETHICS AND DISSEMINATION This systematic review and meta-analysis will be based on published data. Therefore, ethical approval is not required. We will publish our results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022306221 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306221).
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Affiliation(s)
- Shixu Liu
- Guanganmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Xiangning Cui
- Guanganmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Kun Xia
- Guanganmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Yuanyuan Duan
- Guanganmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Mengran Xiong
- Guanganmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Guangxi Li
- Guanganmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
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29
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Huang XF, Brown MA. Progress in the genetics of uveitis. Genes Immun 2022; 23:57-65. [PMID: 35379982 PMCID: PMC9042703 DOI: 10.1038/s41435-022-00168-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
Uveitis is the most common form of intraocular inflammatory disease and is a significant cause of visual impairment worldwide. Aetiologically, uveitis can also be classified into infectious uveitis and non-infectious uveitis. The common non-infectious forms of uveitis include acute anterior uveitis (AAU), Behçet’s disease (BD), Vogt-Koyanagi-Harada (VKH) disease, birdshot chorioretinopathy (BSCR), sarcoid uveitis. In addition, a few monogenic autoinflammatory disorders can also cause uveitis, such as Blau Syndrome and haploinsufficiency of A20 (HA20). Although the exact pathogenesis of non-infectious uveitis is still unclear, it is well-recognised that it involves both genetic and environmental risk factors. A hallmark of uveitis is its strong associations with human leucocyte antigens (HLA). For examples, AAU, BD and BSCR are strongly associated with HLA-B27, HLA-B51, and HLA-A29, respectively. In uveitis studies, multiple GWAS have successfully been conducted and led to identification of novel susceptibility loci, for example, IL23R has been identified in BD, VKH and AAU. In this review, we summarize the latest progress on the genetic associations of both HLA and non-HLA genes with major forms of uveitis, including AAU, BD, VKH, BSCR, sarcoid uveitis, Blau Syndrome and HA20, and potential future research directions.
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Affiliation(s)
- Xiu-Feng Huang
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Queensland University of Technology, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Woolloongabba, Qld, Australia
| | - Matthew A Brown
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, England. .,Genomics England, London, UK.
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30
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Fogel-Levin M, Sadda SR, Rosenfeld PJ, Waheed N, Querques G, Freund KB, Sarraf D. Advanced retinal imaging and applications for clinical practice: A consensus review. Surv Ophthalmol 2022; 67:1373-1390. [DOI: 10.1016/j.survophthal.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 01/20/2023]
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31
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da Fonsêca MLG, Vianna RNG, Rocha ACH, Casella AMB, Cialdini A, Muccioli C, da Costa DS, Lucena DR, Vasconcelos-Santos DV, Morizot E, Castro E, Rodriguez EEC, Diligenti FT, Porto FBO, Nascimento H, Yanamoto JH, Oréfice JL, Muralha LRP, Carneiro LB, Finamor LPS, Frazão MAM, Motta M, Nobrega MJ, Zajdenweber ME, Moraes RT, Meirelles RL, Lemos SR, de Araújo WF. Birdshot retinochoroiditis in Brazil: a multicenter review of 40 patients. Int J Retina Vitreous 2022; 8:5. [PMID: 34996521 PMCID: PMC8740347 DOI: 10.1186/s40942-021-00353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Birdshot retinochoroiditis (BRC) is a rare and chronic bilateral uveitis mostly found in Caucasians. As few data are available about the clinical course of BRC in Hispanic patients, we aimed to report the clinical findings and the evolution of BRC in Brazilian patients. Methods This retrospective cohort multicenter nationwide study was performed by analyzing the records of patients with BRC diagnoses from Brazilian ophthalmological centers from April 1995 to May 2020. Results Forty patients (80 eyes) with a diagnosis of BRC were evaluated. The mean age was 53 years, and there was no sex predominance. All tested patients (34/40) were positive for HLA-A29. The diagnosis of BRC was made following the Levinson et al. criteria, and all ancillary tests were performed to exclude differential diagnoses. Clinical signs and symptoms, such as complications and treatment, were described. Conclusions BRC evolution in Brazilian patients seems to have some peculiarities that diverge from the published literature available about Caucasians, as AS inflammation is higher in this population.
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Affiliation(s)
- Maria Luisa Gois da Fonsêca
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil.
