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Schopp MJ, Strzalkowski P, Dithmar S. SUBFOVEAL CHOROIDAL TUBERCULOMA IN A HEALTHY YOUNG WOMAN CAUSED BY MYCOBACTERIUM BOVIS. Retin Cases Brief Rep 2024; 18:323-327. [PMID: 36800533 DOI: 10.1097/icb.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 11/01/2022] [Indexed: 02/19/2023]
Abstract
PURPOSE To describe a case of a macular tuberculoma in a young and healthy woman after developing a tuberculous lymphadenitis caused by Mycobacterium bovis . METHODS Retrospective case report. RESULTS Tuberculous lymphadenitis caused by M. bovis was detected after biopsy and histological examination as well as polymerase chain reaction test testing of cervical lymph nodes in a 20-year-old patient. An interferon gamma was positive. Shortly starting antitubercular therapy, the patient developed visual deterioration caused by a single yellowish subretinal structure in the macula of the right eye. Optical coherence tomography showed a dome-shaped, hyperreflective, subfoveal choroidal lesion with subtle subretinal fluid. Antitubercular therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide was performed, and the deescalation therapy with isoniazid and rifampicin was extended to 7 months. Further examinations showed regression of choroidal tuberculoma to a scar. CONCLUSION This is the first reported case of choroidal tuberculoma after tuberculous lymphadenitis caused by M. bovis .
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Affiliation(s)
- Maya J Schopp
- Department of Ophthalmology, Helios HSK, Wiesbaden, Germany
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2
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Visioli G, Zeppieri M, Iannucci V, Manni P, Albanese GM, Salati C, Spadea L, Pirraglia MP. From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections. J Clin Med 2023; 12:7216. [PMID: 38068267 PMCID: PMC10707096 DOI: 10.3390/jcm12237216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 01/23/2024] Open
Abstract
In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.
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Affiliation(s)
- Giacomo Visioli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Valeria Iannucci
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Priscilla Manni
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Giuseppe Maria Albanese
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.V.)
- Eye Clinic, Policlinico Umberto I University Hospital, 00161 Rome, Italy
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3
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Wu LZ, Orlowski TM, Karunatilake M, Lee S, Mondal P, Kogilwaimath S, Bursztyn LLCD. Prognostic effect of HIV on visual acuity in ocular syphilis: a systematic review. Eye (Lond) 2023; 37:3271-3281. [PMID: 36944709 PMCID: PMC10564912 DOI: 10.1038/s41433-023-02504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND/OBJECTIVES Ocular syphilis is a vision-threatening disease that can lead to permanent blindness if left untreated. The global re-emergence of syphilis warrants greater investigations into the visual prognosis of eyes affected by this potentially devastating disease. This systematic review investigates the impact of HIV on visual acuity (VA) outcomes in ocular syphilis. METHODS A literature search of Medline, PubMed, Embase, Clinicaltrials.gov and Cochrane Reviews was conducted for studies published between 01 January 2011 and 19 March 2022, reporting non-aggregate initial and post-treatment VA data of eyes with ocular syphilis and corresponding HIV status in patients ≥ 18 years. RESULTS A total of 95 studies, including 364 patients and 568 eyes, were evaluated. Among people living with HIV with a diagnosis of ocular syphilis, affected eyes were more likely to have optic nerve involvement and panuveitis. However, HIV status, CD4 cell count, and HIV viral load were not predictive of VA outcomes of treated ocular syphilis. Prognostic factors of final VA worse than 1.00 logMAR were female sex, the presence of macular edema, and VA ≥ 1.00 at presentation. The strongest predictor of a worse final VA was VA ≥ 1.00 at presentation. CONCLUSIONS This systematic review demonstrates that HIV status, CD4 cell count, and HIV viral load are not significant factors impacting VA outcomes of eyes with ocular syphilis. While visual prognosis is generally good, poor visual outcome is most strongly predicted by poor VA at presentation. This underscores the importance of early recognition and treatment prior to permanent vision loss.
