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Zeng Y, Du Z, Shao C, Zhao M. Comprehensive insights into COVID-19 vaccine-associated multiple evanescent white dot syndrome (MEWDS): A systematic analysis of reported cases. Hum Vaccin Immunother 2024; 20:2350812. [PMID: 38752704 DOI: 10.1080/21645515.2024.2350812] [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: 02/02/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
Considering the widespread use of COVID-19 vaccines as a preventive measure against the spread of the virus, it's necessary to direct attention to the adverse effects associated with vaccines in a limited group of populations. Multiple evanescent white dot syndrome (MEWDS) following COVID-19 vaccination is a rare adverse reaction associated with COVID-19 vaccines. In this systematic review, we collected 19 articles with 27 patients up to November 1, 2023, summarizing the basic information, clinical manifestations, examinations, treatments, and recoveries of the 27 patients. The 27 enrolled patients (6 males, 21 females) had a median age of 34.1 years (15-71 years old) and were mainly from 5 regions: Asia (8), the Mediterranean region (8), North America (7), Oceania (3) and Brazil (1). Symptoms occurred post-first dose in 9 patients, post-second dose in 14 (1 with symptoms after both), post-third dose in 1, and both post-second and booster doses in 1, while details on 2 cases were not disclosed. Treatments included tapered oral steroids (6), topical steroids (3), tapered prednisone with antiviral drugs and vitamins (1), and valacyclovir and acetazolamide (1), while 16 received no treatment. All patients experienced symptom improvement, and nearly all patients ultimately recovered. Moreover, we summarized possible hypotheses concerning the mechanism of COVID-19 vaccine-associated MEWDS. The findings provide insights into the clinical aspects of COVID-19 vaccine-associated MEWDS. More attention should be given to patients with vaccine-associated MEWDS, and necessary treatment should be provided to patients experiencing a substantial decline in visual acuity to improve their quality of life.
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Affiliation(s)
| | - Ziye Du
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chuhan Shao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingyi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Song YY, Kim JT, Chang YS, Lee MW, Lee SC. Increased incidence and diverse manifestations of multiple evanescent white dot syndrome during the COVID-19 pandemic. Sci Rep 2024; 14:12425. [PMID: 38816508 PMCID: PMC11139874 DOI: 10.1038/s41598-024-63255-w] [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: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
The advent of coronavirus disease 2019 (COVID-19) pandemic has affected the incidence and course of various diseases and numerous studies have investigated ocular involvement associated with COVID-19 and corresponding vaccines. In this study, we compared the incidence of multiple evanescent white dot syndrome (MEWDS) before and during the COVID-19 pandemic at a single center in Korea and analyzed the demographic and clinical features of patients with MEWDS presenting during the COVID-19 pandemic. We categorized patients with MEWDS into two groups according to date of diagnosis. Pre-COVID19 group included patients diagnosed during the pre-pandemic period (between March 11, 2017, and March 10, 2020), whereas post-COVID19 group included patients diagnosed during the pandemic period (between March 11, 2020, and March 10, 2023). 6 and 12 patients were included in pre-COVID19 group and post-COVID19 group, respectively. Among all hospital visits during the pre-pandemic and pandemic periods, 0.011% and 0.030% were due to MEWDS, indicating a significant increase during the pandemic (p = 0.029, B = 2.756). The annual incidence of patients with MEWDS in 2017-2022 were 0.73, 0.75, 0.78, 1.32, 2.49, and 2.07 per 10,000 population, respectively, corresponding to a significant increase (p = 0.039, B = 1.316). Our results imply that the incidence and manifestation of MEWDS are likely to become more diverse in the COVID-19 pandemic era.
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Affiliation(s)
- Yong Yeon Song
- Onnuri Eye Hospital, #325 Baekje-daero, Jeonju, Republic of Korea.
| | - Jung Tae Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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3
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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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Ku JY, Mansoor N, Farrag A. Atypical multiple evanescent white dot syndrome presenting with peripheral retinal lesions. BMJ Case Rep 2024; 17:e255522. [PMID: 38684347 PMCID: PMC11146349 DOI: 10.1136/bcr-2023-255522] [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] [Accepted: 04/06/2024] [Indexed: 05/02/2024] Open
Abstract
Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition. We report an atypical case of MEWDS in a man in his 30s who presented with blurred vision (visual acuity 6/9), floaters and photopsia in his left eye. Funduscopy examination showed mild peripheral nasal vascular sheathing with subtle grey-white dots highlighted on fundus autofluorescence. As far as the authors are aware, this is the first case presentation whereby areas affected by MEWDS started in the peripheral retina and migrated centrally. Fluorescein angiography showed hyperfluorescent areas in wreath-like patterns nasally. Optical coherence tomography showed disruption of the ellipsoid zone and hyperreflective projections into the outer nuclear layer. The size of the involved area increased over 3 weeks and subsequently resolved over 4 months. Simultaneously, the patient's symptoms also resolved, without treatment. This case highlights the importance of multimodal imaging, especially ultrawidefield imaging in diagnosing MEWDS.
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Affiliation(s)
- Jae Yee Ku
- Eye and Vision Science, University of Liverpool, Liverpool, UK
- Ophthalmology, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
| | - Nyaish Mansoor
- Ophthalmology, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
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Abu Serhan H, Abu Suilik H, Hassan AK, AlSamhori JF, Hassan AR, Siddiq A, Ahmed N, Elnahry AG. The characteristics of white dot syndromes following COVID-19 Vaccines: a systematic review. Int Ophthalmol 2024; 44:189. [PMID: 38652153 PMCID: PMC11039548 DOI: 10.1007/s10792-024-03119-4] [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: 11/25/2023] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To review all studies reporting the onset of white dot syndromes following COVID-19 vaccines. METHODS Our protocol was registered prospectively on PROSPERO [registration number: CRD42023426012]. We searched five different databases including PubMed, Scopus, Web of Science, Google Scholar, and Science Direct up to May 2023. All the studies that reported the occurrence of white dot syndrome following COVID-19 vaccines were included. All statistical tests were conducted with a 95% confidence interval and a 5% error margin. A p value of less than 0.05 was considered statistically significant. The methodological quality of included studies was performed using the IHE Quality Appraisal Checklist for Case Series studies and JBI Critical Appraisal Checklist for Case Reports. RESULTS Fifty studies involving seventy-one subjects were included. Multiple evanescent white dot syndrome (MEWDS) was the most common disease (n = 25, 35.2% %), followed by acute macular neuroretinopathy (AMN) (n = 22, 31.0%) and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) (n = 4, 5.6%). They were mostly unilateral (n = 50, 70.4%). The presenting symptoms were blurred vision (n = 26, 36.6%), paracentral scotoma (n = 19, 26.8%), visual field disturbance, and photopsia (n = 7, 9.9%). The mean duration for follow-up was 10.15 ± 14.04 weeks. Nineteen subjects (29.69%) received steroids with improvement reported in 68.4%. Eleven subjects (17.19%) were managed by observation only with reported full recovery and improvement. CONCLUSION White dot syndromes are very rare entities. Our findings highlight a possible association between COVID-19 vaccines and the occurrence of white dot syndromes. However, larger studies with good quality should be implemented to confirm these findings.