| | - Raul N G Vianna
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil
| | - Anna C H Rocha
- Retina and Vitreous Service, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Antonio M B Casella
- Retina and Vitreous Service, Londrina State University (UEL), Londrina, PR, Brazil
| | - Arnaldo Cialdini
- Retina and Vitreous Service, Brazilian Center for Eye Surgery (CBCO), Goiânia, GO, Brazil
| | - Cristina Muccioli
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Daniela S da Costa
- Retina and Vitreous Service, Federal Hospital of State Servers (SERVIDORES), Rio de Janeiro, RJ, Brazil
| | - Daniel R Lucena
- Retina and Vitreous Service, Escola Cearence de Oftalmologia, Fortaleza, CE, Brazil
| | | | - Eduardo Morizot
- Retina and Vitreous Service, Botafogo Polyclinic, Rio de Janeiro, RJ, Brazil
| | - Elaine Castro
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil
| | - Ever E C Rodriguez
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Felipe T Diligenti
- Retina and Vitreous Service, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Heloisa Nascimento
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Joyce H Yanamoto
- Ophthalmology Department, Hospital das Clínicas, HCFMUSP (USP), São Paulo, SP, Brazil
| | | | | | | | - Luciana P S Finamor
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria A M Frazão
- Department of Ophthalmology, "Santa Casa"of São Paulo, São Paulo, SP, Brazil
| | - Mario Motta
- Retina and Vitreous Service, Federal University of the State of the Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Mario J Nobrega
- Retina and Vitreous Service, Hospital de Olhos Sadalla Amin Ghanem, Joinville, SC, Brazil
| | | | - Remo T Moraes
- Brazilian Institute of Ophthalmology (IBOL), Rio de Janeiro, RJ, Brazil
| | - Rodrigo L Meirelles
- Ophthalmology Department, Hospital das Clínicas, HCFMUSP (USP), São Paulo, SP, Brazil
| | - Sidney R Lemos
- Retina and Vitreous Service, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Cheng SK, Thompson I, Okeagu C, Sen HN. CHOROIDAL LESIONS UNRESPONSIVE TO FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT IN BIRDSHOT CHORIORETINOPATHY. Retin Cases Brief Rep 2022; 16:56-58. [PMID: 31688672 PMCID: PMC7190444 DOI: 10.1097/icb.0000000000000909] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To report the persistence of choroidal lesions despite fluocinolone acetonide intravitreal implants and their resolution with oral prednisone treatment. METHODS Retrospective chart review of a birdshot chorioretinopathy patient at a tertiary referral clinic. RESULTS Indocyanine angiography revealed resolution of choroidal lesions with oral prednisone and recurrence after discontinuation of oral prednisone. CONCLUSION Choroidal lesions responded to oral prednisone despite bilateral active fluocinolone acetonide intravitreal implant in a birdshot chorioretinopathy patient.
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Affiliation(s)
- Shuk Kei Cheng
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Ian Thompson
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Chinwenwa Okeagu
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - H. Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD
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Abstract
Background In 2006 the Chicago consensus statement on the management of people with variations of sex characteristics (VSC) acknowledged the importance of a multidisciplinary team (MDT) approach. The consensus update from 2016 reinforced the call for multidisciplinary collaborations between medical professionals, parents and support groups, and proposed guidelines to improve shared decision making and patient-centred care embedded in ethical principles of self-determination and child participation. But there is little evidence that successfully MDTs have been implemented in clinical practice. Methods and aims A scoping review was conducted to identify studies that address the collaboration and decision making process of MDTs providing care of people with VSC to identify ideal and actual (1) team composition; (2) models of collaboration and (3) ethical principles that MDTs follow. Six databases were systematically searched: CINAHIL, Medline, Psychinfo, Scopus, Socindex and Web of Science. No restriction was placed on the type of methodology used in the studies. To frame the research, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. Results The MDTs in the literature include mainly medical professionals: endocrinologists, urologists and surgeons. The collaboration among medical professionals in MDTs lacks cooperation as one team member sets the tasks of the team while each professional works separately. Despite the importance of psycho-social support the involvement of psychologists remains secondary. The implementation of ethical principles tends to exclude people with VSC. Conclusion The care of people with VSC described in the papers is medically oriented as the team members are mainly medical professionals working separately. MDT tend to exclude people with VSC despite references to shared decision making processes and informed consent. There was no mention of adult care and lack of inclusion of patient’s perspective in the care process. The future research should do more empirical research of MDTs.
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Gelfman S, Monnet D, Ligocki AJ, Tabary T, Moscati A, Bai X, Freudenberg J, Cooper B, Kosmicki JA, Wolf S, Ferreira MAR, Overton J, Weyne J, Stahl EA, Baras A, Romano C, Cohen JHM, Coppola G, Brézin A. ERAP1, ERAP2, and Two Copies of HLA-Aw19 Alleles Increase the Risk for Birdshot Chorioretinopathy in HLA-A29 Carriers. Invest Ophthalmol Vis Sci 2021; 62:3. [PMID: 34727153 PMCID: PMC8572510 DOI: 10.1167/iovs.62.14.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Birdshot chorioretinopathy (BSCR) is strongly associated with HLA-A29. This study was designed to elucidate the genetic modifiers of BSCR in HLA-A29 carriers. Methods We sequenced the largest BSCR cohort to date, including 286 cases and 108 HLA-A29–positive controls to determine genome-wide common and rare variant associations. We further typed the HLA alleles of cases and 45,386 HLA-A29 controls of European ancestry to identify HLA alleles that associate with BSCR risk. Results Carrying a second allele that belongs to the HLA-Aw19 broad antigen family (including HLA-A29, -A30, -A31, and -A33) increases the risk for BSCR (odds ratio [OR] = 4.44; P = 2.2e-03). This result was validated by comparing allele frequencies to large HLA-A29-controlled cohorts (n = 45,386; OR > 2.5; P < 1.3e-06). We also confirm that ERAP1 and ERAP2 haplotypes modulate disease risk. A meta-analysis with an independent dataset confirmed that ERAP1 and ERAP2 haplotypes modulate the risk for disease at a genome-wide significant level: ERAP1-rs27432 (OR = 2.46; 95% confidence interval [CI], 1.85–3.26; P = 4.07e-10), an expression quantitative trait locus (eQTL) decreasing ERAP1 expression; and ERAP2-rs10044354 (OR = 1.95; 95% CI, 1.55–2.44; P = 6.2e-09), an eQTL increasing ERAP2 expression. Furthermore, ERAP2-rs2248374 that disrupts ERAP2 expression is protective (OR = 0.56; 95% CI, 0.45–0.70; P = 2.39e-07). BSCR risk is additively increased when combining ERAP1/ERAP2 risk genotypes with two copies of HLA-Aw19 alleles (OR = 13.53; 95% CI, 3.79–54.77; P = 1.17e-05). Conclusions The genetic factors increasing BSCR risk demonstrate a pattern of increased processing, as well as increased presentation of ERAP2-specific peptides. This suggests a mechanism in which exceeding a peptide presentation threshold activates the immune response in choroids of A29 carriers.
