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Yu M, Kurup SK. Application of Ophthalmic Electrophysiology in Inflammatory Disorders of Retina and Optic Nerve. J Clin Med 2024; 13:3829. [PMID: 38999396 PMCID: PMC11242465 DOI: 10.3390/jcm13133829] [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: 06/03/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
This review covers the utility of electrophysiological studies relevant to inflammatory diseases of the retina in conditions such as acute posterior multifocal placoid pigment epitheliopathy, acute zonal occult outer retinopathy, Adamantiades-Behçet disease, autoimmune retinopathy and neuro-retinopathy, birdshot chorioretinopathy, multiple evanescent white dot syndrome, and Vogt-Koyanagi-Harada disease. Electrophysiological studies can help with the diagnosis, prognostication, evaluation of treatment effects, and follow-up for these conditions.
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Affiliation(s)
- Minzhong Yu
- Department of Ophthalmology, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Ophthalmic Research, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH 44195, USA
| | - Shree K Kurup
- Department of Ophthalmology, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Chandrasekaran PR, Chan HH, Tan TE, Ibrahim FN, Zhao J, Teo KY. A case of secondary multiple evanescent white dot syndrome in a patient with preexisting wet age-related macular degeneration. Am J Ophthalmol Case Rep 2024; 34:102016. [PMID: 38559365 PMCID: PMC10979012 DOI: 10.1016/j.ajoc.2024.102016] [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: 09/21/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To report a case of secondary Multiple Evanescent White Dot Syndrome in a patient with preexisting wet age-related macular degeneration. Observation A 75-year-old male on treat and extend regimen for wet age-related macular degeneration (AMD) presented with a sudden loss of vision and saw central dark shadow in the right eye (RE) for a duration of 1 week. There was no significant history preceding the visual loss. Examination showed a visual acuity (VA) of counting fingers at 1 meter in the right eye and 20/25 in the left eye. Anterior segment examination was unremarkable with dilated fundus examination showing a clear vitreous, tortuous blood vessel, a hyperemic disc and fibrosis at the macula. The left eye (LE) examination was unremarkable. Optical Coherence Tomography (OCT) showed fibrosis due to the previous wet AMD and hyperreflective excrescences projecting from the retinal pigment epithelium (RPE) outside of the old area of wet AMD. Fundus Fluorescein Angiogram (FFA) showed hyperfluorescent spots in a wreath-like pattern increasing in intensity in the early phase and showing late staining towards the late phase while Indocyanine green angiography (ICGA) did not clearly delineate the lesions. Fundus autofluorescence (FAF) revealed hyper Autofluorescence (AF) at the posterior pole. Optical Coherence Tomography Angiography (OCTA) revealed a flow reduction in the choriocapillaris of the affected area. Basic blood investigations with Venereal Disease Research Laboratory (VDRL), syphilitic IgM and IgG antibodies, Quantiferon TB gold test, complete renal function tests and liver function tests were performed. All the blood investigations were within normal limits and the workup for syphilis and tuberculosis was negative. The patient was started on 1mg/kg body weight of oral prednisolone (after the non-response to low dose of oral steroids) with the diagnosis of secondary multiple evanescent white dot syndrome (MEWDS) secondary to wet AMD. The patient was followed up every weekly and the last visit showed improvement in visual acuity to 20/50 with resolution of lesions on FAF and OCT macula. Conclusion and importance Secondary MEWDS is extremely rare and unique in terms of its presentation and its association with preexisting chorioretinal disease where there is damage to the choriocapillaris- Bruch's membrane-RPE complex. This case report highlights one such rare case scenario and how multimodal imaging helps in the diagnosis, management and follow-up of patients with secondary MEWDS.
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Affiliation(s)
| | - Hiok Hong Chan
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Tien-En Tan
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Farah N.I. Ibrahim
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Jinzhi Zhao
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Tianjin Medical University Eye Hospital, Tianjin, 300392, China
| | - Kelvin Y.C. Teo
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Save Sight Institute, University of Sydney, Camperdown, NSW, Australia
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Rabinovich M, Mehanna CJ, Lopez JM, Souied EH. Retro-mode imaging in acute posterior multifocal placoid pigment epitheliopathy. Eur J Ophthalmol 2024; 34:NP72-NP77. [PMID: 38311889 DOI: 10.1177/11206721241231329] [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] [Indexed: 02/06/2024]
Abstract
AIM to provide a detailed description and multimodal imaging (MMI) including retro-mode imaging of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). METHODS Case report of a young male patient presenting with APMPPE picture. Initially, visual acuity testing was performed, followed by biomicroscopic and fundus examinations along with MMI including Optical Coherence Tomography (OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), Indocyanine Green (ICG) angiography, and Retro-mode imaging. The patient was then monitored over a duration of two months. RESULTS visual acuity was 20/20 with normal biomicroscopic examination; fundus examination detected multiple pale placoid lesions. MMI was consistent with typical APMPPE. Notably, Retro-mode imaging revealed numerous crater-like round lesions that corresponded to those observed on angiography. CONCLUSION Retromode imaging in APMPPE can serve as a non-invasive tool that highlights the number and distribution of lesions as well as on angiography.