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Affiliation(s)
- Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Al Sadd, Al Rayyan St., PO: 3050, Doha, Qatar.
| | | | - Amr K Hassan
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | | | - Abdul Rhman Hassan
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Nagi Ahmed
- Department of Ophthalmology, Hamad Medical Corporations, Al Sadd, Al Rayyan St., PO: 3050, Doha, Qatar
| | - Ayman G Elnahry
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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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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Lund-Andersen C, Klefter ON, Schneider M. Long-term follow-up of a bilateral acute posterior multifocal placoid pigment epitheliopathy following COVID-19 infection: a case report. J Ophthalmic Inflamm Infect 2024; 14:2. [PMID: 38177891 PMCID: PMC10766895 DOI: 10.1186/s12348-023-00382-x] [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: 09/04/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory eye disorder that is characterized by the presence of multiple placoid lesions in the posterior pole of the eye. Relentless placoid chorioretinitis (RPC) is an inflammatory chorioretinopathy that combines clinical features of APMPPE and serpiginous chorioretinitis, which is a progressive condition with a high risk of visual disability. Patients with COVID-19 can develop various ocular manifestations, however, there have been limited reports of APMPPE and RPC associated with the infection. We report a case of a patient who developed APMPPE after a COVID-19 infection and subsequently progressed into RPC. CASE PRESENTATION A 17-year-old male presented with a one-week history of painless gradual visual loss in both eyes. Two months prior to the visual symptoms, the patient had a SARS CoV-2 infection, confirmed by polymerase chain reaction test. Clinical findings with fundoscopy, optical coherence tomography and fluorescein angiography were consistent with APMPPE. Due to the severely affected vision in both eyes, the patient was started on 50 mg oral prednisolone daily, after which vision began to improve rapidly. Two months after symptom onset during steroid taper, the impression of continued inflammatory activity and new lesions in the retinal periphery of both eyes suggested RPC. Adalimumab 40 mg every other week was initiated with 12.5 mg prednisolone daily followed by slow tapering. Vision improved and five months after the start of the adalimumab treatment, the steroid was discontinued and there were no signs of active inflammation. The patient has been followed for a total of 21 months since presentation, had full visual recovery and good tolerance of the immunosuppressive treatment. CONCLUSION COVID-19 might cause long-lasting activity of APMPPE. The scarcity of reports compared with the number of confirmed COVID-19 infections worldwide suggests a rare entity. The association of APMPPE with a variety of infections may suggest a common immunological aberrant response that might be triggered by various factors. Further examinations and case reports are needed to understand the role of biological therapy in the treatment of such cases.
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Affiliation(s)
- Casper Lund-Andersen
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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Zou Y, Kamoi K, Zong Y, Zhang J, Yang M, Ohno-Matsui K. Ocular Inflammation Post-Vaccination. Vaccines (Basel) 2023; 11:1626. [PMID: 37897028 PMCID: PMC10611055 DOI: 10.3390/vaccines11101626] [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: 09/29/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
The association between vaccines and ocular disorders has attracted significant attention in scientific research. Numerous mainstream vaccines are associated with a range of uveitis types, including anterior, intermediate, and posterior uveitis. Additionally, they are associated with distinct ocular diseases such as multifocal choroiditis, Vogt-Koyanagi-Harada (VKH) disease, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), and multiple evanescent white dot syndrome (MEWDS). These ocular conditions are often transient, with a vast majority of patients experiencing improvement after steroid intervention. To date, numerous cases of vaccine-induced uveitis have been reported. This study analyzed the correlation between antiviral vaccines, including the hepatitis B virus (HBV), human papillomavirus (HPV), measles-mumps-rubella (MMR), varicella zoster virus (VZV), and influenza vaccines, and different manifestations of uveitis. This is the first comprehensive study to offer a detailed analysis of uveitis types induced by antiviral vaccines. Through an extensive database search, we found a particularly strong link between influenza vaccines, followed by VZV and HPV vaccines. While anterior uveitis is common, conditions such as APMPPE, MEWDS, and VKH are particularly notable and merit careful consideration in clinical practice. Corticosteroid treatment was effective; however, half of the observed patients did not achieve full recovery, indicating potentially prolonged effects of the vaccine.
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Affiliation(s)
| | - Koju Kamoi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (Y.Z.); (Y.Z.); (J.Z.); (M.Y.); (K.O.-M.)
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10
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Sejournet L, Kodjikian L, Rezkallah A, Denis P, Mathis T, Loria O. Multiple evanescent white dot syndrome relapse following BNT162b2 mRNA COVID-19 vaccination. Int J Ophthalmol 2023; 16:1724-1726. [PMID: 37854372 PMCID: PMC10559028 DOI: 10.18240/ijo.2023.10.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/10/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Lucas Sejournet
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon F-69004, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon F-69004, France
- Laboratoire UMR-CNR 5510 Matéis, Université Lyon 1, Villeurbane 69100, France
| | - Amina Rezkallah
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon F-69004, France
| | - Philippe Denis
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon F-69004, France
| | - Thibaud Mathis
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon F-69004, France
- Laboratoire UMR-CNR 5510 Matéis, Université Lyon 1, Villeurbane 69100, France
| | - Olivier Loria
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon F-69004, France
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11
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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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12
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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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13
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Adzic Zecevic A, Vukovic D, Djurovic M, Lutovac Z, Zecevic K. Multiple Evanescent White Dot Syndrome Associated with Coronavirus Infection: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:98-101. [PMID: 36688189 PMCID: PMC9843462 DOI: 10.30476/ijms.2022.95007.2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/05/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023]
Abstract
Coronavirus disease 2019 (COVID-19) causes ocular manifestations in approximately 11% of patients. Most patients typically develop ocular symptoms within 30 days of the onset of the first COVID-19 symptoms. The most common ocular manifestation is conjunctivitis, which affects nearly 89% of patients with eye problems. Other much less common anterior segment abnormalities caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are scleritis, episcleritis, and acute anterior uveitis. Posterior segment abnormalities caused by SARS-CoV-2 are mainly vascular, such as hemorrhages, cotton wool spots, dilated veins, and vasculitis. Herein, we report a rare manifestation of COVID-19 and multiple evanescent white dot syndrome (MEWDS) of the retina. In April 2021, a 40-year-old female patient was admitted to the Eye Clinic of Clinical Center of Montenegro (Podgorica, Montenegro). The patient's main complaint was sudden vision impairment, which occurred 14 days after a positive polymerase chain reaction (PCR) test result for SARS-CoV-2 infection. A complete eye examination was performed, followed by fundoscopy, optical coherence tomography (OCT), and fluorescein angiography (FA) tests. The results showed retinal changes associated with MEWDS. The patient underwent additional examinations to rule out common causes of multifocal retinitis, all of which were unremarkable. Therefore, it was concluded that retinitis was a complication of COVID-19. Given its non-invasive nature, fundus examination should be used as a standard screening method for retinal changes in patients with COVID-19.