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Affiliation(s)
- Sahar Gelfman
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Dominique Monnet
- Université de Paris, Hôpital Cochin, service d'ophtalmologie, Paris, France
| | - Ann J Ligocki
- Regeneron Pharmaceuticals, Tarrytown, New York, United States
| | | | - Arden Moscati
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Xiaodong Bai
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Jan Freudenberg
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Blerta Cooper
- Regeneron Pharmaceuticals, Tarrytown, New York, United States
| | - Jack A Kosmicki
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Sarah Wolf
- Regeneron Genetics Center, Tarrytown, New York, United States
| | | | - John Overton
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Jonathan Weyne
- Regeneron Pharmaceuticals, Tarrytown, New York, United States
| | - Eli A Stahl
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Carmelo Romano
- Regeneron Pharmaceuticals, Tarrytown, New York, United States
| | | | | | - Antoine Brézin
- Université de Paris, Hôpital Cochin, service d'ophtalmologie, Paris, France
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Testi I, Modugno RL, Pavesio C. Multimodal imaging supporting the pathophysiology of white dot syndromes. J Ophthalmic Inflamm Infect 2021; 11:32. [PMID: 34529201 PMCID: PMC8446150 DOI: 10.1186/s12348-021-00261-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
White dot syndromes (WDS) represent a heterogeneous group of inflammatory diseases, primarily affecting the outer retina, choriocapillaris and choroid. Recent advances in the field of ocular imaging and development of new technologies, including optical coherence tomography angiography (OCT-A), have allowed a better characterization of the morphology of these conditions. This review will analyse the WDS from an imaging-based perspective, providing a better understanding of the pathophysiology underlying these disorders.
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Affiliation(s)
- Ilaria Testi
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK
| | | | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK.
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Vidas Pauk S, Vukojević N, Jandroković S, Kalauz M, Tomić M, Masnec S, Škegro I, Mrazovac Zimak D. Bilateral juxtapapillary choroidal neovascularization secondary to Birdshot chorioretinopathy-case report. Clin Case Rep 2021; 9:e04601. [PMID: 34429993 PMCID: PMC8365546 DOI: 10.1002/ccr3.4601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022] Open
Abstract
Central vision loss, photopsia, floaters, and macular edema in a highly myopic patient can easily be misinterpreted as high myopia complications. In atypical cases, detailed examination and a thorough diagnostic workup are required to establish the proper diagnosis, which is often beyond the scope of diagnoses initially considered.
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Affiliation(s)
- Sania Vidas Pauk
- Department of OphthalmologyZagreb University Hospital CenterZagrebCroatia
| | - Nenad Vukojević
- Department of OphthalmologyZagreb University Hospital CenterZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
| | - Sonja Jandroković
- Department of OphthalmologyZagreb University Hospital CenterZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
| | - Miro Kalauz
- Department of OphthalmologyZagreb University Hospital CenterZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
| | - Martina Tomić
- Department of OphthalmologyVuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic DiseasesMerkur University HospitalZagrebCroatia
| | - Sanja Masnec
- Department of OphthalmologyZagreb University Hospital CenterZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
| | - Ivan Škegro
- Department of OphthalmologyZagreb University Hospital CenterZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
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HLA-A29 Birdshot Retinochoroiditis in Its 5th Decade: Selected Glimpses into the Intellectual Meanderings and Progresses in the Knowledge of a Long-Time Misunderstood Disease. Diagnostics (Basel) 2021; 11:diagnostics11071291. [PMID: 34359373 PMCID: PMC8305470 DOI: 10.3390/diagnostics11071291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
The appraisal of HLA-A29 birdshot retinochoroiditis (BRC) was fraught with pitfalls and misunderstandings. Progress in investigational methods has led to better knowledge and management of the disease. Our aim was to assess some of the steps that have led to better characterisation of the clinical entity of BRC. We performed a literature search analysing the relevant progress in disease origin, investigational and imaging methods, clinicopathology and classification, diagnostic criteria and management. Following developments were judged essential in the better appraisal and understanding of the disease: (1) new immunopathological hypotheses regarding the role of endoplasmic reticulum peptidases, (2) the essential importance of HLA testing, (3) relevant imaging modalities among which indocyanine green angiography is crucial, (4) diagnostic criteria that allow early diagnosis and (5) need of an early prolonged, as well as aggressive treatment combining more than one immunosuppressive agent. Based on these findings it is now possible to better define BRC, an indolent however severe disease, unlike thought before, involving the choroidal stroma and the retina independently and concomitantly that can be diagnosed early thanks to indocyanine green angiography and should be treated early and relentlessly.
