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Perez Y, Neri P, Pichi F. Multimodal Imaging in Retinal Vasculitis. Ophthalmologica 2024; 247:203-213. [PMID: 39097964 DOI: 10.1159/000540647] [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: 02/15/2024] [Accepted: 07/28/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Retinal vasculitis is an inflammatory condition that affects the retinal blood vessels. SUMMARY It can manifest as an idiopathic disorder or be secondary to various infectious or non-infectious diseases, mimicking syndromes, isolated ocular disorders, or drug-induced reactions. Recognizing its distinctive features is crucial for early diagnosis and accurate treatment. This review aimed to demonstrate the variety of tools available to detect disease activity, assess complications, measure the extent of retinal damage, and guide therapy effectively. KEY MESSAGE This review article highlights the use of multimodal imaging in the comprehensive evaluation of retinal vasculitis.
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Affiliation(s)
- Yanny Perez
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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2
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Davis JL. Defining Retinal Vasculitis. Am J Ophthalmol 2024; 267:84-89. [PMID: 38925285 DOI: 10.1016/j.ajo.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To assess the validity of retinal vasculitis as the preferred diagnostic term for multiple conditions. DESIGN Perspective. METHODS This Perspective is based on expert opinion and review of literature focused on the current nosology and pathology of retinal vasculitis. Interpretation of the subset of intraocular inflammation named "retinal vasculitis" based on fundamental knowledge of the blood-retinal barrier, the neurovascular unit, and pathological and functional responses to a variety of stimuli is provided. Correlation with multimodal imaging and known mechanisms of immunologically mediated disease are discussed. RESULTS A search of Medline in early 2024 for the phrase "retinal vasculitis" resulted in 2041 citations encompassing immunologic, genetic, neoplastic, infectious, drug-related, and ischemia-related disorders. Classification schemes and angiographic grading systems are descriptive and do not address pathologic mechanisms adequately, in part due to lack of histologic confirmation. Although optical coherence tomography (OCT) angiography holds promise for better imaging of retinal vascular changes, it does not reveal the key feature of leakage and only partially improves understanding of pathophysiology. Diagnosing catastrophic retinal vascular occlusion after intravitreal injections as a retinal vasculitis is the most recent example of speculative application of the term to complex and rare disorders. CONCLUSIONS Retinal vasculitis is a diagnostic term that is over-used and imprecise. Revised nosology should limit the term to primary inflammation of the retinal vasculature itself that results in opening of the blood-retinal barrier with or without retinal vascular occlusions. Pending new histologic or mechanistic evidence, the provisional term of "retinal vascular inflammation" or "retinal vasculopathy" should be used for leakage or occlusion occurring in the context of intraocular inflammation.
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Affiliation(s)
- Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Chen X, Wang X, Li X. Intra-Ocular Inflammation and Occlusive Retinal Vasculitis Following Intravitreal Injections of Faricimab: A Case Report. Ocul Immunol Inflamm 2024:1-4. [PMID: 38856728 DOI: 10.1080/09273948.2024.2361834] [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: 04/02/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Faricimab is a bispecific antibody that inhibits angiopoietin-2 and vascular endothelial growth factor-A action and has been approved for the treatment of neovascular age-related macular degeneration and diabetic macular edema. Clinical trials have demonstrated its favorable safety profile. This report presents a case of intra-ocular inflammation and occlusive retinal vasculitis following a second intravitreal injection of faricimab. METHODS A single case report was obtained from a tertiary referral center. RESULTS A 73-year-old Asian man diagnosed with polypoidal choroidal vasculopathy presented with decreased vision in the left eye (OS) 2 weeks after the second faricimab administration. In the fourth week after the second faricimab injection, swept-source optical coherence tomography (OCT) revealed hyperreflective dots in the vitreous cavity, indicating vitreous cells. Color fundus photography showed new-onset perivenular hemorrhages and pallor of the inferonasal retina OS, of which OCT revealed retinal inner layer thickening, suggestive of retinal arteriolar occlusions. Retinal fluorescein angiography revealed delayed filling of the inferior temporal vein. The patient was diagnosed with intraocular inflammation and occlusive retinal vasculitis OS associated with repeated intravitreal faricimab administrations. Intravitreal dexamethasone implant was used instead of faricimab at this visit. CONCLUSIONS The findings of this case hint towards the potential risk of retinal occlusive events associated with intravitreal faricimab injections.