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Affiliation(s)
- Antoaneta Adzic Zecevic
- Eye Clinic, Clinical Center of Montenegro and Medical Faculty, University of Montenegro, Podgorica, Montenegro
| | | | - Maja Djurovic
- Eye Clinic, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Ksenija Zecevic
- School of Medicine, University of Montenegro, Podgorica, Montenegro
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14
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Rozanova OI, Shchuko AG, Grigoryeva AV, Samsonov DY. [Patterns of structural and functional changes in the retina and choroid in acute posterior multifocal placoid pigment epitheliopathy]. Vestn Oftalmol 2023; 139:44-51. [PMID: 37638571 DOI: 10.17116/oftalma202313904144] [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: 08/29/2023]
Abstract
PURPOSE The study analyzes the patterns of pathological changes in the retina and choroid in acute posterior multifocal placoid pigmented epitheliopathy (APMPPE). MATERIAL AND METHODS The results of the examination of two patients with bilateral APMPPE were analyzed retrospectively. The examination had included visometry, tonometry, static perimetry, autofluorescence, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). RESULTS The analysis revealed signs of the inflammatory nature of the choriocapillary vascular wall lesion with the development of their local obstruction and, consequently, local ischemia of the retinal pigment epithelium (RPE) and the outer layers of the retina in the acute period. At the same time, partial destruction of the ellipsoid zone, uneven hyperreflectivity of the RPE with local areas of its elevation and impaired connection with photoreceptors were revealed. The subsequent restoration of choriocapillaris perfusion was accompanied by significant restoration of the functional and structural state of the RPE over a larger area, as well as partial restoration of the ellipsoid zone of the retina. Two years after the onset of the disease, separate areas of defects of the RPE and the outer retina were observed, coinciding in localization with zones of severe circulatory deficiency at the level of choriocapillaris in the acute stage. CONCLUSION According to the results of multimodal imaging, choriocapillaritis is the initial link in the pathogenesis of APMPPE. The change in RPE and the outer retina is secondary to the local ischemic zones due to choriocapillaris nonperfusion. The nature of RPE change over a larger area manifests as a functional structural disorder, with the potential for recovery in case of choriocapillaris reperfusion.
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Affiliation(s)
- O I Rozanova
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
| | - A G Shchuko
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
- Irkutsk Branch of Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - A V Grigoryeva
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
| | - D Yu Samsonov
- Irkutsk Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye microsurgery", Irkutsk, Russia
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15
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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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16
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Wiley ZC, Pakravan M, Charoenkijkajorn C, Kavoussi SC, Lee AG. Uveomeningeal syndrome presenting with bilateral optic disc edema and multiple evanescent white dots syndrome (MEWDS). Am J Ophthalmol Case Rep 2022; 26:101538. [PMID: 35514800 PMCID: PMC9062123 DOI: 10.1016/j.ajoc.2022.101538] [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: 09/30/2021] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a uveomeningeal syndrome with bilateral optic disc edema and a MEWDS-like presentation. Observations A 17-year-old female experienced daily fevers for 3 days (ranging from 101.4 F to 102 F), then received the first dose of the Pfizer SARS-CoV-2 vaccine nearly three weeks later. Within two days she experienced severe headaches with severity scale of 8/10. Retinal imaging at the time showed optic disc edema in both eyes (OU) and multifocal well-circumscribed chorioretinal white lesions in the periphery OU. Neuroimaging and routine infectious and inflammatory laboratory testing were normal. Lumbar puncture showed elevated opening pressure and cerebrospinal pleocytosis consistent with an aseptic meningitis. At follow up, one month later the symptoms and retinal findings resolved. Conclusions MEWDS is typically an idiopathic condition but can occur in the setting of viral illness. Although other white dot syndromes have been associated with uveomeningeal presentations, to our knowledge this is the first such case to be described in the English language ophthalmic literature. MEWDS is a retinal white dot syndrome that commonly follows a viral illness. Diagnostic retinal findings include foveal granularity with white or orange specks. MEWDS typically presents to retina specialists but can be seen by neuro-ophthalmologists in the setting of optic disc edema.
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Affiliation(s)
- Zachary C. Wiley
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Mohammad Pakravan
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Chaow Charoenkijkajorn
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Shawn C. Kavoussi
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Andrew G. Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A and M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Corresponding author. Department of Ophthalmology - Blanton Eye Institute Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA.
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17
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Jones NP, Pockar S, Steeples LR. Changing Trends in Uveitis in the United Kingdom: 5000 Consecutive Referrals to a Tertiary Referral Centre. Ocul Immunol Inflamm 2022:1-6. [PMID: 35442852 DOI: 10.1080/09273948.2022.2067067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To demonstrate changes in the demography and diagnosis of uveitis in a specialist clinic in the United Kingdom. METHODS Retrieval of data including all new referrals to Manchester Uveitis Clinic from 1991 to 2020. The incidence and proportions of diagnoses between 4 quartiles was compared. RESULTS 5000 patients with uveitis were seen. Referral rates trebled over time. Highly significant increases in referrals were seen for multiple evanescent white dot syndrome-spectrum disorders, syphilis and tuberculosis; increases were also seen for herpetic retinitis, vitreoretinal lymphoma and sarcoidosis. Highly significant decreases were seen for Fuchs' uveitis, Behçet's uveitis and ocular toxoplasmosis. CONCLUSIONS Subspecialisation and de-skilling has changed referral patterns to specialist clinics; changes cannot be entirely attributed to disease incidences, which also vary between countries. International data are non-comparable. There are clear changes in referral patterns and disease incidence in this population, influenced by evolving diagnosis. Local data should steer care planning.
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Affiliation(s)
- N P Jones
- School of Biological Sciences, The University of Manchester, UK
| | - S Pockar
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - L R Steeples
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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18
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Jain A, Shilpa IN, Biswas J. Multiple evanescent white dot syndrome following SARS-CoV-2 infection - A case report. Indian J Ophthalmol 2022; 70:1418-1420. [PMID: 35326071 PMCID: PMC9240486 DOI: 10.4103/ijo.ijo_3093_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To report a case of MEWDS post-COVID-19 infection with multimodal imaging. A 17-year-old boy reported blurring of vision in both eyes 2 months and 10 days following the SARS-CoV-2 infection. Fundus examination revealed hypopigmented lesions nasal to the optic disc, inferior periphery, and near macula in both eyes. Multimodal imaging was consistent with MEWDS. A complete systemic workup was performed to exclude infectious etiology. Fundus lesions resolved with a course of oral corticosteroids and was confirmed on multimodal imaging.
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Affiliation(s)
- Anupreeti Jain
- Observer, Department of Uveitis and Ocular Pathology, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - I N Shilpa
- Vitreo Retina Fellow, Sri Bhagwan Mahavir, Department of Vitreoretinal Services Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Director Department of Uveitis and Ocular Pathology, Sankara Netralaya, Chennai, Tamil Nadu, India
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19
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Identifying and Treating Ocular Manifestations in Psoriasis. Am J Clin Dermatol 2022; 23:51-60. [PMID: 34731450 DOI: 10.1007/s40257-021-00648-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/04/2023]
Abstract
Psoriasis is a chronic immune-mediated inflammatory skin condition that commonly presents with red, thickened, and scaling plaques. Given the prominent cutaneous manifestations of psoriasis, more subtle ophthalmic findings of the disease may initially go undetected, with the potential for significant ocular morbidity. Associated ocular disease can involve nearly any structure of the eye, with the eyelids most commonly being affected, resulting in relatively common signs and symptoms of ocular surface discomfort. The presence of intraocular inflammation (i.e., uveitis) or retinal involvement carry a heightened risk of vision loss, and are often more difficult to diagnose outside of the ophthalmology clinic. Early detection and treatment of ocular disease can limit morbidity and are critical to the management of these patients, which requires coordination of care between dermatologists and ophthalmologists. The objective of this article was to review the most common ocular conditions that affect psoriatic patients, when to consider referral to an ophthalmologist, and to summarize the adverse ocular effects of current psoriasis treatments.