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Rathinam SR, Tugal-Tutkun I, Agarwal M, Rajesh V, Egriparmak M, Patnaik G. Immunological tests and their interpretation in uveitis. Indian J Ophthalmol 2021; 68:1737-1748. [PMID: 32823389 PMCID: PMC7690523 DOI: 10.4103/ijo.ijo_570_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Uveitis is a complex disorder including both infectious and non-infectious etiologies. Clinical diagnosis is a challenge because many diseases share common clinical signs. Laboratory support is crucial for confirming the clinical diagnosis. Laboratory diagnosis includes direct tests and indirect tests. For example smear, culture, and molecular diagnostics demonstrate the pathogens, hence they are direct tests. Immunologic tests employ an antigen to detect presence of antibodies to a pathogen, or an antibody to detect the presence of an antigen, of the pathogen in the specimens. The immunological tests used in laboratories are made by producing artificial antibodies that exactly “match” the pathogen in question. When these antibodies come into contact with a sample they bind to the matching pathogen if found in the sample. Hence they are grouped under indirect evidence. There are several investigations in uveitis to reach the confirmed diagnosis including microbiological, immunological, imaging and molecular diagnostic testing. In this section we will discuss immunological investigations of infectious and non-infectious uveitis.
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Affiliation(s)
- S R Rathinam
- Uveitis Service, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Mamta Agarwal
- Uveitis Service, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Merih Egriparmak
- Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Gazal Patnaik
- Uveitis Service, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Trombke J, Loyal L, Braun J, Pleyer U, Thiel A, Pohlmann D. Analysis of peripheral inflammatory T cell subsets and their effector function in patients with Birdshot Retinochoroiditis. Sci Rep 2021; 11:8604. [PMID: 33883633 PMCID: PMC8060342 DOI: 10.1038/s41598-021-88013-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Birdshot Retinochoroiditis (BSRC) is a progressive non-infectious intraocular inflammation that affects choroid and retina. Inflammatory processes have adverse effects on vision by affecting photoreceptor-bearing cells that do not regenerate. This study aimed at characterizing inflammatory CD4+ and CD8+ T cell subsets in the peripheral blood of active and inactive BSRCs. Furthermore, we correlated phenotypical and functional immunological analyses with clinical data. We observed a slight increase of terminally differentiated effector memory CD8+ T cells expressing CD45RA (TEMRA) in blood of inactive, compared to active BSRCs. Moreover, we identified a trend for a decreased population of TH2 cells and increased TH1 frequencies in active BSRCs, a typical sign of ongoing autoimmune processes. Functional assays demonstrated severe and overall impairment of effector function of both, CD4+ and CD8+ inflammatory T cells, which might reflect T cell exhaustion. Although the eye is the main site of inflammation in BSRC, we observed altered T cell subset compositions in the peripheral blood, dependent on the disease status. Our results indicate that T cells may play a major role in BSRC pathology, although our cohort size is too limited for definitve conclusions. Future studies with larger BSRCs have to be performed.
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Affiliation(s)
- Janine Trombke
- Regenerative Immunology and Aging, BIH Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lucie Loyal
- Regenerative Immunology and Aging, BIH Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Si-M/"Der Simulierte Mensch" a Science Framework of Technische Universität Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Braun
- Regenerative Immunology and Aging, BIH Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Uwe Pleyer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Thiel
- Regenerative Immunology and Aging, BIH Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Si-M/"Der Simulierte Mensch" a Science Framework of Technische Universität Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominika Pohlmann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Takeuchi M, Mizuki N, Ohno S. Pathogenesis of Non-Infectious Uveitis Elucidated by Recent Genetic Findings. Front Immunol 2021; 12:640473. [PMID: 33912164 PMCID: PMC8072111 DOI: 10.3389/fimmu.2021.640473] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/22/2021] [Indexed: 01/01/2023] Open
Abstract
Uveitis is a generic term for inflammation of the uvea, which includes the iris, ciliary body, and choroid. Prevalence of underlying non-infectious uveitis varies by race and region and is a major cause of legal blindness in developed countries. Although the etiology remains unclear, the involvement of both genetic and environmental factors is considered important for the onset of many forms of non-infectious uveitis. Major histocompatibility complex (MHC) genes, which play a major role in human immune response, have been reported to be strongly associated as genetic risk factors in several forms of non-infectious uveitis. Behçet’s disease, acute anterior uveitis (AAU), and chorioretinopathy are strongly correlated with MHC class I-specific alleles. Moreover, sarcoidosis and Vogt-Koyanagi-Harada (VKH) disease are associated with MHC class II-specific alleles. These correlations can help immunogenetically classify the immune pathway involved in each form of non-infectious uveitis. Genetic studies, including recent genome-wide association studies, have identified several susceptibility genes apart from those in the MHC region. These genetic findings help define the common or specific pathogenesis of ocular inflammatory diseases by comparing the susceptibility genes of each form of non-infectious uveitis. Interestingly, genome-wide association of the interleukin (IL)23R region has been identified in many of the major forms of non-infectious uveitis, such as Behçet’s disease, ocular sarcoidosis, VKH disease, and AAU. The interleukin-23 (IL-23) receptor, encoded by IL23R, is expressed on the cell surface of Th17 cells. IL-23 is involved in the homeostasis of Th17 cells and the production of IL-17, which is an inflammatory cytokine, indicating that a Th17 immune response is a common key in the pathogenesis of non-infectious uveitis. Based on the findings from the immunogenetics of non-infectious uveitis, a personalized treatment approach based on the patient’s genetic make-up is expected.