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Affiliation(s)
- Xiuju Chen
- Retina Department, Xiamen Eye Center, Xiamen University, Xiamen, China
| | - Xiaobo Wang
- Retina Department, Xiamen Eye Center, Xiamen University, Xiamen, China
| | - Xiaoxin Li
- Retina Department, Xiamen Eye Center, Xiamen University, Xiamen, China
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4
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Hsu AY, Wang YH, Lin CJ, Li YL, Hsia NY, Lai CT, Kuo HT, Chen HS, Tsai YY, Wei JCC. Assessing Uveitis Risk following Pediatric Down Syndrome Diagnosis: A TriNetX Database Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:710. [PMID: 38792893 PMCID: PMC11123068 DOI: 10.3390/medicina60050710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The risks of uveitis development among pediatric patients with Down syndrome (DS) remain unclear. Therefore, we aimed to determine the risk of uveitis following a diagnosis of DS. Materials and Methods: This multi-institutional retrospective cohort study utilized the TriNetX database to identify individuals aged 18 years and younger with and without a diagnosis of DS between 1 January 2000 and 31 December 2023. The non-DS cohort consisted of randomly selected control patients matched by selected variables. This included gender, age, ethnicity, and certain comorbidities. The main outcome is the incidence of new-onset uveitis. Statistical analysis of the uveitis risk was reported using hazard ratios (HRs) and 95% confidence intervals (CIs). Separate analyses of the uveitis risk among DS patients based on age groups and gender were also performed. Results: A total of 53,993 individuals with DS (46.83% female, 58.26% white, mean age at index 5.21 ± 5.76 years) and 53,993 non-DS individuals (45.56% female, 58.28% white, mean age at index 5.21 ± 5.76 years) were recruited from the TriNetX database. Our analysis also showed no overall increased risk of uveitis among DS patients (HR: 1.33 [CI: 0.89-1.99]) compared to the non-DS cohort across the 23-year study period. Subgroup analyses based on different age groups showed that those aged 0-1 year (HR: 1.36 [CI: 0.68-2.72]), 0-5 years (HR: 1.34 [CI: 0.75-2.39]), and 6-18 years (HR: 1.15 [CI: 0.67-1.96]) were found to have no association with uveitis risk compared to their respective non-DS comparators. There was also no increased risk of uveitis among females (HR: 1.49 [CI: 0.87-2.56]) or males (HR: 0.82 [CI: 0.48-1.41]) with DS compared to their respective non-DS comparators. Conclusions: Our study found no overall increased risk of uveitis following a diagnosis of DS compared to a matched control population.
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Affiliation(s)
- Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (Y.-H.W.); (J.C.-C.W.)
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - You-Ling Li
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - Hou-Ting Kuo
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- Department of General Medicine, China Medical University Hospital, Taichung 40201, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung 43655, Taiwan;
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40202, Taiwan; (A.Y.H.); (C.-J.L.); (C.-T.L.); (H.-T.K.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - James Cheng-Chung Wei
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (Y.-H.W.); (J.C.-C.W.)