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Affiliation(s)
- Mark Rabinovich
- Department of Ophthalmology, Creteil Intercommunal Hospital, Paris, France
| | - Carl-Joe Mehanna
- Department of Ophthalmology, Creteil Intercommunal Hospital, Paris, France
| | - Juan Manual Lopez
- Department of Ophthalmology, Creteil Intercommunal Hospital, Paris, France
| | - Eric H Souied
- Department of Ophthalmology, Creteil Intercommunal Hospital, Paris, France
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Niederer RL, Samalia PD, Chen YH, Goh JK, Cornish EE, Guest S, McCluskey PJ, Lim LL, Sims JL, Lightman S, Tomkins-Netzer O. Acute posterior multifocal placoid pigment epitheliopathy: clinical presentation and risk of stroke and transient ischaemic attack. Br J Ophthalmol 2024; 108:398-404. [PMID: 36657959 DOI: 10.1136/bjo-2022-321517] [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: 03/23/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS Acute posterior multifocal placoid pigment epitheliopathy is a rare but important disease that can be associated with life-threatening complications due to cerebral vasculitis. The primary objective was to determine the incidence of neurological complications and risk factors for stroke and transient ischaemic attack (TIA) associated with acute posterior multifocal placoid pigment epitheliopathy. Secondary objectives included the clinical presentation, visual outcomes and recurrence rates. METHODS This was a multicentre retrospective case series including 111 eyes from 60 subjects presenting from January 2009 to June 2020. RESULTS Median age at presentation was 29 years (IQR 24.7-35.1) and 36 subjects (60.0%) were male. 20 subjects (33.3%) reported a viral prodrome. Stroke and TIA were observed in seven subjects (11.7%). Older age was the only significant risk factor for stroke/TIA (p=0.042). Vision loss occurred in seven eyes, with four eyes (3.6%) having final visual acuity 6/15-6/60 and three eyes (2.7%) having visual acuity of 6/60 or worse. Recurrence occurred in 10 subjects (16.7%). CONCLUSIONS The presence of headache cannot reliably predict those at risk of stroke/TIA. Individuals presenting with acute posterior multifocal pigment epitheliopathy should therefore undergo a clinical neurological review and work-up for cerebral vasculitis as deemed appropriate by the treating ophthalmologist and collaborating neurologist.
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Affiliation(s)
- Rachael L Niederer
- Ophthalmology, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Priya D Samalia
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Yi-Hsing Chen
- Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jonathan Ks Goh
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Elisa Eleanor Cornish
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Guest
- Ophthalmology, Waikato District Health Board, Hamilton, New Zealand
| | - Peter J McCluskey
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lyndell L Lim
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Joanne L Sims
- Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Susan Lightman
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital, London, England
| | - Oren Tomkins-Netzer
- Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, Lady David Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Mordechaev E, Shakarov G, Parikh D. Unilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with delayed contralateral eye involvement. BMC Ophthalmol 2024; 24:17. [PMID: 38195467 PMCID: PMC10775658 DOI: 10.1186/s12886-023-03221-8] [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: 03/23/2023] [Accepted: 11/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare presumed inflammatory chorioretinopathy characterized by creamy, yellow-white placoid lesions at the level of the retinal pigment epithelium (RPE). Unilateral cases often have fellow eye involvement within days to a few weeks. This report details a rare case of delayed contralateral APMPPE, in which unilateral lesion resolution was followed by contralateral eye involvement 31 months later. CASE PRESENTATION A 38-year-old woman presented with three days of blurry vision and photopsias in the right eye (OD). She endorsed a viral GI illness one month prior. Visual acuity was 20/25 -2 OD and 20/20 -1 in the left eye (OS). Examination revealed creamy, yellow-white placoid lesions in the posterior pole. Fluorescein angiography (FA) was notable for early hypofluorescence and late hyperfluorescence of the lesions, consistent with APMPPE. MRI and MRA brain were negative for cerebral vasculitis. She was treated with oral prednisone with complete resolution of her symptoms, vision, and lesion regression. She then presented 31 months later, with blurry vision OS and similar new creamy, yellow-white placoid lesions in the posterior pole OS. She endorsed receiving an influenza vaccine one month prior. FA again was notable for early hypofluorescence. She was diagnosed with APMPPE, this time involving the left eye, and was once again started on oral steroids with complete resolution. She denied any neurologic symptoms. CONCLUSIONS APMPPE is an inflammatory vasculitis of the choroid, leading to hypoperfusion and ischemic injury of the RPE with subsequent lesion formation. APMPPE may be preceded by a viral prodrome or vaccination, both of which were seen in this case. Choroidal inflammation seen in APMPPE is therefore thought to stem from immune-mediated processes. Unilateral cases often have fellow eye involvement within days to a few weeks. Single eye involvement with delayed contralateral presentation, as seen in our patient, is rare. This case demonstrates that lesion resolution in one eye can be followed by contralateral eye involvement up to 31 months later, highlighting the importance of routine ophthalmic monitoring for patients with unilateral APMPPE.
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Affiliation(s)
- Emanuel Mordechaev
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
| | - Gabriel Shakarov
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
| | - Deep Parikh
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA.
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Fernandez AI, Muñoz-Ramon PV, Bodaghi B. [Multimodal imaging in acute posterior multifocal placoid pigment epitheliopathy]. J Fr Ophtalmol 2024; 47:103952. [PMID: 37758544 DOI: 10.1016/j.jfo.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 09/29/2023]
Affiliation(s)
- A I Fernandez
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - P V Muñoz-Ramon
- Department of Ophthalmology, Hospital Clínico San Carlos, Madrid, Espagne
| | - B Bodaghi
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Barbosa RC, Gonçalves R, Vieira B. Atypical case of acute posterior multifocal placoid pigment epitheliopathy with intraretinal fluid. BMJ Case Rep 2023; 16:e255464. [PMID: 37798044 PMCID: PMC10565154 DOI: 10.1136/bcr-2023-255464] [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] [Indexed: 10/07/2023] Open
Abstract
Acute posterior multifocal placoid pigment epitheliopathy is a rare inflammatory chorioretinopathy, classified as a white dot syndrome, in which ischaemia of the choriocapillaris leads to atrophy of the external retinal layers, including the retinal pigment epithelium.A male patient in his 20s presented with sudden severe loss of vision in the left eye. Funduscopy revealed with yellow placoid lesions in the macula and near periphery. Spectral-domain optical coherence tomography and fluorescein angiography revealed the presence of central intraretinal fluid in the left eye and multiple areas of macular ischaemia bilaterally. Treatment with oral corticosteroids was initiated, and the anatomical changes, including the intraretinal fluid, improved steadily over the following weeks.Although rare, the presence of subretinal or intraretinal fluid should not decrease the suspicion of acute posterior multifocal placoid pigment epitheliopathy. Reabsorption of the fluid is usually accompanied by the improvement of the remaining anatomical changes and the visual function.