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Affiliation(s)
- Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Servant M, Couret C, Lebreton O, Masse H, Weber M. [Anatomic-functional correlations in birdshot chorioretinopathy: An observational single-center prospective study]. J Fr Ophtalmol 2021; 44:632-642. [PMID: 33840496 DOI: 10.1016/j.jfo.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to identify anatomic-functional correlations in patients with Birdshot chorioretinopathy in order to better understand the mechanisms of visual loss. MATERIALS AND METHODS We conducted a single-center observational prospective study at the Nantes University Medical Center including all patients followed for Birdshot chorioretinopathy between January 2019 and July 2019. The parameters studied were visual acuity, microperimetry, standard automated perimetry, SD-OCT, EDI-OCT, OCT-A, RNFL-OCT, wide-field fundus photographs, and fluorescein and ICG angiography. RESULTS Forty-four eyes were studied. A significant correlation was found between visual acuity and retinal thickness (P=0.002, r=0.44), but not choroidal thickness (P=0.16). A significant correlation was also observed between retinal sensitivity and total macular thickness (P<0.001, r=0.68) as well as inner retinal thickness (P<0.001, r=0.65), while the correlation was weaker with choroidal thickness (P=0.03, r=0.32). There was a weak correlation between retinal sensitivity and superficial capillary density (P=0.02, r=0.42) as well as deep capillary density (P=0.02, r=0.41). The peripheral hypo-autofluorescent zones correspond to the visual field defects, but these defects are larger than the hypo-autofluorescent zones. Patients with paracentral or peripheral field defects had a history of vasculitis more often than hypo-ICG spots. DISCUSSION We found significant correlations between functional parameters such as visual acuity and retinal sensitivity and retinal anatomic parameters, particularly the inner retina, while there was no correlation shown with choroidal anatomic parameters. CONCLUSION The main results of our study suggest a retinal rather than choroidal origin of the degradation of visual function in birdshot chorioretinopathy.
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Affiliation(s)
- M Servant
- Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 4000 Nantes, France.
| | - C Couret
- Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 4000 Nantes, France.
| | - O Lebreton
- Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 4000 Nantes, France.
| | - H Masse
- Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 4000 Nantes, France.
| | - M Weber
- Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 4000 Nantes, France.
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van Dijk EHC, Boon CJF. Serous business: Delineating the broad spectrum of diseases with subretinal fluid in the macula. Prog Retin Eye Res 2021; 84:100955. [PMID: 33716160 DOI: 10.1016/j.preteyeres.2021.100955] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023]
Abstract
A wide range of ocular diseases can present with serous subretinal fluid in the macula and therefore clinically mimic central serous chorioretinopathy (CSC). In this manuscript, we categorise the diseases and conditions that are part of the differential diagnosis into 12 main pathogenic subgroups: neovascular diseases, vitelliform lesions, inflammatory diseases, ocular tumours, haematological malignancies, paraneoplastic syndromes, genetic diseases, ocular developmental anomalies, medication-related conditions and toxicity-related diseases, rhegmatogenous retinal detachment and tractional retinal detachment, retinal vascular diseases, and miscellaneous diseases. In addition, we describe 2 new clinical pictures associated with macular subretinal fluid accumulation, namely serous maculopathy with absence of retinal pigment epithelium (SMARPE) and serous maculopathy due to aspecific choroidopathy (SMACH). Differentiating between these various diseases and CSC can be challenging, and obtaining the correct diagnosis can have immediate therapeutic and prognostic consequences. Here, we describe the key differential diagnostic features of each disease within this clinical spectrum, including representative case examples. Moreover, we discuss the pathogenesis of each disease in order to facilitate the differentiation from typical CSC.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Venema WJ, Hiddingh S, de Boer JH, Claas FHJ, Mulder A, den Hollander AI, Stratikos E, Sarkizova S, van der Veken LT, Janssen GMC, van Veelen PA, Kuiper JJW. ERAP2 Increases the Abundance of a Peptide Submotif Highly Selective for the Birdshot Uveitis-Associated HLA-A29. Front Immunol 2021; 12:634441. [PMID: 33717175 PMCID: PMC7950316 DOI: 10.3389/fimmu.2021.634441] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Birdshot Uveitis (BU) is a blinding inflammatory eye condition that only affects HLA-A29-positive individuals. Genetic association studies linked ERAP2 with BU, an aminopeptidase which trims peptides before their presentation by HLA class I at the cell surface, which suggests that ERAP2-dependent peptide presentation by HLA-A29 drives the pathogenesis of BU. However, it remains poorly understood whether the effects of ERAP2 on the HLA-A29 peptidome are distinct from its effect on other HLA allotypes. To address this, we focused on the effects of ERAP2 on the immunopeptidome in patient-derived antigen presenting cells. Using complementary HLA-A29-based and pan-class I immunopurifications, isotope-labeled naturally processed and presented HLA-bound peptides were sequenced by mass spectrometry. We show that the effects of ERAP2 on the N-terminus of ligands of HLA-A29 are shared across endogenous HLA allotypes, but discover and replicate that one peptide motif generated in the presence of ERAP2 is specifically bound by HLA-A29. This motif can be found in the amino acid sequence of putative autoantigens. We further show evidence for internal sequence specificity for ERAP2 imprinted in the immunopeptidome. These results reveal that ERAP2 can generate an HLA-A29-specific antigen repertoire, which supports that antigen presentation is a key disease pathway in BU.