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan
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Dhirachaikulpanich D, Xie J, Chen X, Li X, Madhusudhan S, Zheng Y, Beare NAV. Using Deep Learning to Segment Retinal Vascular Leakage and Occlusion in Retinal Vasculitis. Ocul Immunol Inflamm 2024:1-8. [PMID: 38261457 DOI: 10.1080/09273948.2024.2305185] [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: 04/13/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Retinal vasculitis (RV) is characterised by retinal vascular leakage, occlusion or both on fluorescein angiography (FA). There is no standard scheme available to segment RV features. We aimed to develop a deep learning model to segment both vascular leakage and occlusion in RV. METHODS Four hundred and sixty-three FA images from 82 patients with retinal vasculitis were used to develop a deep learning model, in 60:20:20 ratio for training:validation:testing. Parameters, including deep learning architectures (DeeplabV3+, UNet++ and UNet), were altered to find the best binary segmentation model separately for retinal vascular leakage and occlusion, using a Dice score to determine the reliability of each model. RESULTS Our best model for vascular leakage had a Dice score of 0.6279 (95% confidence interval (CI) 0.5584-0.6974). For occlusion, the best model achieved a Dice score of 0.6992 (95% CI 0.6109-0.7874). CONCLUSION Our RV segmentation models could perform reliable segmentation for retinal vascular leakage and occlusion in FAs of RV patients.
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Affiliation(s)
- Dhanach Dhirachaikulpanich
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, UK
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jianyang Xie
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, UK
| | - Xiuju Chen
- Xiamen Eye Center, Xiamen University, Xiamen, Fujian, China
| | - Xiaoxin Li
- Xiamen Eye Center, Xiamen University, Xiamen, Fujian, China
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Savita Madhusudhan
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, UK
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Yalin Zheng
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, UK
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Nicholas A V Beare
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, UK
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Dhirachaikulpanich D, Madhusudhan S, Parry D, Babiker S, Zheng Y, Beare NA. RETINAL VASCULITIS SEVERITY ASSESSMENT: Intraobserver and Interobserver Reliability of a New Scheme for Grading Wide-Field Fluorescein Angiograms in Retinal Vasculitis. Retina 2023; 43:1534-1543. [PMID: 37229721 PMCID: PMC10442128 DOI: 10.1097/iae.0000000000003838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE Wide-field fluorescein angiography is commonly used to assess retinal vasculitis (RV), which manifests as vascular leakage and occlusion. Currently, there is no standard grading scheme for RV severity. The authors propose a novel RV grading scheme and assess its reliability and reproducibility. METHODS A grading scheme was developed to assess both leakage and occlusion in RV. Wide-field fluorescein angiography images from 50 patients with RV were graded by four graders, and one grader graded them twice. An intraclass correlation coefficient (ICC) was used to determine intraobserver-interobserver reliability. Generalized linear models were calculated to associate the scoring with visual acuity. RESULTS Repeated grading by the same grader showed good intraobserver reliability for both leakage (ICC = 0.85, 95% CI 0.78-0.89) and occlusion (ICC = 0.82, 95% CI 0.75-0.88) scores. Interobserver reliability among four independent graders showed good agreement for both leakage (ICC = 0.66, 95% CI 0.49-0.77) and occlusion (ICC = 0.75, 95% CI 0.68-0.81) scores. An increasing leakage score was significantly associated with worse concurrent visual acuity (generalized linear models, β = 0.090, P < 0.01) and at 1-year follow-up (generalized linear models, β = 0.063, P < 0.01). CONCLUSION The proposed grading scheme for RV has good to excellent intraobserver and interobserver reliability across a range of graders. The leakage score related to present and future visual acuity.
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Affiliation(s)
- Dhanach Dhirachaikulpanich
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, United Kingdom
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; and
| | - Savita Madhusudhan
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, United Kingdom
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; and
| | - David Parry
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; and
| | - Salma Babiker
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; and
| | - Yalin Zheng
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, United Kingdom
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; and
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Nicholas A.V. Beare
- Department of Eye & Vision Sciences, University of Liverpool, Liverpool, United Kingdom
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; and
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Apivatthakakul A, Liu R, Sobrin L. Successful treatment of idiopathic retinal vasculitis with rituximab in two patients. Am J Ophthalmol Case Rep 2023; 30:101844. [PMID: 37124152 PMCID: PMC10133649 DOI: 10.1016/j.ajoc.2023.101844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose To describe results of treatment of idiopathic retinal vasculitis with intravenous rituximab. Observations We present two patients with idiopathic retinal vasculitis who required steroid-sparing therapy and achieved steroid-free remission with intravenous rituximab. Rituximab was used as a first-line steroid-sparing agent after steroids in one patient and as a second-line steroid-sparing agent in the other patient. Both patients achieved steroid-free remission of disease with follow up of at least one year after rituximab initiation. Conclusions and importance Rituximab achieved steroid-free remission in two patients with idiopathic retinal vasculitis. It should be considered as a treatment option in these patients.