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20
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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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21
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Bourke C, Stephenson KAJ, Delaney Y, Morgan J. Persistent photopsia: multiple evanescent white dot syndrome in a sexagenarian. BMJ Case Rep 2021; 14:e246140. [PMID: 34642221 PMCID: PMC8513220 DOI: 10.1136/bcr-2021-246140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Christine Bourke
- Ophthalmology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kirk A J Stephenson
- Ophthalmology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yvonne Delaney
- Ophthalmology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - James Morgan
- Ophthalmology Department, Mater Misericordiae University Hospital, Dublin, Ireland
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22
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Classification Criteria for Punctate Inner Choroiditis. Am J Ophthalmol 2021; 228:275-280. [PMID: 33845011 PMCID: PMC8675391 DOI: 10.1016/j.ajo.2021.03.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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 The purpose of this study was to determine classification criteria for punctate inner choroiditis (PIC). DESIGN Machine learning of cases with PIC 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 by using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the posterior uveitides. The resulting criteria were evaluated in the validation set. RESULTS A total of 1,068 cases of posterior uveitides, including 144 cases of PIC, were evaluated by machine learning. Key criteria for PIC included: 1) "punctate"-appearing choroidal spots <250 µm in diameter; 2) absent to minimal anterior chamber and vitreous inflammation; and 3) involvement of the posterior pole with or without mid-periphery. 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 PIC were 15% in the training set and 9% in the validation set. CONCLUSIONS The criteria for PIC had a reasonably low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
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Classification Criteria For Multiple Evanescent White Dot Syndrome. Am J Ophthalmol 2021; 228:198-204. [PMID: 33845025 PMCID: PMC8594763 DOI: 10.1016/j.ajo.2021.03.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to determine classification criteria for multiple evanescent white dot syndrome (MEWDS). DESIGN Machine learning of cases with MEWDS 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 in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior, or panuveitides. The resulting criteria were evaluated in the validation set. RESULTS A total of 1,068 cases of posterior uveitides, including 51 cases of MEWDS, were evaluated by machine learning. Key criteria for MEWDS included: 1) multifocal gray-white chorioretinal spots with foveal granularity; 2) characteristic imaging on fluorescein angiography ("wreath-like" hyperfluorescent lesions) and/or optical coherence tomography (hyper-reflective lesions extending from retinal pigment epithelium through ellipsoid zone into the retinal outer nuclear layer); and 3) absent to mild anterior chamber and 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. Misclassification rates for MEWDS were 7% in the training set and 0% in the validation set. CONCLUSIONS The criteria for MEWDS had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
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24
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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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25
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Classification Criteria for Acute Posterior Multifocal Placoid Pigment Epitheliopathy. Am J Ophthalmol 2021; 228:174-181. [PMID: 33845024 PMCID: PMC8594760 DOI: 10.1016/j.ajo.2021.03.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine classification criteria for acute posterior multifocal placoid pigment epitheliopathy (APMPPE). DESIGN Machine learning of cases with APMPPE 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 82 cases of APMPPE, were evaluated by machine learning. Key criteria for APMPPE included (1) choroidal lesions with a plaque-like or placoid appearance and (2) characteristic imaging on fluorescein angiography (lesions "block early and stain late diffusely"). Overall accuracy for posterior uveitides was 92.7% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for APMPPE were 5% in the training set and 0% in the validation set. CONCLUSIONS The criteria for APMPPE had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
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26
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Sassalos TM, Vitale AT, Conrady CD. Posterior scleritis and acute posterior multifocal placoid pigment epitheliopathy: A case of painful chorioretinitis and review of the current literature. Am J Ophthalmol Case Rep 2021; 23:101159. [PMID: 34278050 PMCID: PMC8261531 DOI: 10.1016/j.ajoc.2021.101159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/20/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To describe a patient who developed concurrent acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and posterior scleritis. Observations We describe a middle-aged woman that developed eye pain and photopsia. She was found to have a “T-sign” on ultrasound of the right eye and multiple, nearly confluent, ill-defined subretinal whitish lesions in both eyes. After an extensive laboratory evaluation and neuroimaging, her photopsia, pain with eye movements, and subretinal lesions began to regress on high dose systemic corticosteroids. Conclusions and Importance This is the first reported case of bilateral APMPPE and concurrent posterior scleritis. Our case highlights the importance of performing a full review of systems, specifically eliciting neurological changes, and dilated eye examination in all new uveitis cases.
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Affiliation(s)
- Thérèse M Sassalos
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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Temporally independent association of multiple evanescent white dot syndrome and optic neuritis. Graefes Arch Clin Exp Ophthalmol 2021; 259:2807-2811. [PMID: 34050810 DOI: 10.1007/s00417-021-05249-2] [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] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To describe three patients that developed temporally distinct episodes of optic neuritis and multiple evanescent white dot syndrome (MEWDS). METHODS We retrospectively reviewed the medical records and imaging studies of three women evaluated at a tertiary referral center for both optic neuritis and MEWDS. RESULTS Three otherwise healthy women, aged 17, 36, and 41, developed temporally separated episodes of optic neuritis and MEWDS. The time periods between the two events were 3, 48, and 60 months, and in two of the three cases, the optic neuritis event preceded the episode of MEWDS. No patient endorsed prodromal flu-like symptoms prior to developing vision loss. The mean presenting visual acuities were better with the optic neuritis episode (LogMAR 0.360, Snellen 20/46) than with retinal event (LogMAR 0.684, Snellen 20/97). All three patients had improvement in vision, with mean visual acuity of 20/29 (LogMAR 0.165) at last follow-up. One patient later developed idiopathic noninfectious posterior uveitis and another developed multiple sclerosis requiring treatment. CONCLUSION While a rare association, patients can develop both optic neuritis and MEWDS within the same eye at different time points. It is unknown whether such patients are at even higher risk of developing systemic autoimmune disease than are patients with either MEWDS or optic neuritis alone.