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Affiliation(s)
- Wouter J Venema
- Department of Ophthalmology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Sanne Hiddingh
- Department of Ophthalmology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Arend Mulder
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Anneke I den Hollander
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Efstratios Stratikos
- Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, Greece
| | - Siranush Sarkizova
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States.,Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Lars T van der Veken
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - George M C Janssen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Peter A van Veelen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Jonas J W Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
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Ameri H, Naser M, Choudhury F, Rao NA. Electroretinogram and Visual Field Correlation in Birdshot Chorioretinopathy. Asia Pac J Ophthalmol (Phila) 2021; 10:208-211. [PMID: 33793442 DOI: 10.1097/apo.0000000000000374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to assess possible correlation between the visual field and electroretinogram (ERG) parameters in birdshot chorioretinopathy (BCR). DESIGN Retrospective cross-sectional study. METHODS This single-center study included 21 eyes of 11 patients with BCR with prior ERG and Goldmann kinetic perimetry. Generalized estimating equation was used for statistical analysis, and isopters V4e and I4e were modeled as separate outcomes with each parameter of ERG as the main independent variable. The main outcome measure was presence or absence of correlation between the Goldmann isopters and ERG parameters including the amplitudes and implicit times of dark adapted (DA) and light adapted (LA) a-waves and b-waves (DA 0.01, DA 3.0, DA 10.0, and LA 3.0) and LA 30 Hz. RESULTS There was a strong positive correlation between the size of isopter V4e and all the scotopic and photopic standard ERG amplitudes [P < 0.0001 for all, except LA 3.0 a-wave (P = 0.0019) and LA 30 Hz (P = 0.0026)]. For the implicit times, only DA 3.0 a-wave (P = 0.007) and LA 30 Hz (P < 0.0001) showed significant negative correlations. There were no correlations between the size of isopter I4e and any ERG amplitudes; however, 3 implicit times showed some negative correlation: DA 3.0 a-wave (P < 0.0001), DA 10.0 b-wave (P = 0.0251), and LA 3.0 b-wave (P < 0.0001). CONCLUSIONS In this study, the largest isopter of Glodmann visual field showed a strong positive correlation with all standard ERG amplitudes in BCR. This novel finding underscores the role of ERG as an objective visual function test in monitoring the disease activity.
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Affiliation(s)
- Hossein Ameri
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maryam Naser
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Farzana Choudhury
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Narsing A Rao
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Maleki A, Maldonado Cerda A, Garcia CM, Zein M, Manhapra A, Foster CS. Chlorambucil combination therapy in refractory serpiginous choroiditis: A cure? Am J Ophthalmol Case Rep 2021; 21:101014. [PMID: 33615036 PMCID: PMC7881218 DOI: 10.1016/j.ajoc.2021.101014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose To find a remedy for serpiginous choroiditis refractory to oral prednisone and chlorambucil treatment. Observations Eight eyes of four patients (all female) with advanced macular involvement secondary to serpiginous choroiditis were included in the study. The average age of the patients was 45.2 years. One eye of each patient was legally blind and the lesion was close to the fovea in the other eye. All four patients failed oral prednisone and chlorambucil therapy. However, case 1 responded to chlorambucil treatment after intravitreal dexamethasone implant implantation and discontinuation of oral prednisone. Case 2 responded to chlorambucil therapy when oral prednisone was stopped in combination with infliximab therapy. Due to long follow-up period of more than four years, these two cases are considered to be cured. Case 3 and case 4 were not able to achieve remission with chlorambucil and immunomodulatory therapy. They refused intravitreal steroid implant due to side effects profile. Conclusions and importance The stability of WBC counts within toxic levels close to normal or lower limits of normal (3000–4500 cells/μl) during treatment with chlorambucil is an essential factor for the success of this therapy. A combination of dexamethasone intravitreal implant with chlorambucil therapy can be an effective and promising regimen in inducing and maintaining remission in refractory serpiginous choroiditis patients who fail a combination of systemic corticosteroid and chlorambucil therapy. Serpiginous choroiditis may be recurrent or refractory to chlorambucil in conjunction with systemic corticosteroids. The stability of WBC counts within lower limits of normal is an essential factor for the success of chlorambucil therapy. This can be achieved with dexamethasone intravitreal implant or systemic immunomodulatory without systemic corticosteroid therapy.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Anapatricia Maldonado Cerda
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Cristina M. Garcia
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Mike Zein
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - C. Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
- Harvard Medical School, Department of Ophthalmology, Boston, MA, United States
- Corresponding author. Massachusetts Eye Research and Surgery Institution, 1440 Main St. Ste. 201, Waltham, MA, USA.