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Affiliation(s)
- Atitaya Apivatthakakul
- Department of Ophthalmology, Mass Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - Renee Liu
- Department of Ophthalmology, Mass Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Mass Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Corresponding author.
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Albahlal A, Khayyat W, Alsulaiman SM. Combined central retinal vein occlusion and cilioretinal artery occlusion as the initial presentation of frosted branch angiitis: a case report and literature review. J Ophthalmic Inflamm Infect 2023; 13:28. [PMID: 37227553 DOI: 10.1186/s12348-023-00340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/01/2023] [Indexed: 05/26/2023] Open
Abstract
PURPOSE To report a case of combined central retinal vein occlusion (CRVO) with cilioretinal artery occlusion (CLRAO) that heralded the development of frosted branch angiitis (FBA). CASE REPORT A 25-year-old healthy male presented with sudden painless visual loss in his left eye with a visual acuity (VA) of 20/300. Fundus exam and fluorescein angiography showed signs of combined CRVO and CLRAO. Without treatment, his vision gradually improved until it reached 20/30 within four months. Five months after initial presentation, he returned with severe visual loss (20/400) in the same eye and a clinical picture of severe occlusive periphlebitis resembling a frosted branch angiitis pattern associated with severe macular edema. This was promptly and successfully treated with systemic steroids and immunosuppressive medications. CONCLUSION CRVO in young population can have an unusual course and one should carefully rule out underlying uveitic etiologies in each visit. Clinical suspicion and close follow‑up are required for early detection and timely management of FBA.
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Affiliation(s)
- Abdullah Albahlal
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Khayyat
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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Nagaraj KB, Hiremath CDH, Tumbadi KL, Pankaja PS, Shilpa YD, Hemalatha BC. Clinical study of profile of retinal detachment in vasculitis and its management at tertiary eye care hospital. Indian J Ophthalmol 2023; 71:2041-2044. [PMID: 37203078 PMCID: PMC10391391 DOI: 10.4103/ijo.ijo_2157_22] [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: 05/20/2023] Open
Abstract
Purpose The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention. Methods It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three-port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection. Results In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re-procedure but was lost for follow-up. The anatomical success was 83.33% on the first surgery. Conclusion The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated.
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Affiliation(s)
- Kalpana B Nagaraj
- Medical Superintendent and Chief of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - Chan-Drashekarayya H Hiremath
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - Kavitha L Tumbadi
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - P S Pankaja
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - Y D Shilpa
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
| | - B C Hemalatha
- Department of Vireoretina, Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bengaluru, Karnataka, India
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Dhirachaikulpanich D, Chanthongdee K, Zheng Y, Beare NAV. A systematic review of OCT and OCT angiography in retinal vasculitis. J Ophthalmic Inflamm Infect 2023; 13:1. [PMID: 36715778 PMCID: PMC9886715 DOI: 10.1186/s12348-023-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Retinal vasculitis is a component of uveitis for which the Standardisation of Uveitis Nomenclature (SUN) working group has no standard diagnostic criteria or severity grading. Fluorescein angiography is the gold standard test to assess retinal vasculitis, but is invasive and time-consuming. Optical coherence tomography (OCT) provides non-invasive detailed imaging of retinal structures and abnormalities, including blood vessel architecture and flow with OCT angiography (OCT-A). However, use of OCT in retinal vasculitis beyond assessing macular oedema, is not well established. We conducted a systematic review to understand the features of retinal vasculitis in OCT, Enhanced-depth imaging OCT (OCT-EDI) and OCT-A imaging. METHODS The systematic search was done in March 2022 and updated in January 2023, through PubMed, EMBASE and the Web of Science database for studies related to OCT, OCT-EDI and OCT-A findings and retinal vasculitis. Bias assessment was assessed using JBI Critical Appraisal Checklist, and any findings associated with retinal vasculitis were extracted by qualitative analysis. RESULTS We identified 20 studies, including 8 articles on OCT, 6 on OCT-EDI and 6 on OCT-A. The studies included analytical retrospective studies, case-series, and a case-control study. Five OCT studies reported secondary complications could be detected, and four reported retinal thickness alteration in retinal vasculitis. Five studies explored choroidal thickness alteration in OCT-EDI, and four explored capillary density alterations in retinal vasculitis using OCT-A. The heterogeneity in the studies' analysis and design precluded a meta-analysis. DISCUSSION There were no clear OCT, OCT-EDI or OCT-A findings that demonstrated potential to supersede fluorescein angiography for assessing retinal vasculitis. Some signs of macular structural effects secondary to retinal vasculitis may help prognostication for vision. The OCT signs of inflamed retinal vessels and perivascular tissue is an unexplored area.