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Affiliation(s)
| | - Rita Gonçalves
- Ophthalmology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Bruna Vieira
- Ophthalmology Department, Hospital Pedro Hispano, Matosinhos, Portugal
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Köksaldı S, Tunc M, Saatci AO. Unilateral Multiple Evanescent White Dot Syndrome-Like Reaction Following the CyberKnife Stereotactic Radiotherapy for Choroidal Malignant Melanoma. Turk J Ophthalmol 2023; 53:261-265. [PMID: 37602675 PMCID: PMC10442750 DOI: 10.4274/tjo.galenos.2023.93507] [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: 01/06/2023] [Accepted: 05/27/2023] [Indexed: 08/22/2023] Open
Abstract
A 58-year-old otherwise healthy man received a diagnosis of choroidal malignant melanoma (CMM) in June 2021 and underwent a single session of (21 Gy) CyberKnife stereotactic radiotherapy (SRT). Eleven months later, we noticed 3+ anterior chamber cells with occasional vitreous cells in the left eye. Though the tumor looked regressed, there were mild optic disc leakage, early hypofluorescent and late hyperfluorescent punctate lesions scattered 360 degrees, and late staining of the mass on fluorescein angiogram. The findings were compatible with a unilateral multiple evanescent white dot syndrome (MEWDS)-like reaction that was most likely related to CyberKnife SRT-induced tumor necrosis, and a dexamethasone implant was administered intravitreally into the left eye together with topical steroids. A second intravitreal injection of dexamethasone was given three months later due to remittance of the angiographic features. As there are only a few reports on CyberKnife SRT for the treatment of CMM, we wanted to share our interesting observation of a post-treatment MEWDS-like reaction likely related to tumor necrosis syndrome with the ophthalmic community.
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Affiliation(s)
- Seher Köksaldı
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye
| | - Murat Tunc
- Tunç Clinic of Ophthalmology, Ankara, Türkiye
| | - Ali Osman Saatci
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye
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Dutt DDCS, Lam J, Richards J. Bilateral Relentless Placoid Chorioretinitis Following Pfizer-BioNTech COVID-19 Vaccination: Specific Antigenic Trigger or Nonspecific Immune Activation? Ocul Immunol Inflamm 2023:1-6. [PMID: 37552853 DOI: 10.1080/09273948.2023.2239338] [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: 04/24/2022] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To report bilateral relentless placoid chorioretinitis following Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine administration. CASE REPORT A 55-year-old Caucasian New Zealand-born woman presented with progressive left eye vision loss and bilateral photopsias and floaters occurring 10 days after receiving the Pfizer-BioNTech COVID-19 vaccination. She had a similar self-limiting episode of photopsias and floaters without vision loss 1 year prior after receiving the influenza vaccine. Snellen visual acuity (VA) was 20/25 in the right eye, and count fingers at 2 m in the left eye. Bilateral, active, creamy, plaque-like lesions were present at the level of the retinal pigment epithelium and choroid, suggestive of relentless placoid chorioretinitis. Commencement of 100 mg oral prednisolone and 3 g mycophenolate daily resulted in recovery of the foveal ellipsoid layer with VA of 20/25 in each eye after 8 weeks. Subsequent activations occurred following COVID-19 infection and respiratory infection. CONCLUSION This is the first reported case of relentless placoid chorioretinitis occurring as a potential side-effect of the Pfizer-BioNTech COVID-19 vaccine. Vaccination, and not infection, could be assumed to be the likely trigger. Subsequent flares following COVID-19 and a nonspecific respiratory infection during periods of inadequate immunosuppression suggest that a COVID-19 antigen or general immune activation could also be the trigger.
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Bravo FJV, Ayliffe W, Stanga SFE, Reinstein UI, Moxham R, Tariq Z, Downes SM, Stanga PE. New Imaging Technology for Simultaneous Multiwavelength-UWF Fundus Fluorescein Angiography and Indocyanine Green Angiography With Navigated Central and Peripheral SS-OCT. Ophthalmic Surg Lasers Imaging Retina 2023:1-10. [PMID: 37418670 DOI: 10.3928/23258160-20230607-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Our aim was to assess central and peripheral retinal and choroidal diseases using novel simultaneous multiwavelength-ultra-widefield (MW-UWF) fundus fluorescein angiography (FFA)/indocyanine green angiography (ICGA) with navigated central and peripheral swept-source optical coherence tomography (SS-OCT) technology. METHODS Retrospective evaluation was carried out of 30 consecutive patients (60 eyes) who underwent UWF red/green (RG), infrared (IR), FFA and ICGA with simultaneous navigated SS-OCT using Optos Silverstone (Optos PLC). Angiographic retinal and choroidal findings in vascular pathologies and their relationship with the vitreoretinal interface (VRI) were assessed. RESULTS Simultaneous FFA with navigated SSOCT was performed in all patients and simultaneous FFA-ICGA with SS-OCT in 18 eyes (30%). Cross-sectional central and peripheral changes in the retina, choroid, and VRI corresponding with angiographic findings in several diseases were imaged. CONCLUSION First-in-human study of a new technology providing UWF RG/FFA/ICGA with simultaneous navigated central and peripheral SS-OCT can guide clinical management and provide new insights and understanding of central and peripheral retinal and choroidal disease. [Ophthalmic Surg Lasers Imaging Retina 2023;54:xx-xx.].