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46
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Hang C, Leishangthem L, Yan Y. Not All Cases of Visual Snows are Benign: Mimics of Visual Snow Syndrome. Neuropsychiatr Dis Treat 2021; 17:3293-3300. [PMID: 34785899 PMCID: PMC8591117 DOI: 10.2147/ndt.s338111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/27/2021] [Indexed: 01/08/2023] Open
Abstract
Visual snow syndrome (VSS) is a clinical disorder characterized by pan-field visual disturbance. It is a diagnosis of exclusion since its pathophysiology remains unknown. Excluding other mimics is of great significance since some serious pathologies can have secondary visual snow (VS) as an initial presentation. Delayed or incorrect diagnosis of these VSS mimics may lead to permanent vision loss or even death. The purpose of this review is to help physicians distinguish VSS mimics promptly to avoid bad outcomes. The authors performed a PubMed literature search of articles, case reports, and reviews describing VS symptoms in patients with underlying diseases other than VSS. The red flags of secondary VS symptoms were highlighted, such as new-onset or intermittent VS, unilateral or quadrant VS, and accompanied ocular or neurological deficits. There are four main categories of VSS mimics, ie, including neurological disorders, ocular pathologies, drug-related VS, and other systemic diseases. The physicians could largely exclude most etiologies based on history taking, ophthalmologic and neurologic examinations, and neuroimaging. Further research in VS should carefully define and unify the inclusion and exclusion criteria of this disorder and investigate these secondary VS conditions and their pathogenesis.
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Affiliation(s)
- Chenyue Hang
- Ottawa-Shanghai Joint School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lakshmi Leishangthem
- Department of Neurology and Ophthalmology, University of Connecticut, Farmington, CT, USA
| | - Yan Yan
- Department of Ophthalmology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Ajamil-Rodanes S, Testi I, Luis J, Robson AG, Westcott M, Pavesio C. Evaluation of fluocinolone acetonide 0.19 mg intravitreal implant in the management of birdshot retinochoroiditis. Br J Ophthalmol 2020; 106:234-240. [PMID: 33243833 DOI: 10.1136/bjophthalmol-2020-317372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To report treatment outcomes and efficacy of the fluocinolone acetonide 0.19 mg intravitreal implant (Iluvien) in controlling retinal and choroidal inflammation in 11 patients with birdshot retinochoroiditis. METHODS A single-centre, retrospective, interventional case series. The primary efficacy end point was improvement in vascular leakage on fluorescein angiography (FA), effect on cystoid macular oedema (CMO) and resolution of hypofluorescent lesions on indocyanine green angiography (ICGA); secondary measures were improvements on pattern and full-field electroretinogram (PERG; ERG) parameters. Safety outcome measures were intraocular elevation and cataractogenesis. RESULTS Fifteen eyes received Iluvien implant with an average follow-up of 31 months (range 12-36 months). Prior to the implant, 5 (33.3%) eyes had received dexamethasone intravitreal implant 0.7 mg (Ozurdex). FA showed evidence of vascular leakage in all eyes at baseline. Between month 6 and 12, FA showed that 73.4% of eyes had no leakage, this increased to 84.6% by month 24. Three eyes in our study had CMO at baseline. 6 months after Iluvien implant, all eyes achieved complete CMO resolution. One year after insertion of the implant, the characteristic hypofluorescent lesions on ICGA were unchanged in all cases. There was baseline ERG evidence indicating a high incidence of peripheral cone system dysfunction and most showed PERG evidence of macular dysfunction. Retinal function improved and macular function improved or was stable in the majority following treatment. CONCLUSIONS The results show the possible therapeutic effect of Iluvien in the management of Birdshot-related vascular leakage, CMO and retinal dysfunction. However, choroidal lesions seem to persist with no detectable response to treatment.