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28
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Morel JB, Fajnkuchen F, Amari F, Giocanti-Aurégan A, Mrejen S. [Multiple Evanescent White Dot Syndrome (MEWDS) with severe visual acuity loss]. J Fr Ophtalmol 2021; 44:e343-e346. [PMID: 33632626 DOI: 10.1016/j.jfo.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- J-B Morel
- Service d'ophtalmologie, centre hospitalier universitaire Avicenne-Paris 13, 125, rue de Stalingrad, 93000 Bobigny, France
| | - F Fajnkuchen
- Service d'ophtalmologie, centre hospitalier universitaire Avicenne-Paris 13, 125, rue de Stalingrad, 93000 Bobigny, France; Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France.
| | - F Amari
- Service d'ophtalmologie, centre hospitalier universitaire Avicenne-Paris 13, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Aurégan
- Service d'ophtalmologie, centre hospitalier universitaire Avicenne-Paris 13, 125, rue de Stalingrad, 93000 Bobigny, France
| | - S Mrejen
- Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France
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Ramakrishnan MS, Patel AP, Melles R, Vora RA. Multiple Evanescent White Dot Syndrome: Findings from a Large Northern California Cohort. Ophthalmol Retina 2020; 5:850-854. [PMID: 33271345 DOI: 10.1016/j.oret.2020.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the clinical and imaging characteristics of multiple evanescent white dot syndrome (MEWDS) from a large single-center cohort. DESIGN Single-center, retrospective cohort study. PARTICIPANTS A total of 111 patients previously diagnosed with MEWDS in the Kaiser Permanente Northern California system from 2012 to 2019. METHODS Two retina specialists reviewed the medical records and all available retinal imaging, including Humphrey visual field testing, fundus photography (FP), OCT, fluorescein angiogram (FA), and fundus autofluorescence (FAF). Patients were excluded from analysis if confirmatory imaging was unavailable. MAIN OUTCOME MEASURES Patient characteristics, visual acuity, clinical examination and imaging findings, and final diagnosis. RESULTS Seventy-three patients (65.8%) were confirmed to have the diagnosis of MEWDS. Fifty-eight (79.5%) were female, with a mean (standard deviation [SD]) age at presentation of 35.2 (14.2) years, and mean refractive error of -1.6 diopters. Initial mean (SD) visual acuity was logarithm of the minimum angle of resolution (logMAR) 0.39 (0.31) and improved to mean (SD) logMAR 0.07 (0.15) at final follow-up. Presenting symptoms included blurred vision (82%), scotomas (56%), photopsias (43%), and floaters (23%). Nine patients (12%) had a previously diagnosed autoimmune condition, and 2 patients (3%) had documentation of a recent vaccination. Antecedent upper respiratory infection was documented in 15 of 66 patients (23%). Noted clinical and imaging features include ellipsoid zone disruption (100%), white fundus lesions (92%), FA hyperfluorescence (92%), foveal granularity (74%), vitreous cell (53%), and optic disc edema (52%). Twenty-nine of the 111 patients (26%) were initially misdiagnosed with MEWDS and subsequently given an alternative diagnosis, including other white dot syndromes, syphilis, primary vitreoretinal lymphoma, myopic degeneration, and central serous chorioretinopathy. CONCLUSIONS Multiple evanescent white dot syndrome is a rare self-limiting condition of the outer retina. Although a distinct set of clinical exam and imaging findings permit recognition of this disease, misdiagnosis is not uncommon.
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Affiliation(s)
| | - Amar P Patel
- Kaiser Permanente Northern California, Oakland, California
| | - Ronald Melles
- Kaiser Permanente Northern California, Oakland, California
| | - Robin A Vora
- Kaiser Permanente Northern California, Oakland, California.
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Bosello F, Westcott M, Casalino G, Agorogiannis G, Micciolo R, Rees A, Pavesio C. Multiple evanescent white dot syndrome: clinical course and factors influencing visual acuity recovery. Br J Ophthalmol 2020; 106:121-127. [DOI: 10.1136/bjophthalmol-2020-317357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 01/13/2023]
Abstract
ObjectiveTo report the demographics and the clinical course of patients with multiple evanescent white dot syndrome (MEWDS) and to investigate for those factors which influence visual acuity (VA) recovery.MethodsThis is a retrospective single-centre observational study. Electronic medical records and retinal imaging of patients with a diagnosis of MEWDS with a minimum follow-up of 3 months were reviewed. Patients were categorised into three groups according to the VA at presentation and at the last visit: group 1 >0.48 logarithm of the minimum angle of resolution (LogMAR), group 2 ≤0.48 and ≥0.18 LogMAR and group 3 <0.18 LogMAR. All patients had non-invasive multimodal imaging including optical coherence tomography, near-infrared reflectance imaging and blue fundus autofluorescence at presentation and during follow-up.ResultsA total of 51 eyes from 51 patients (41 women, mean age 29.8±7.8 years) were included. Significantly more patients presented in the autumn (X2=8.69, p=0.034). The percentage of eyes recovering vision to 0.0 LogMAR or better was 80.3% (41/51). Worse presenting vision and young age at presentation were independent significant predictive variables for poorer final VA (p=0.002 and p=0.02, respectively). No imaging features were significantly predictive of complete versus incomplete recovery, but disc hyperfluorescence on fluorescein angiography was more common in those with incomplete recovery.ConclusionsAlthough the majority of cases have a benign prognosis, the clinical spectrum of MEWDS includes incomplete visual recovery. In our series, poor presenting VA and young age were associated with poor VA outcome. Further study is warranted to confirm these findings.
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Gamulescu MA. [Gender medicine in ophthalmology : The "small difference" between women and men]. Ophthalmologe 2020; 117:831-842. [PMID: 32699941 DOI: 10.1007/s00347-020-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gender-specific or sex-specific medicine is part of "personalized" medicine. After differences in heart diseases between women and men were first identified and increasingly published in the field of cardiology since the 1980s, differences between the sexes have also become the focus of interest in other disciplines. Immunological and hormonal aspects indicate significant differences, e.g. in the severity of the disease or the response to treatment. Even in ophthalmology epidemiological differences in some diseases are known but so far these do not lead to a different approach in the practical treatment of patients. This CME article aims to raise awareness of gender medicine also in the field of ophthalmology and at the same time to promote understanding of these differences by presenting the fundamental differences between the sexes.
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Affiliation(s)
- M-A Gamulescu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Deutschland.
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Azar G, Wolff B, Azam S, Mauget-Faÿsse M. Acute syphilitic posterior placoid chorioretinopathy presenting as atypical multiple evanescent white dot syndrome. Eur J Ophthalmol 2020; 31:NP141-NP144. [PMID: 32878455 DOI: 10.1177/1120672120957589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This paper reports the case of a young man who presented with syphilis masquerading as multiple evanescent white dots syndrome (MEWDS), which turned out to be an acute syphilitic posterior placoid chorioretinopathy (ASPPC) during follow-up. CASE PRESENTATION A 59-year-old healthy male consulted for a three days' history of visual impairment in both eyes. On multimodal imaging, he was diagnosed as MEWDS. Fundus fluorescein angiography (FFA) showed early peripheral bilateral granular hyperfluorescence that correlated with the yellow-white dots found on fundus exam. Indocyanine green angiography (ICGA) depicted hypofluorescent dots on late phase. Spectral-domain optical coherence tomography (SD-OCT) revealed numerous inner retinal highly reflective deposits in the outer nuclear layer and disruption of the ellipsoid zone. After initial improvement, he presented again for a sudden visual loss at 3 weeks. FFA, ICGA and SD-OCT demonstrated the same but more numerous and outer lesions suggesting an ASPPC. A full inflammatory work-up revealed highly positive titers of rapid plasma regain (RPR) and fluorescent treponemal antibody absorption (FTA-Abs), suggesting a syphilis infection. The ophthalmological manifestations dramatically improved after the patient was admitted for high-dose intravenous penicillin G 24 million per day for 2 weeks. CONCLUSION This is the first case that reports an ocular syphilitic infection masquerading as MEWDS at presentation and that turns to be an ASPPC. Syphilis serology should be routinely done in every case of atypical MEWDS especially when unusually presented in a young healthy man, with bilateral involvement and a bad clinical evolution.