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Munro M, Sabbagh MA, Mieler WF. EIGHTY-TWO-YEAR-OLD MONOCULAR FEMALE WITH ACUTE DECREASED CENTRAL VISION. Retin Cases Brief Rep 2023; 17:S31-S35. [PMID: 36730825 DOI: 10.1097/icb.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To present a case of suspected sympathetic ophthalmia in an 82-year-old monocular woman. METHODS Case report. RESULTS Here, we present an 82-year-old woman, status postcataract extraction with lens subluxation followed by a complicated course ultimately requiring enucleation because of a blind and painful eye in 2020, who developed contralateral choroidal lesions 6 months postenucleation along with vitritis and anterior uveitis. The lesions were suspicious for an infectious versus autoimmune etiology. Thorough systemic work-up and multimodal imaging suggest an autoimmune case. The findings in this patient suggest early identified sympathetic ophthalmia with multifocal choroiditis. This patient responded well to treatment of the acute episode with systemic corticosteroids and ultimately required steroid-sparing immunosuppression. CONCLUSION Sympathetic ophthalmia is a rare entity classically observed after intraocular surgery and trauma. It may mimic many infectious and noninfectious uveitis entities. In this patient, sympathetic is a primary concern given her history and age of presentation with consideration for other uveitic entities.
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Affiliation(s)
- Monique Munro
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
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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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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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McElhinney K, McGrath R, Ahern E, O'Connell E. Bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) following SARS-CoV-2 mRNA vaccine. BMJ Case Rep 2022; 15:e250346. [PMID: 35750434 PMCID: PMC9234791 DOI: 10.1136/bcr-2022-250346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Edward Ahern
- Ophthalmology, Cork University Hospital, Cork, Ireland
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15
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Kon OM, Beare N, Connell D, Damato E, Gorsuch T, Hagan G, Perrin F, Petrushkin H, Potter J, Sethi C, Stanford M. BTS clinical statement for the diagnosis and management of ocular tuberculosis. BMJ Open Respir Res 2022; 9:9/1/e001225. [PMID: 35379660 PMCID: PMC9021811 DOI: 10.1136/bmjresp-2022-001225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022] Open
Abstract
The BTS clinical statement for the diagnosis and management of ocular tuberculosis (TB) draws on the expertise of both TB and and ophthalmic specialists to outline the current understanding of disease pathogenesis, diagnosis and management in adults. Published literature lacks high-quality evidence to inform clinical practice and there is also a paucity of data from animal models to elucidate mechanisms of disease. However, in order to improve and standardise patient care, this statement provides consensus points with the currently available data and agreed best practice.
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Affiliation(s)
- Onn Min Kon
- Chest and Allergy Clinic, Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Nicholas Beare
- St Paul's Eye Unit, Liverpool University Hospitals, Liverpool, UK
- Department of Eye and Vision Research, University of Liverpool, Liverpool, UK
| | - David Connell
- Respiratory Medicine, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Erika Damato
- Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Gorsuch
- Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Guy Hagan
- Respiratory Medicine, City Hospital, Birmingham, UK
| | - Felicity Perrin
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Harry Petrushkin
- Ophthalmology, Moorfields Eye Hospital City Road Campus, London, UK
| | - Jessica Potter
- Respiratory Medicine, North Middlesex University Hospital NHS Trust, London, UK
| | - Charanjit Sethi
- Ophthalmology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Miles Stanford
- Ophthalmology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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16
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Testi I, Vermeirsch S, Pavesio C. Acute posterior multifocal placoid pigment epitheliopathy (APMPPE). J Ophthalmic Inflamm Infect 2021; 11:31. [PMID: 34524577 PMCID: PMC8443720 DOI: 10.1186/s12348-021-00263-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory eye disease, affecting the inner choroid and the outer retina. Recent advances in multimodal imaging have been important in the understanding of the pathophysiology of the disease, allowing a better characterization of the morphology of this condition. Methods Narrative review. Results In this review, a comprehensive overview of clinical features, imaging findings, treatment management, and long-term outcomes of patients with APMPPE will be provided. Conclusions Although APMPPE was originally believed to be a self-limited condition with a good prognosis, the disease can be recurrent and result in significant loss of vision function. Fundus imaging plays an important role in the diagnosis and management of the disease, allowing to evaluate response to treatment and onset of complications.
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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
| | - Sandra Vermeirsch
- 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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17
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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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18
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Leclaire MD, Clemens CR, Eter N, Mihailovic N. [Choroidal neovascularization due to a punctate inner choroidopathy visualized by optical coherence tomography angiography]. Ophthalmologe 2021; 118:842-846. [PMID: 32767099 PMCID: PMC8342402 DOI: 10.1007/s00347-020-01200-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Punctate inner choroidopathy (PIC) is often accompanied by the development of choroidal neovascularization (CNV). The identification of a fresh CNV in the context of PIC is often difficult. We present the case of a 30-year-old female patient with typical morphological features of PIC. A CNV could not be detected with certainty by optical coherence tomography (OCT) or by fluorescein angiography (FAG); however, OCT angiography (OCT-A) revealed a circumscribed CNV. The case suggests that there are a high number of undiagnosed, subclinical secondary CNVs not requiring treatment in PIC patients.
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Affiliation(s)
- Martin Dominik Leclaire
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland.
| | - Christoph R Clemens
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Nataša Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
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19
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Classification Criteria for Multifocal Choroiditis With Panuveitis. Am J Ophthalmol 2021; 228:152-158. [PMID: 33845016 PMCID: PMC8559518 DOI: 10.1016/j.ajo.2021.03.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine classification criteria for multifocal choroiditis with panuveitis (MFCPU). DESIGN Machine learning of cases with MFCPU and 8 other posterior uveitides. METHODS Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the posterior uveitides. The resulting criteria were evaluated on the validation set. RESULTS One thousand sixty-eight cases of posterior uveitides, including 138 cases of MFCPU, were evaluated by machine learning. Key criteria for MFCPU included (1) multifocal choroiditis with the predominant lesions size >125 µm in diameter; (2) lesions outside the posterior pole (with or without posterior involvement); and either (3) punched-out atrophic chorioretinal scars or (4) more than minimal mild anterior chamber and/or vitreous inflammation. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for MFCPU were 15% in the training set and 0% in the validation set. CONCLUSIONS The criteria for MFCPU had a reasonably low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
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20
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Benjamin ESDP, Santana JCD, Azevedo LGBD, Aleixo ALQDC, Biancardi AL, Moraes HVD. Manejo da coroidite interna punctata complicada por membrana neovascular sub-retiniana. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Tauscher RG, Simon SS, Volpe NJ. Retinal disease in the neurology clinic. Curr Opin Neurol 2021; 34:122-132. [PMID: 33278143 DOI: 10.1097/wco.0000000000000883] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW Retinal disease can manifest with visual symptoms similar to those which result from central nervous system disorders. We provide a framework for considering retinal causes of common visual complaints presenting to a neurology clinic. RECENT FINDINGS Technological advances have afforded quicker detection and a more thorough understanding of these retinal entities and are crucial to consider when evaluating visual complaints in the neurology clinic. SUMMARY It is essential to maintain a working knowledge of common retinal conditions that symptomatically overlap with common neurologic conditions. Furthermore, the ophthalmoscopic exam and retinal imaging modalities can both aid in the diagnosis and workup of visual complaints and neurologic disease.