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Affiliation(s)
- Laura Z Wu
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | | | - Malshi Karunatilake
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephen Lee
- Division of Infectious Diseases, University of Saskatchewan, Regina, SK, Canada
| | - Prosanta Mondal
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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Kalogeropoulos D, Asproudis I, Stefaniotou M, Moschos MM, Kozobolis VP, Voulgari PV, Katsanos A, Gartzonika C, Kalogeropoulos C. The Large Hellenic Study of Uveitis: Diagnostic and Therapeutic Algorithms, Complications, and Final Outcome. Asia Pac J Ophthalmol (Phila) 2023; 12:44-57. [PMID: 36588192 DOI: 10.1097/apo.0000000000000594] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/20/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The purpose of this study is to present the diagnostic and therapeutic algorithms, complications, and final outcome in the management of uveitic patients at a tertiary academic referral center. DESIGN Observational study. METHODS Analysis of the archives of 6191 uveitic patients at the Ocular Inflammation Service of the Department of Ophthalmology of the University Hospital of Ioannina in Greece from 1991 to 2020. RESULTS During the 30 years of the study, the diagnostic ability climbed from 45.43% (1991-1995) to 73.4% (2016-2020). This improvement was linked to several factors including the increase in the number of diagnostic paracenteses for the analysis of intraocular fluids, the range and quality of laboratory blood tests, the multimodal ophthalmic imaging, the proper use of nonophthalmic imaging, and the multidisciplinary approach. The degree of uveitis-related complications was related to the severity and cause of inflammation, the recurrence rate, inappropriate treatment, and the prolonged or initially inactive inflammation. The 3 most common complications included cataract, macular edema, and glaucoma. Apart from the modern treatments and surgical techniques, the 3-month preoperative control of inflammation played a critical role in the surgical outcomes. The percentage of patients with a successful outcome increased from 72% (2001-2005) to 90.50% (2016-2020). The center's experience, prompt referral, patient's compliance, and regular follow-ups are associated with a better outcome. The analysis of the results allowed the development of diagnostic and therapeutic algorithms. CONCLUSIONS Developing diagnostic and therapeutic algorithms allows for the efficient management of uveitis, leading to better visual outcome and therefore a better quality of life.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Ioannis Asproudis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios P Kozobolis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Patras, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Constantina Gartzonika
- Laboratory of Microbiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
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5
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Tam EK, Port A, Martin D, Fridman G, Ness S, Siegel NH. Ocular syphilis resurgence in an urban underserved community in the United States. Int J Ophthalmol 2022; 15:1357-1362. [PMID: 36017039 PMCID: PMC9358170 DOI: 10.18240/ijo.2022.08.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the clinical characteristics, demographics, and visual outcomes of patients with ocular syphilis at an urban hospital to increase awareness and assist in earlier diagnosis and treatment of the resurgent disease. METHODS A retrospective chart review was performed on patients with ICD-9 and ICD-10 diagnosis codes correlating with syphilis or syphilis-related ocular diseases between 2010 and 2019. Variables evaluated included age, gender, race, vision, ocular findings, human immunodeficiency virus (HIV) status and men who have sex with men status, recreational drug and alcohol use. RESULTS Ocular syphilis was diagnosed in 40 patients (53 eyes) of a total of 229 patients who tested positive for syphilis via serum and/or cerebrospinal fluid treponemal testing from 2010-2019. Among patients with ocular syphilis, most patients were males, aged 45 or above and Black, and had no diagnosed HIV infection. Approximately 50% patients had 20/40 vision or better. Nearly 50% had non-granulomatous anterior uveitis as their initial presentation, and 49% of patients had involvement of the posterior segment. Neovascular glaucoma (5.7%), papillitis (7.5%), vasculitis (5.7%), and retinal detachment (5.7%) were rarer presentations of the disease and were associated with a poorer visual prognosis. CONCLUSION Given the increased prevalence and protean manifestations of syphilis, early diagnosis and treatment are paramount. More studies on ocular syphilis are warranted to understand this resurging disease.
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Affiliation(s)
- Emily K Tam
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
| | - Alexander Port
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
| | - Diana Martin
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
| | - Gabrielle Fridman
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
| | - Steven Ness
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
| | - Nicole H Siegel
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
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Mehta D, Chan K. Syphilis presenting as acute syphilitic posterior placoid chorioretinitis. BMJ Case Rep 2021; 14:14/7/e243923. [PMID: 34321269 PMCID: PMC8319970 DOI: 10.1136/bcr-2021-243923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Deepesh Mehta
- Ophthalmology, Capital and Coast District Health Board, Wellington, New Zealand
| | - Kenneth Chan
- Ophthalmology, Capital and Coast District Health Board, Wellington, New Zealand
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Guemes-Villahoz N, Burgos-Blasco B, Vidal-Villegas B, Donate-López J, Martín-Sánchez FJ, Porta-Etessam J, López-Guajardo L, Martín JLR, González-Armengol JJ, García-Feijoó J. Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection. ACTA ACUST UNITED AC 2021; 156:541-546. [PMID: 34109275 PMCID: PMC8178962 DOI: 10.1016/j.medcle.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
Purpose To describe macular vessel density and perfusion in COVID-19 patients using coherence tomography angiography (OCTA) and to investigate whether there is a correlation between retinal vascular abnormalities and clinical and laboratory parameters. Methods Cross-sectional analysis conducted at the Hospital Clinico San Carlos in Madrid, Spain. Patients with laboratory-confirmed COVID-19 that were attended in the Emergency Department (ED) from March 23 to March 29, 2020 were included. Fundus examination and OCTA were performed 4 weeks after being attended in ED. Macular OCTA parameters were analyzed and correlated with clinical (severity and hypoxemia- oxygen saturation < 92%) and laboratory parameters during hospital stay (D-Dimer-DD, lactate dehydrogenase-LDH and C-reactive protein-CRP). Results 80 patients were included, mean age 55(SD9) years old; 46.3% male. We reported macular vessel density and perfusion measurements in COVID-19 patients. Those patients with D-Dimer ≥ 500 ng/ml during SARS-CoV-2 infection had a decrease of central vessel density (mean difference 2.2; 95%CI 0.4-3.9) and perfusion density (mean difference 4.9; 95%CI 0.9-8.9) after the acute phase of COVID-19. These variations of vessel density and perfusion density were not documented in patients with LDH ≥ 500 U/L, CRP ≥ 10 mg/L and hypoxemia. Conclusions COVID-19 patients showed short-term retinal vasculature abnormalities which may be related to a prothrombotic state associated with SARS-CoV-2 infection. Since the retinal microvasculature shares many morphological and physiological properties with the vasculature of other vital organs, further research is needed to establish whether patients with increased D-Dimer levels require more careful assessment and follow-up after COVID-19.