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Affiliation(s)
- Georges Azar
- Eye & Ear Hospital International, Beirut, Lebanon.,Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Benjamin Wolff
- Fondation Ophtalmologique Adolphe de Rothschild, Service du Professeur Sahel, Paris, France
| | - Stéphane Azam
- Fondation Ophtalmologique Adolphe de Rothschild, Service du Professeur Sahel, Paris, France
| | - Martine Mauget-Faÿsse
- Fondation Ophtalmologique Adolphe de Rothschild, Service du Professeur Sahel, Paris, France
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CHARACTERIZATION AND CORRELATION OF "JAMPOL DOTS" ON ADAPTIVE OPTICS WITH FOVEAL GRANULARITY ON CONVENTIONAL FUNDUS IMAGING. Retina 2020; 39:235-246. [PMID: 29190245 DOI: 10.1097/iae.0000000000001958] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe features characteristic of multiple evanescent white dot syndrome (MEWDS) using adaptive optics scanning laser ophthalmoscopy (AOSLO). METHODS Six women (seven eyes) who presented with MEWDS between June 2014 and April 2017 underwent ophthalmologic examinations and multimodal imaging including infrared, AOSLO, and spectral domain optical coherence tomography. RESULTS Bright hyperreflective lesions on AOSLO throughout the course of MEWDS could be correlated to the hyperreflective dots of foveal granularity on infrared imaging without apparent corresponding changes on spectral domain optical coherence tomography. During the acute phase of MEWDS, extrafoveal hyperreflective dots were also visible on AOSLO and infrared and were associated with accumulations of hyperreflective material above the retinal pigment epithelium on spectral domain optical coherence tomography. CONCLUSION Foveal granularity on conventional fundus imaging could be correlated with hyperreflective lesions visible on AOSLO. We hypothesize that these hyperreflective lesions, "Jampol dots," are the foveal corollaries of the same process associated with the classic "dot" lesions in MEWDS. Based on the intact photoreceptor mosaic on AOSLO, we surmise that this material is accumulating at the level of the retinal pigment epithelium.
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Fernández-Vega González A, Fernández-Vega González C, Fernández-Vega Sanz B, Peláez MT, Merayo-Lloves J. Bilateral fungal infection inducing a serpiginous-like picture. Eur J Ophthalmol 2020; 31:NP50-NP56. [PMID: 32106701 DOI: 10.1177/1120672120908726] [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: 11/17/2022]
Abstract
PURPOSE To report the clinical findings of a patient who presented with an atypical bilateral fungal retinitis that was established by retinochoroidal biopsy. METHODS Case report. RESULTS A 56-year-old systemically healthy man presented with progressive visual loss in his left eye for 3 weeks. Visual acuity was 20/40 in the left eye, and 20/20 in the right eye and fundus examination showed macular retinal pigmented epithelium changes in his left eye. Over the following four months, his lesions progressed to serpiginous-like widespread retinal pigmented epithelium atrophy and his visual acuity decreased to 20/100, but no signs of ocular inflammation were found. Treatment with oral corticoids, valganciclovir and trimethoprim/sulfamethoxazole showed no efficacy. Blood analysis and cultures, laboratory investigations, and imaging tests were carried out looking for infectious and inflammatory diseases, but all tests were negative. Two months later, the patient presented with the same kind of lesions in the other eye (right eye), so he was subjected to retinochoroidal biopsy. Histopathological examination of specimen revealed the presence of intraretinal and choroidal fungal hyphae. Oral voriconazole was initiated achieving clinical remission, but no visual improvement was obtained. The source of the infection remains unknown since all tests results were negative. However, his profession as brewmaster might be related to the origin of the infection. CONCLUSION Diagnosis of intraocular fungal infection can be challenging. Retinochoroidal biopsy may be useful to establish the diagnosis in those atypical cases with nonrevealing workup and inflammation localized to the retina.
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Affiliation(s)
- Alvaro Fernández-Vega González
- Instituto Universitario Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica Fernández-Vega and Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Carlos Fernández-Vega González
- Instituto Universitario Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica Fernández-Vega and Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Beatriz Fernández-Vega Sanz
- Instituto Universitario Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica Fernández-Vega and Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - María Teresa Peláez
- Instituto Universitario Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica Fernández-Vega and Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Jesús Merayo-Lloves
- Instituto Universitario Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica Fernández-Vega and Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
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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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Lages V, Mantovani A, Papadia M, Herbort CP. MEWDS is a true primary choriocapillaritis and basic mechanisms do not seem to differ from other choriocapillaritis entities. J Curr Ophthalmol 2018; 30:281-286. [PMID: 30555959 PMCID: PMC6277221 DOI: 10.1016/j.joco.2018.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/30/2018] [Accepted: 09/26/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Vânia Lages
- Centro Hospitalar do Porto, Porto, Portugal
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care Montchoisi Teaching Centre, Lausanne, Switzerland
- Ophthalmology Unit, Ospedale Valduce, Como, Italy
- Istituto Auxologico Italiano, Milan, Italy
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care Montchoisi Teaching Centre, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Alessandro Mantovani
- Ophthalmology Unit, Ospedale Valduce, Como, Italy
- Istituto Auxologico Italiano, Milan, Italy
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care Montchoisi Teaching Centre, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Marina Papadia
- Istituto Auxologico Italiano, Milan, Italy
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care Montchoisi Teaching Centre, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Carl P Herbort
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care Montchoisi Teaching Centre, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
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Referral characteristics and wait times for uveitis consultation at academic tertiary care centres in Toronto. Can J Ophthalmol 2018; 53:639-645. [PMID: 30502992 DOI: 10.1016/j.jcjo.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the characteristics of referrals to academic uveitis tertiary care centres in Toronto and identify determinants of wait time for consultation. DESIGN Retrospective case series. METHODS Consecutive new uveitis referrals received at 5 University of Toronto-affiliated uveitis tertiary care centres, between February 2016 and November 2016, were included. RESULTS A total of 159 new uveitis referrals were received from academic (69%) and community (31%) providers. A large proportion of referrals were sent by comprehensive ophthalmologists (33%) and retina specialists (38%). Disease was bilateral in 46% of cases, had an acute onset in 43% of cases, and was classified as posterior uveitis in 38% of cases. Disease etiology at the time of referral was unknown in 55% of cases. Only 43% of all referrals included a basic uveitis workup, and patients who had undergone diagnostic testing had a shorter wait time for consultation (41 ± 43 vs. 59 ± 54 days, p = 0.033). Acute uveitis had a shorter wait time compared with recurrent and chronic uveitis (33 ± 42 vs. 66 ± 44 and 59 ± 58 days, p < 0.001). Referrals triaged as urgent had significantly shorter wait times compared with referrals triaged as semiurgent or elective (7 ± 10 vs. 54 ± 43 and 88 ± 59, p < 0.001). CONCLUSIONS Referrals to academic uveitis tertiary care centres in Toronto are often acute, bilateral cases affecting the posterior segment without a known etiology. Approximately half of referrals include no diagnostic workup, which may delay diagnosis for patients and lengthen wait times for consultation. We provide a set of recommendations for investigations that should be included in uveitis referrals.