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Affiliation(s)
| | - Shira S Simon
- Department of Ophthalmology
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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22
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Mahendradas P, Sridharan A, Kawali A, Sanjay S, Venkatesh R. Role of Ocular Imaging in Diagnosis and Determining Response to Therapeutic Interventions in Posterior and Panuveitis. Asia Pac J Ophthalmol (Phila) 2021; 10:74-86. [PMID: 33512829 DOI: 10.1097/apo.0000000000000354] [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: 12/14/2022] Open
Abstract
ABSTRACT This review provides a comprehensive description and careful interpretation of various ocular imaging techniques to visualize the different ocular structures in posterior and panuveitis. This can help in the diagnosis, follow-up, and monitoring the response to treatment in patients with different posterior and panuveitic entities.
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Affiliation(s)
| | - Akhila Sridharan
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ramesh Venkatesh
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
- Department of Vitreoretinal Services, Narayana Nethralaya, Bangalore, India
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23
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Zhang J, Zhang M, Ouyang W, Wang F, Li S. Characteristics of punctate inner choroidopathy complicated by choroidal neovascularisation on Multispectral Imaging in comparison with other imaging modalities. Ocul Immunol Inflamm 2020; 30:402-408. [PMID: 33215937 DOI: 10.1080/09273948.2020.1800751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the characteristics seen on multispectral imaging (MSI) in patients with punctate inner choroidopathy (PIC) and choroidal neovascularisation (CNV) and compare the findings with current standard multimodal imaging techniques. METHODS This is a retrospective observational case series of 10 patients with PIC complicated by CNV that underwent multimodal retinal imaging examinations. RESULTS Twelve eyes of 10 patients were included. CNV was identified in 11 of the 12 eyes (91.7%) by MSI with nodular or trunk-like hyperreflectance on retinal oxy/deoxyhemoglobin map. MSI revealed choroidal vasculature around CNV in 91.7% eyes and pathological changes including retinal pigment epithelial atrophy and melanin disruption of punctate lesions in all eyes. CONCLUSION MSI helps in noninvasively detecting CNV in PIC patients and observing associated changes in choroidal vasculature. This imaging technique is also a promising tool for better tracking pathological changes of PIC lesions complementary to current standard multimodal imaging modalities.
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Affiliation(s)
- Jie Zhang
- Department of Ophthalmology, American-Sino Women's & Children's Hospital, Shanghai, China
| | - Minfang Zhang
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Wangbin Ouyang
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Fang Wang
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Shiying Li
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
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24
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Ortiz-Seller A, Martínez Costa L, Hernández-Pons A, Valls Pascual E, Solves Alemany A, Albert-Fort M. Ophthalmic and Neuro-ophthalmic Manifestations of Coronavirus Disease 2019 (COVID-19). Ocul Immunol Inflamm 2020; 28:1285-1289. [PMID: 33021422 DOI: 10.1080/09273948.2020.1817497] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To describe a case of inflammatory chorioretinopathy and Adie's syndrome possibly associated with COVID-19. METHODS Observational case report. RESULTS A 51-year-old woman developed fever, cough, and headache followed by retro-ocular pain and reading impairment. She tested positive for SARS-COV-2 infection by qualitative real-time reverse-transcriptase-polymerase-chain-reaction. The slit-lamp and funduscopic exam revealed abnormal pupillary response and yellowish creamy deep chorioretinal lesions, which were not present in previous examinations. Instillation of pilocarpine demonstrated denervation supersensitivity, and it was suggestive of bilateral Adie tonic pupil. A comprehensive work-up ruled out other systemic, autoimmune, or infectious diseases. CONCLUSIONS This case illustrates the possible association between multifocal chorioretinitis and Adie's syndrome, and the SARS-COV-2 infection in humans. Further investigation of virus infectivity specifically within ocular tissues has to be conducted.
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Affiliation(s)
- Amparo Ortiz-Seller
- Department of Ophthalmology, Hospital Universitari Doctor Peset , Valencia, Spain
| | - Lucía Martínez Costa
- Department of Ophthalmology, Hospital Universitari Doctor Peset , Valencia, Spain
| | | | - Elia Valls Pascual
- Department of Rheumatology, Hospital Universitari Doctor Peset , Valencia, Spain
| | | | - Mara Albert-Fort
- Department of Ophthalmology, Hospital Universitari Doctor Peset , Valencia, Spain
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25
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Espinosa G, Herreras JM, Muñoz-Fernández S, García Ruiz de Morales JM, Cordero-Coma M. Recommendations statement on the immunosuppressive treatment of non-infectious, non-neoplastic, non-anterior uveitis. Med Clin (Barc) 2020; 155:220.e1-220.e12. [PMID: 32199631 DOI: 10.1016/j.medcli.2019.10.023] [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: 06/18/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To generate recommendations on the use of immunomodulators in patients with non-infectious, non-neoplastic intermediate uveitis (IU), posterior uveitis (PU) and panuveitis (PanU) based on best evidence and experience. METHODS A multidisciplinary panel of 5 experts was established, who defined the scope, users, and sections of the document. A systematic literature review (SLR) was performed to assess the efficacy and safety of immunomodulatory drugs in patients with non-infectious, non-neoplastic, non-anterior uveitis. The results of the SLR were presented and discussed during an expert meeting in which 34 recommendations were generated. The level of agreement with the recommendations was also tested in 25 additional experts following a Delphi process. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of the experts voted ≥7. The level of evidence and grade or recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS The SLR included 33 articles. The 34 recommendations were accepted after 2 Delphi rounds (3 of them were modified after the first round). They include specific recommendations on patients with non-infectious, non-neoplastic, PU and PanU, as well as different treatment guidelines. CONCLUSIONS In patients with non-infectious, non-neoplastic, non-anterior uveitis these recommendations might help treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.