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Affiliation(s)
- Dhanach Dhirachaikulpanich
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.416009.aFaculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanat Chanthongdee
- grid.10223.320000 0004 1937 0490Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yalin Zheng
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.415992.20000 0004 0398 7066Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nicholas A. V. Beare
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK ,grid.10025.360000 0004 1936 8470St Paul’s Eye Unit, Liverpool University Hospitals NHS Trust, Liverpool, UK
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Alberti P, Salvalaggio A, Argyriou AA, Bruna J, Visentin A, Cavaletti G, Briani C. Neurological Complications of Conventional and Novel Anticancer Treatments. Cancers (Basel) 2022; 14:cancers14246088. [PMID: 36551575 PMCID: PMC9776739 DOI: 10.3390/cancers14246088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Various neurological complications, affecting both the central and peripheral nervous system, can frequently be experienced by cancer survivors after exposure to conventional chemotherapy, but also to modern immunotherapy. In this review, we provide an overview of the most well-known adverse events related to chemotherapy, with a focus on chemotherapy induced peripheral neurotoxicity, but we also address some emerging novel clinical entities related to cancer treatment, including chemotherapy-related cognitive impairment and immune-mediated adverse events. Unfortunately, efficacious curative or preventive treatment for all these neurological complications is still lacking. We provide a description of the possible mechanisms involved to drive future drug discovery in this field, both for symptomatic treatment and neuroprotection.
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Affiliation(s)
- Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- NeuroMI (Milan Center for Neuroscience), 20126 Milan, Italy
| | | | - Andreas A. Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Hospitalet, Bellvitge Institute for Biomedical Research (IDIBELL), 08908 Barcelona, Spain
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35131 Padova, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, 35131 Padova, Italy
- Correspondence:
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Koutsiaris AG, Batis V, Liakopoulou G, Tachmitzi SV, Detorakis ET, Tsironi EE. Optical Coherence Tomography Angiography (OCTA) of the eye: A review on basic principles, advantages, disadvantages and device specifications. Clin Hemorheol Microcirc 2022; 83:247-271. [PMID: 36502308 DOI: 10.3233/ch-221634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Optical Coherence Tomography Angiography (OCTA) is a relatively new imaging technique in ophthalmology for the visualization of the retinal microcirculation and other tissues of the human eye. This review paper aims to describe the basic definitions and principles of OCT and OCTA in the most straightforward possible language without complex mathematical and engineering analysis. This is done to help health professionals of various disciplines improve their understanding of OCTA and design further clinical research more efficiently. First, the basic technical principles of OCT and OCTA and related terminology are described. Then, a list of OCTA advantages and disadvantages, with a special reference to blood flow quantification limitations. Finally, an updated list of the basic hardware and software specifications of some of the commercially available OCTA devices is presented.
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Affiliation(s)
- Aristotle G. Koutsiaris
- Medical Informatics Laboratory, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Vasilios Batis
- Jules Gonin Eye Hospital Lausanne, Switzerland
- Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece
| | - Georgia Liakopoulou
- Medical Informatics Laboratory, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | | | | | - Evangelia E. Tsironi
- Department of Ophthalmology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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