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Suh SY, Park JH, Lee SM, Park SW, Lee JE, Byon IS. A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.9.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Su Youn Suh
- Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jong Ho Park
- Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Min Lee
- Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Who Park
- Medical Research Institute, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Eun Lee
- Medical Research Institute, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ik Soo Byon
- Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
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Cozubas R, Ungureanu E, Instrate SL, Alexandrescu C, Nanu RV, Carstocea L, Voinea LM, Ciuluvica R. Similarities and differences between three different types of white dot syndrome and the therapeutic possibilities. Rom J Ophthalmol 2018; 62:183-187. [PMID: 30505986 PMCID: PMC6256077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
White dot syndromes consists a group of inflammatory eye diseases with an unknown etiology involving the external retina, retinal pigment epithelium, choroid or combinations of them. They affect one or both eyes, at the same time or not. White dot syndromes are often self-limited, with a variable prognosis, depending on the type of the disease. The purpose of this article was to look at the similarities and the differences between the different types of syndromes and the therapeutic possibilities existing at present. Abbreviations: WDS = White dot syndromes, MEWDS = Multiple Evanescent White Dot Syndrome, APMPPE = Acute Posterior Multifocal Placoid Pigment epitheliopathy, SC = serpiginous choroiditis RPE = retinal pigment epithelium.
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Affiliation(s)
- Roxana Cozubas
- ”Grigore Alexandrescu”, Emergency Hospital for Children, Bucharest, Romania
| | - Emil Ungureanu
- Ophthalmology Department, University Emergency Hospital; “Carol Davila”
University of Medicine and Pharmacy, Bucharest, Romania
| | - Sinziana Luminita Instrate
- Ophthalmology Department, University Emergency Hospital; “Carol Davila”
University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Alexandrescu
- Ophthalmology Department, University Emergency Hospital; “Carol Davila”
University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Laura Carstocea
- PhD Student, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Liliana Mary Voinea
- Ophthalmology Department, University Emergency Hospital; “Carol Davila”
University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Ciuluvica
- Anatomy Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Multimodal Imaging in an Unusual Cluster of Multiple Evanescent White Dot Syndrome. J Ophthalmol 2017; 2017:7535320. [PMID: 28584665 PMCID: PMC5444036 DOI: 10.1155/2017/7535320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/14/2017] [Indexed: 11/28/2022] Open
Abstract
Objective To describe an unusual cluster of multiple evanescent white dot syndrome (MEWDS) encountered within a 3-month period. Methods This retrospective observation study is comprised of seven patients who presented with MEWDS in a 3-month period in central Israel. Data were collected from patients' medical records on clinical, multimodal imaging, and viral serology findings. Results Six women and one man of mean age 31.5 ± 7.2 years. Three reported a precedent viral infection. All had unilateral decreased vision. Funduscopy revealed foveal granularity. Main Imaging Findings Hyperfluorescent spots on blue autofluorescence (BAF), hypofluorescent spots on indocyanine green angiography, dark lesions on infrared photos, and ellipsoid zone irregularities on spectral domain optical coherence tomography (SD-OCT). Resolution of the spots on BAF correlated with anatomic (SD-OCT) and visual recovery. OCT angiography performed following the convalescence stage demonstrated intact retinal and choroidal flow. Serologic findings were inconclusive. Conclusion We report a unique cluster of MEWDS patients presented in a short period of time. SD-OCT findings of ellipsoid zone disruption in combination with other multimodal imaging modalities are outlined meticulously. Recognizing these imaging features along with high index of clinical suspicion is important for the diagnosis of MEWDS. Serologic testing might be considered in future patients.
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Brydak-Godowska J, Gołębiewska J, Turczyńska M, Moneta-Wielgoś J, Samsel A, Borkowski PK, Ciszek M, Płonecka-Rodzoch A, Kużnik-Borkowska A, Ciszewska J, Makomaska-Szaroszyk E, Brydak LB, Kęcik D. Observation and Clinical Pattern in Patients with White Dot Syndromes: The Role of Color Photography in Monitoring Ocular Changes in Long-Term Observation. Med Sci Monit 2017; 23:1106-1115. [PMID: 28253223 PMCID: PMC5345700 DOI: 10.12659/msm.901744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study was to assess the clinical course and distinctive features of different white dot syndromes (WDS) in patients attending the Ophthalmology Department, Medical University of Warsaw in the years 1995–2015. Material/Methods Sixty-two (62) patients (43 females and 19 males), aged 18 to 77 years, referred with a WDS were included in this prospective study, with observation period ranging from 5 months to 16 years. All patients underwent a complete ophthalmological examination and multimodal imaging studies. Results In this cohort of 62 patients, the following WDS entities were identified: multifocal choroiditis with panuveitis (MFCPU), multifocal choroiditis (MFC), punctate inner choroidopathy (PIC), birdshot, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), subretinal fibrosis and uveitis, multiple evanescent white dot syndrome (MEWDS), serpiginous choroiditis, and single cases of acute annular outer retinopathy (AAOR). Conclusions The study was performed at a Polish referral center and may to some extent reflect the varied geographical distribution of white dot syndromes, as none of the subjects was found to suffer from acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy (AMN), or diffuse unilateral subacute neuroretinitis (DUSN). Long-term follow-up is warranted by the evolution of lesions in the eye fundus, while management depends on correct diagnosis of WDS. When the posterior pole is involved in some cases of the WDS an immunosuppressive treatment, the use of the PDT or anti-VEGF injections were necessary.
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Affiliation(s)
| | - Joanna Gołębiewska
- Department of Ophthalmology, Children's Memorial Health Institute, Warsaw, Poland
| | - Monika Turczyńska
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | - Agnieszka Samsel
- Department of Ophthalmology, Children's Jan Bogdanowicz Hospital, Warsaw, Poland
| | - Piotr K Borkowski
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Ciszek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Joanna Ciszewska
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Dariusz Kęcik
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
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Zagora SL, Symes R, Yeung A, Yates W, Wakefield D, McCluskey PJ. Etiology and Clinical Features of Ocular Inflammatory Diseases in a Tertiary Referral Centre in Sydney, Australia. Ocul Immunol Inflamm 2016; 25:S107-S114. [PMID: 27901620 DOI: 10.1080/09273948.2016.1247871] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the pattern of uveitis in patients attending a tertiary uveitis service in Sydney, Australia. METHODS The charts of patients seen between January 2009 and December 2015 were retrospectively reviewed. Data pertaining to patient demographics, eye examination on presentation, work-up and final diagnoses were collected. RESULTS The total number of patients with uveitis seen over this period was 1165. There were 650 males (56%) and 515 females (44%). There were 838 patients aged 17-60 years (72%) and 327 patients aged >60 years (28%). Uveitis was anterior in 735 patients (63%), posterior in 234 patients (20%), pan in 109 patients (9%), and intermediate in 87 patients (8%). The most common associations were HLA-B27+ve (264 patients; 22.8%), sarcoidosis (78 patients; 6.7%) and Fuchs (33 patients; 2.8%), while VZV (51 patients; 4.4%), HSV (49 patients; 4.2%), tuberculosis (49 patients; 4.2%) and toxoplasmosis (48 patients; 4.1%) were the most common infectious causes of uveitis. No identifiable association was found in 389 patients (33.4%). HLA-B27 was more common in the younger age group compared with the older age group (p<0.001, χ2-test), but there was no difference between the age groups for no identifiable cause (p value 0.24) and sarcoidosis (p value 0.08). CONCLUSIONS This retrospective case review reveals a broad spectrum of uveitis in a tertiary referral service in Sydney, Australia. It is comparable with other major studies around the world.