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Affiliation(s)
- Gerard Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España
| | - José M Herreras
- IOBA (Instituto Universitario de Oftalmobiología), Universidad de Valladolid, Valladolid, España; Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Santiago Muñoz-Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Universidad Europea, San Sebastián de los Reyes, Madrid, España
| | - José M García Ruiz de Morales
- Unidad de Uveítis, Servicio de Inmunología, Complejo Asistencial Universitario de León, León, España; Instituto de Biomedicina, Universidad de León (IBIOMED), León, España
| | - Miguel Cordero-Coma
- Instituto de Biomedicina, Universidad de León (IBIOMED), León, España; Unidad de uveítis, Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España.
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26
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Gilbert RM, Niederer RL, Kramer M, Sharief L, Sharon Y, Bar A, Lightman S, Tomkins-Netzer O. Differentiating Multifocal Choroiditis and Punctate Inner Choroidopathy: A Cluster Analysis Approach. Am J Ophthalmol 2020; 213:244-251. [PMID: 32027868 DOI: 10.1016/j.ajo.2020.01.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/30/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To develop a robust approach to clinical phenotyping of multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC). DESIGN Cross-sectional and longitudinal observational study. METHODS This multicenter study included sites in the United Kingdom and Israel. The study population included 343 eyes of 185 subjects with hospital record diagnoses of MFC or PIC. Eyes were observed over a period of 5 years for clinically relevant characteristics, including demographics and multimodal imaging features, by observers masked to the original diagnoses. Multivariate 2-step cluster analysis was used to identify clusters of eyes in the database with similar clinical phenotypes, which were then analyzed for between-group differences. The primary outcome measure was the difference between clinical phenotype clusters identified using clinical criteria from the multivariate cluster analysis. RESULTS Subjects ranged from 11 to 89 years of age, with a baseline best-corrected visual acuity of 2.3 to -0.2 logarithm of minimal angle of resolution. Eighty-two percent of eyes were from females, 74% were myopic with a refractive error of +3.00 to -17.00 diopters (spherical equivalent). Cluster analysis prioritized clinical criteria of chorioretinal lesion location and intraocular inflammation and identified 2 distinct phenotype clusters resembling the original descriptions of MFC and PIC. During the 5-year period of observation, the initial clinical diagnosis remained stable for most eyes and only 1 eye (0.3%) changed diagnosis from PIC to MFC because of newly developed peripheral lesions. There were significant between-group differences in clinical characteristics, for example, in choroidal neovascular membrane development and treatment received. CONCLUSIONS Cluster analysis of this large cohort of eyes identified peripheral lesions and intraocular inflammation as distinct clinical phenotypes of MFC and PIC. The initial diagnosis remained stable for most eyes. This methodology could be useful for future uveitis classification and management.
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Affiliation(s)
- Rose M Gilbert
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom.
| | - Rachael L Niederer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Greenlane Medical CentreAuckland District Health Board, Auckland, New Zealand
| | - Michal Kramer
- Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lazha Sharief
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Yael Sharon
- Rabin Medical Center, Petah Tikva, Israel; Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey, USA
| | - Asaf Bar
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Wolfson Medical Centre, Holon, Tel Aviv-Yafo, Israel
| | - Sue Lightman
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Carmel Medical Center, Haifa, Israel
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28
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Caplash S, Kodati S, Cheng SK, Akanda M, Vitale S, Thompson I, Gangaputra S, Sen HN. Repeatability of Optical Coherence Tomography Angiography in Uveitic Eyes. Transl Vis Sci Technol 2019; 8:17. [PMID: 31772828 PMCID: PMC6859831 DOI: 10.1167/tvst.8.6.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose To investigate the intravisit repeatability of optical coherence tomography angiography (OCTA) in a cohort of uveitis patients. Methods One hundred ten patients were imaged twice per eye, per visit, using the Zeiss Cirrus HD-OCT Model 5000 device. To calculate choriocapillaris flow void area (CC FV) 6 × 6-mm images were used, and 3 × 3-mm images were used to calculate vessel density (VD) and the foveal avascular zone area (FAZ) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Repeatability was measured using Bland-Altman analyses and intraclass correlation coefficients (ICC) with associated coefficient of variation (CV). Results The level of intravisit repeatability differed across indices ranging from moderate to excellent. CC FV had the highest intravisit repeatability with an ICC of 0.980 (95%CI, 0.966–0.989), a CV of 15.9% and Bland-Altman limits of agreement from −0.398 to 0.411 mm2. DCP FAZ had the lowest intravisit repeatability with an ICC of 0.677 (95%CI, 0.510–0.796), a CV of 17.4% and Bland-Altman limits of agreement from −0.395 to −0.355 mm2. Intraoperator repeatability was excellent across all indices. Conclusions This study demonstrates that OCTA is a reliable tool to quantitatively assess specific indices of vascular structure in uveitis patients with good intravisit repeatability. However, the range of variability for each index should be taken into account when evaluating clinically meaningful changes. Translational Relevance The repeatability of the metrics we have described has implications in supporting the development of OCTA-derived quantitative assessments of the retinal and choroidal vasculature in uveitis patients as potential imaging biomarkers.