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Affiliation(s)
- Sofia Ajamil-Rodanes
- Medical Retina and Uveitis Department, Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ilaria Testi
- Medical Retina and Uveitis Department, Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Joshua Luis
- Medical Retina and Uveitis Department, Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Anthony G Robson
- Electrophysiology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, London
| | - Mark Westcott
- Medical Retina and Uveitis Department, Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, London
| | - Carlos Pavesio
- Medical Retina and Uveitis Department, Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, London
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48
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Testi I, Ajamil-Rodanes S, AlBloushi AF, Pavesio C. Peripheral Capillary Non-perfusion in Birdshot Retinochoroiditis: A Novel Finding on Ultra-widefield Fluorescein Angiography. Ocul Immunol Inflamm 2020; 28:1192-1195. [PMID: 32469666 DOI: 10.1080/09273948.2020.1758157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To report a novel peripheral finding in patients with Birdshot retinochoroiditis (BRC) using ultra-widefield fluorescein angiography (UWFFA). Methods: UWFFA images from 90 patients diagnosed with BRC were reviewed. All images were evaluated for the presence of peripheral retinal ischemic changes and ischemia-related complications. Findings: Thirty-six eyes of 24 patients showed features of peripheral ischemia, including 18 eyes with peripheral capillary non-perfusion (CNP), 5 eyes with teleangectasias, with or without microaneurysms, and 13 eyes with both teleangectasias and CNP. None of the 36 eyes with peripheral ischemic changes developed retinal neovascularization following the diagnosis of peripheral ischemia. Conclusions: Peripheral ischemia may present in eyes with chronic inflammation as seen in BRC but does not seem to progress to neovascular complications. This is likely to be more common than suspected and has now become evident following the advent of UWFFA. Abbreviations: HLA-A29: Human leukocyte antigen - A29; FFA: Fundus fluorescein angiography; OCT: Optical coherence tomography; ICGA: Indocyanine green angiography; UWF: Ultra-wide field; UWFFA: Ultra-wide field fluorescein angiography; CNP: Capillary non-perfusion.
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Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, National Health Service Foundation Trust , London, UK
| | | | | | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust , London, UK
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49
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Kuiper JJW, Venema WJ. HLA-A29 and Birdshot Uveitis: Further Down the Rabbit Hole. Front Immunol 2020; 11:599558. [PMID: 33262772 PMCID: PMC7687429 DOI: 10.3389/fimmu.2020.599558] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
HLA class I alleles constitute established risk factors for non-infectious uveitis and preemptive genotyping of HLA class I alleles is standard practice in the diagnostic work-up. The HLA-A29 serotype is indispensable to Birdshot Uveitis (BU) and renders this enigmatic eye condition a unique model to better understand how the antigen processing and presentation machinery contributes to non-infectious uveitis or chronic inflammatory conditions in general. This review will discuss salient points regarding the protein structure of HLA-A29 and how key amino acid positions impact the peptide binding preference and interaction with T cells. We discuss to what extent the risk genes ERAP1 and ERAP2 uniquely affect HLA-A29 and how the discovery of a HLA-A29-specific submotif may impact autoantigen discovery. We further provide a compelling argument to solve the long-standing question why BU only affects HLA-A29-positive individuals from Western-European ancestry by exploiting data from the 1000 Genomes Project. We combine novel insights from structural and immunopeptidomic studies and discuss the functional implications of genetic associations across the HLA class I antigen presentation pathway to refine the etiological basis of Birdshot Uveitis.
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Affiliation(s)
- Jonas J. W. Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Wouter J. Venema
- Department of Ophthalmology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
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50
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Pohlmann D, Barth A, Macedo S, Pleyer U, Winterhalter S, Albayrak Ö. The impact of impending / onset of vision loss on depression, anxiety, and vision-related quality of life in Birdshot-Retinochoroiditis and Serpiginous Choroiditis. PLoS One 2020; 15:e0239210. [PMID: 33017403 PMCID: PMC7535062 DOI: 10.1371/journal.pone.0239210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022] Open
Abstract
To evaluate the impact of Birdshot-Retinochoroidopathy (BSRC) and Serpiginous Choroiditis (SC) on depression, anxiety, and vision-related quality of life. 72 individuals (BSRC: n = 28, SC: n = 8; healthy control group (HC): n = 36) completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Visual Function Questionnaire (VFQ-25). Multivariate linear regression models were used to analyze different subscales of the PHQ-9, the GAD-7 and the VFQ-25. The results showed that the mean of PHQ-9 was significantly higher while the mean of the VFQ-25 and its´ subscales were consistently lower in the disease group compared to HC. The mean of GAD-7 was not significantly lower in the disease group compared to HC. Stratification for different disease severity stages and duration of disease did not reveal any differences in sum scores of PHQ-9, GAD-7, and VFQ-25, whereas there were significant differences in some subscales of the VFQ-25. We conclude that BSRC and SC patients show higher levels of depression and a reduced visual quality of life due to imminent loss of vision. Because depression and quality of life are adversely affected by lack of social contacts and functioning, psychological treatment should enable patients to maintain their independence and ability to social interaction. Psychosomatic care should be taken in account for the treatment of BSRC and SC.
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Affiliation(s)
- Dominika Pohlmann
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Anne Barth
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sergio Macedo
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Özgür Albayrak
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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