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Affiliation(s)
- Sophia L Zagora
- a Save Sight Institute, Sydney Medical School, University of Sydney , Sydney , NSW , Australia.,b Sydney Eye Hospital , Sydney , NSW , Australia
| | - Richard Symes
- a Save Sight Institute, Sydney Medical School, University of Sydney , Sydney , NSW , Australia.,b Sydney Eye Hospital , Sydney , NSW , Australia
| | - Aaron Yeung
- a Save Sight Institute, Sydney Medical School, University of Sydney , Sydney , NSW , Australia.,b Sydney Eye Hospital , Sydney , NSW , Australia
| | - Will Yates
- a Save Sight Institute, Sydney Medical School, University of Sydney , Sydney , NSW , Australia.,b Sydney Eye Hospital , Sydney , NSW , Australia
| | - Denis Wakefield
- c School of Medical Sciences, Faculty of Medicine University of NSW , Sydney , NSW , Australia
| | - Peter J McCluskey
- a Save Sight Institute, Sydney Medical School, University of Sydney , Sydney , NSW , Australia.,b Sydney Eye Hospital , Sydney , NSW , Australia
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Brownlee WJ, Anderson NE, Sims J, Pereira JA. Neurological complications of acute multifocal placoid pigment epitheliopathy. J Clin Neurosci 2016; 31:76-80. [PMID: 27183958 DOI: 10.1016/j.jocn.2016.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/13/2016] [Indexed: 10/21/2022]
Abstract
Acute multifocal placoid pigment epitheliopathy (AMPPE) is an autoimmune chorioretinal disease that can be complicated by neurological involvement. There is limited information on this potentially treatable condition in the neurological literature. The objective of this patient series is to describe the neurological complications of AMPPE. We retrospectively identified patients with neurological complications of AMPPE seen at Auckland Hospital between 2008 and 2013 and summarised cases in the literature between 1976 and 2013. We identified five patients with neurological complications of AMPPE at Auckland Hospital and 47 reported patients. These patients demonstrated a spectrum of neurological involvement including isolated headache, stroke or transient ischaemic attack, seizures, venous sinus thrombosis, optic neuritis, sensorineural hearing loss and peripheral vestibular disorder. We propose criteria to define AMPPE with neurological complications. A cerebrospinal fluid (CSF) lymphocytosis in a patient with isolated headache may predict the development of cerebrovascular complications of AMPPE. Patients with cerebrovascular complications of AMPPE have a poor prognosis with high rates of death and neurological disability among survivors. Predictors of poor outcome in those who develop neurological complications of AMPPE are a relapsing course, generalised seizures and multifocal infarction on MRI. All patients with neurological complications of AMPPE, including headache alone, should be investigated with an MRI brain and CSF examination. Patients with focal neurological symptoms should receive intravenous (IV) methylprednisolone followed by a tapering course of oral steroids for at least 3months. Patients with AMPPE and an isolated headache with a CSF pleocytosis should be treated with oral steroids.
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Affiliation(s)
- W J Brownlee
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - N E Anderson
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - J Sims
- Department of Ophthalmology, Auckland City Hospital, Auckland, New Zealand
| | - J A Pereira
- Centre for Brain Research, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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Pellegrini F, Interlandi E. A case of multiple evanescent white dot syndrome misdiagnosed as optic neuritis: Differential diagnosis for the neurologist. J Neurosci Rural Pract 2016; 7:283-5. [PMID: 27114663 PMCID: PMC4821940 DOI: 10.4103/0976-3147.178658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 25-year-old female presented to a local hospital for acute onset of a central scotoma in the left visual field. She was visited by the neurologist, and a diagnosis of left retrobulbar optic neuritis was made. Magnetic resonance imaging scan was normal. Ophthalmic examination revealed a multiple evanescent white dot syndrome. After a description of the case, a brief differential diagnosis between these two entities is made. The neurologist should be aware of this uncommon condition.
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Affiliation(s)
| | - Emanuela Interlandi
- Department of Ophthalmology, Conegliano Hospital, Conegliano, Treviso, Italy
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EXPANDED CLINICAL SPECTRUM OF MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH MULTIMODAL IMAGING. Retina 2016; 36:64-74. [DOI: 10.1097/iae.0000000000000685] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Branisteanu D, Bilha A. ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY FOLLOWING INFLUENZA VACCINATION. Rom J Ophthalmol 2015; 59:52-58. [PMID: 27373117 PMCID: PMC5729817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 06/06/2023] Open
Abstract
PURPOSE To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE), following influenza vaccination. CASE REPORT An 18-year-old female patient developed a painless significant bilateral decrease of vision, moderate photophobia, metamorphopsia and intermittent headaches two weeks after having a seasonal anti-flu immunization. Clinical evaluation and ancillary testing pointed toward the diagnosis of APMPPE. The case evolved favorable after oral prednisone 0.5 mg/kg/day gradually decreased for over 4 weeks. A total recovery of visual function and no recurrences were noticed at 1, 3 and 5 years follow-up. CONCLUSIONS Previous case reports already suggested a possible relationship between various immunizations and APMPPE onset. This case is the first one reported in our country. Epidemiological studies are required to link APMPPE occurrence and vaccination.
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Affiliation(s)
- Daniel Branisteanu
- Ophthalmology Department, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Retina Center Eye Clinic, Iasi, Romania
| | - Andrei Bilha
- Ophthalmology Department, N. Oblu Clinical Emergency Hospital, Iasi, Romania
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Kim SY, Han KJ, Jin SY, Lee YH, Chang YS. Multiple Evanescent White-Dot Syndrome in a 14-Year-Old Girl. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.8.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seo Young Kim
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Kyu Jin Han
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Sun Young Jin
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hoon Lee
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Abstract
Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.
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Sen HN, Davis J, Ucar D, Fox A, Chan CC, Goldstein DA. Gender disparities in ocular inflammatory disorders. Curr Eye Res 2014; 40:146-61. [PMID: 24987987 DOI: 10.3109/02713683.2014.932388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ocular inflammatory disorders disproportionately affect women, and the majority of affected women are of childbearing age. The role of sex or reproductive hormones has been proposed in many other inflammatory or autoimmune disorders, and findings from non-ocular autoimmune diseases suggest a complex interaction between sex hormones, genetic factors and the immune system. However, despite the age and sex bias, factors that influence this disparity are complicated and unclear. This review aims to evaluate the gender disparities in prevalence, incidence and severity of the most common infectious and non-infectious ocular inflammatory disorders.
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Affiliation(s)
- Hatice Nida Sen
- National Eye Institute, National Institutes of Health , Bethesda, MD , USA
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Abdulaal M, Antonios R, Barikian A, Jaroudi M, Hamam RN. Etiology and Clinical Features of Ocular Inflammatory Diseases in a Tertiary Center in Lebanon. Ocul Immunol Inflamm 2014; 23:271-277. [DOI: 10.3109/09273948.2014.902077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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