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Affiliation(s)
- Sonny Caplash
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shilpa Kodati
- Baylor College of Medicine, Cullen Eye Institute, Houston, TX, USA
| | - Shuk Kei Cheng
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marib Akanda
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ian Thompson
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sapna Gangaputra
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA.,Vanderbilt Eye Institute, Nashville, TN
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
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29
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Cekić S, Jovanović P, Jovanović I, Stanković-Babić G, Risimić D. MULTIMODAL IMAGING IN PATIENTS WITH MULTIFOCAL CHOROIDITIS WITH OUTER RETINAL/CHORIOCAPILLARIS-BASED PATHOLOGY. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Visual acuity loss and development of ocular complications in white dot syndromes: a longitudinal analysis of 3 centers. Graefes Arch Clin Exp Ophthalmol 2019; 257:2505-2516. [DOI: 10.1007/s00417-019-04429-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
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Asano S, Tanaka R, Kawashima H, Kaburaki T. Relentless Placoid Chorioretinitis: A Case Series of Successful Tapering of Systemic Immunosuppressants Achieved with Adalimumab. Case Rep Ophthalmol 2019; 10:145-152. [PMID: 31143110 PMCID: PMC6528075 DOI: 10.1159/000500077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Adalimumab, a human anti-tumor necrosis factor-ɑ monoclonal antibody, was recently reported to be effective in lowering the risk of recurrence of noninfectious uveitis. This is the first case series of adalimumab administrations for relentless placoid chorioretinitis (RPC) patients. Case Presentation We report 2 cases of RPC where successful treatments were achieved with adalimumab. A 34-year-old woman developed conjunctival hyperemia, mild iridocyclitis, and multiple atrophic retinal lesions, along with exudative changes that were widespread from the posterior pole to peripheral retina in both eyes. The diagnosis of RPC was made based on the characteristic recurrences of choroiditis despite systemic corticosteroid and cyclosporine. Adalimumab therapy was introduced to the patient, and thereafter no recurrence was observed while tapering the immunosuppressive agents. The second case was a 22-year-old man with visual deterioration in both eyes who exhibited widespread multiple chorioretinal atrophic lesions. We diagnosed the case as RPC based on characteristic clinical findings and recurring chorioretinitis during tapering of systemic corticosteroids. Adalimumab therapy was administrated, and immunosuppressant dosage was successfully reduced without any recurrences. Conclusions In the current two RPC cases, adalimumab was quite effective and useful to reduce the dosages of systemic immunosuppressants. Further study is necessary to confirm the effectiveness of adalimumab in RPC patients.
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Affiliation(s)
- Shotaro Asano
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | | | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Li J, Li Y, Li H, Zhang L. Imageology features of different types of multifocal choroiditis. BMC Ophthalmol 2019; 19:39. [PMID: 30709392 PMCID: PMC6359807 DOI: 10.1186/s12886-019-1045-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multifocal choroiditis (MFC) is multi-inflammatory lesions that occur in the retinal pigment epithelium (RPE) and the choriocapillaris. Optical examinations are the major diagnostic methods to diagnose the disease. OBJECTIVE To examine patients with different types of MFC by multiple imageological methods. To summarize the imageology features of different types of MFC to make a medical examination guideline for clinician practices. METHOD All of the patients who included in the study received examinations of fundus color photography, infrared fundus photography, fundus auto fluorescence (FAF), fluorescein fundus angiography (FFA), and optical coherence tomography (OCT), respectively. Finally, imageology features of different types of multifocal choroiditis were summarized. RESULTS A total of 51 eyes from 28 patients with diagnosed MFC were included in the study. These patients consisted of 10 males and 18 females aged from 31 to 49 (mean age: 41.5 ± 0.8). 23 patients had MFC on both eye whilst 5 had monocular disease. The MFC lesions were classified as active inflammatory lesions, inactive inflammatory lesions, inflammatory lesions secondary active choroidal neovascularization (CNV) and inflammatory lesions secondary inactive CNV according to literature reports and comprehensive fundus imaging examinations. CONCLUSION Examinations via fundus color photography, infrared fundus photography, FAF, FFA and OCT indicate typical imageological signals of different types of MFC. These imageology tests can greatly assist the clinicians to identify the MFC and provide proper therapies.
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Affiliation(s)
- Juanjuan Li
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province, No.176 Qingnian Rd, Kunming, 650021, Yunnan, People's Republic of China.
| | - Yunpeng Li
- Department of Anti-drug, Yunnan Police Officer Academy, Kunming, 6500223, Yunnan, China
| | - Hua Li
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province, No.176 Qingnian Rd, Kunming, 650021, Yunnan, People's Republic of China
| | - Liwei Zhang
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province, No.176 Qingnian Rd, Kunming, 650021, Yunnan, People's Republic of China
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Lee LC, Huang KH, Chen YH, Lin HT, Hsu CC, Tai MC, Liang CM, Chen JT, Chen CL. Optical coherence tomography angiography in unilateral multifocal choroiditis and panuveitis: A case report. Medicine (Baltimore) 2019; 98:e14259. [PMID: 30681623 PMCID: PMC6358364 DOI: 10.1097/md.0000000000014259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/26/2018] [Accepted: 01/01/2019] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Optical coherence tomography angiography (OCT-A) has the advantage to visualize the microvascular structure of the retina in vivo and was utilized clinically in various neovascular retinal diseases. The OCT-A has also been used to examine the lesion in multifocal choroiditis and panuveitis (MCP). This study aimed to describe a case of MCP and present the disease process of a punched-out lesion in the chorioretina with neovascular activity using OCT-A. PATIENTS CONCERNS A 32-year-old female Caucasian patient presented with a 2-week history of progressive blurred vision in her right eye with photophobia and a diminished temporal visual field. On presentation, her best corrected visual acuity was 6/60 in the right eye with a prominent anterior uveitis seen under slit lamp examination. DIAGNOSES Dilated fundus examination of the right eye showed vitritis and multiple, punched-out yellowish-white lesions over the peripheral retina. Additional multimodal imaging (MMI) were done including fluorescein angiography (FA), indocyanine green angiography (ICGA) and fundus autofluorescence (FAF), which all revealed characteristic findings of MCP. In general, the diagnosis of unilateral MCP was made. Furthermore, one of the punched-out lesions in the right eye was particularly selected and examined under OCT and OCT-A, which revealed a subretinal elevated lesion with high flow signal under OCT-A. INTERVENTIONS Treatment with oral prednisolone at 30 mg daily with topical prednisolone acetate 1% every 2 hours were prescribed, which were gradually tapered down within a 2-month course. OUTCOMES The patient's best corrected visual acuity of the right eye returned to 6/6 at 2 months after the diagnosis. The flow signal in the OCT-A study of the punched-out lesion had also resolved after steroid treatment. LESSONS The MCP is an uncommon uveitis with multiple inflammatory chorioretinal lesions. Using multimodal imaging technique, physicians can better differentiate these lesions for diagnosis and for further monitoring. Our results demonstrated that these chorioretinal lesions in MCP may display neovascular activities that might not be seen easily using conventional FA or ICGA study. With OCT-A, ophthalmologists could identify and monitor subtle choroidal neovascularization (CNV) changes over these punched-out lesions.
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Affiliation(s)
- Lung-Chi Lee
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
| | - Ke-Hao Huang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
- Department of Ophthalmology, Songshan Branch of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
| | - Hsin-Ting Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
| | - Chia-Chen Hsu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
| | - Chang-Min Liang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center
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Brydak-Godowska J, Moskal K, Borkowski PK, Przybyś M, Turczyńska M, Kęcik D. A Retrospective Observational Study of Uveitis in a Single Center in Poland with a Review of Findings in Europe. Med Sci Monit 2018; 24:8734-8749. [PMID: 30504763 PMCID: PMC6289025 DOI: 10.12659/msm.910749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aimed to review the causes, presentation, and clinicopathological associations of uveitis in a single department of ophthalmology in Poland, and to compare the findings with previously published studies from other European countries. MATERIAL AND METHODS Review of local patient records between 2005-2015 identified patients diagnosed with uveitis. Data obtained included age, gender, imaging findings, and laboratory diagnostic findings. A literature review identified 24 publications from 1976-2017 that reported observational data from patients with uveitis in Europe. Statistical analysis compared the findings. RESULTS Between 2005-2015, 279 patients were diagnosed with uveitis (mean age, 38.3±15.3 years) (61.6% women) including unilateral uveitis (60.5%), with posterior uveitis (48.4%), anterior uveitis (26.5%), and intermediate uveitis (12.9%). A general etiology was established in 76.3% and included ocular-specific syndromes (31.8%), infection (27.9%), and an association with systemic disease (16.8%), but 23.6% were unclassifiable. Specific causes of uveitis included toxoplasmosis (17.9%), Fuchs uveitis (12.2%), white dot syndromes (WDS) (10.4%), sarcoidosis (6.1%), toxocariasis (6.1%), HLA-B27-associated acute anterior uveitis (AAU) (5.7%), multiple sclerosis (4.7%), ankylosing spondylitis (3.6%) and herpesvirus infection (2.5%). Data from 26 published studies (24,126 patients with uveitis) from 12 European countries showed that idiopathic uveitis was most common (36.6%); the identified causes included toxoplasmosis (9.4%), WDS (7.2%), and Fuchs uveitis (6.1%). CONCLUSIONS In a single ophthalmic center in Poland, and throughout Europe, the causes of uveitis are varied. Genetic, geographic, social and environmental factors are likely to affect the cause of uveitis in different populations.
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Affiliation(s)
| | - Katarzyna Moskal
- Student Research Group (Ophthalmology), Medical University of Warsaw, Warsaw, Poland
| | - Piotr K. Borkowski
- Department of Infectious Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Przybyś
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Turczyńska
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Kęcik
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
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Tsaousis KT, Nassr M, Kapoor B, Konidaris VE, Tyradellis S, Empeslidis T. Long-term results of intravitreal bevacizumab and dexamethasone for the treatment of punctate inner choroidopathy associated with choroidal neovascularization: A case series. SAGE Open Med Case Rep 2018; 6:2050313X18772478. [PMID: 29760922 PMCID: PMC5946604 DOI: 10.1177/2050313x18772478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/29/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction To present a case series of three female patients with punctate inner choroidopathy. We report the outcomes after an essentially long follow-up period of up to 14 years and provide evidence of the effectiveness of intravitreal injections of bevacizumab and dexamethasone 0.7 mg in punctate inner choroidopathy patients with choroidal neovascular membrane formation. Case series presentation This is a retrospective case series of three female patients with punctate inner choroidopathy who were treated with intravitreal injections anti-vascular endothelial growth factor agent (bevacizumab, 1.25 mg/0.05 mL). Two patients also received intravitreal dexamethasone 0.7 mg. Once a choroidal neovascular membrane developed, the outcome was poor with a best-corrected visual acuity of 6/60 or counting fingers in the affected eyes. The patients were followed up for 5, 14 and 8 years. Conclusion The use of dexamethasone 0.7 mg in punctate inner choroidopathy yielded encouraging results and long periods of stability. When choroidal neovascular membrane complicates the primary disease, the prognosis is unfavourable, especially if the macula integrity has already been considerably affected. On the contrary, aggressive early therapy and continued monthly monitoring can prevent severe fibrosis, as showed in previous reports. Further larger-scale studies are needed to evaluate the efficacy of intravitreal dexamethasone 0.7 mg and bevacizumab as an alternative treatment in non-infectious uveitis.
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Affiliation(s)
| | - Mohamed Nassr
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - Bharat Kapoor
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Straton Tyradellis
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - Theo Empeslidis
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
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