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Affiliation(s)
- Noemi Guemes-Villahoz
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Barbara Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Beatriz Vidal-Villegas
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Juan Donate-López
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Jesús Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Lorenzo López-Guajardo
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid (UCM), Madrid, Spain
| | | | - Juan Jorge González-Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Julián García-Feijoó
- Profesor y jefe de servicio de Oftalmología, Hospital Clínico San Carlos; Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
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8
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Guemes-Villahoz N, Burgos-Blasco B, Vidal-Villegas B, Donate-López J, Martín-Sánchez FJ, Porta-Etessam J, López-Guajardo L, Martín JLR, González-Armengol JJ, García-Feijoó J. Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection. Med Clin (Barc) 2021; 156:541-546. [PMID: 33593634 PMCID: PMC7843095 DOI: 10.1016/j.medcli.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To describe macular vessel density and perfusion in COVID-19 patients using coherence tomography angiography (OCTA) and to investigate whether there is a correlation between retinal vascular abnormalities and clinical and laboratory parameters. METHODS Cross-sectional analysis conducted at the Hospital Clinico San Carlos in Madrid, Spain. Patients with laboratory-confirmed COVID-19 that were attended in the Emergency Department (ED) from March 23 to March 29, 2020 were included. Fundus examination and OCTA were performed 4 weeks after being attended in ED. Macular OCTA parameters were analyzed and correlated with clinical (severity and hypoxemia- oxygen saturation<92%) and laboratory parameters during hospital stay (D-Dimer-DD, lactate dehydrogenase-LDH and C-reactive protein-CRP). RESULTS 80 patients were included, mean age 55(SD9) years old; 46.3% male. We reported macular vessel density and perfusion measurements in COVID-19 patients. Those patients with D-Dimer≥500ng/ml during SARS-CoV-2 infection had a decrease of central vessel density (mean difference 2.2; 95%CI 0.4-3.9) and perfusion density (mean difference 4.9; 95%CI 0.9-8.9) after the acute phase of COVID-19. These variations of vessel density and perfusion density were not documented in patients with LDH≥500U/L, CRP≥10mg/L and hypoxemia. CONCLUSIONS COVID-19 patients showed short-term retinal vasculature abnormalities which may be related to a prothrombotic state associated with SARS-CoV-2 infection. Since the retinal microvasculature shares many morphological and physiological properties with the vasculature of other vital organs, further research is needed to establish whether patients with increased D-Dimer levels require more careful assessment and follow-up after COVID-19.
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Affiliation(s)
- Noemi Guemes-Villahoz
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Barbara Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Beatriz Vidal-Villegas
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Juan Donate-López
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Jesús Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Lorenzo López-Guajardo
- Servicio de Oftalmología, Hospital Clínico San Carlos; Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid (UCM), Madrid, Spain
| | | | - Juan Jorge González-Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdiSCC), Universidad Complutense de Madrid, Spain
| | - Julián García-Feijoó
- Profesor y jefe de servicio de Oftalmología, Hospital Clínico San Carlos; Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
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El Jammal T, Loria O, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Sève P. Uveitis as an Open Window to Systemic Inflammatory Diseases. J Clin Med 2021; 10:E281. [PMID: 33466638 PMCID: PMC7828680 DOI: 10.3390/jcm10020281] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Spondyloarthritis (Spa), Behçet's disease (BD) and sarcoidosis are major systemic inflammatory diseases worldwide. They are all multisystem pathologies and share a possible ocular involvement, especially uveitis. We hereby describe selected cases who were referred by ophthalmologists to our internal medicine department for unexplained uveitis. Physical examination and/or the use of laboratory and imaging investigations allowed to make a diagnosis of a systemic inflammatory disease in a large proportion of patients. In our tertiary referral center, 75 patients have been diagnosed with Spa (n = 20), BD (n = 9), or sarcoidosis (n = 46) in the last two years. There was a significant delay in the diagnosis of Spa-associated uveitis. Screening strategies using Human Leukocyte Antigen (HLA)-B27 determination and sacroiliac magnetic resonance imaging in patients suffering from chronic low back pain and/or psoriasis helped in the diagnosis. BD's uveitis affects young people from both sexes and all origins and usually presents with panuveitis and retinal vasculitis. The high proportion of sarcoidosis in our population is explained by the use of chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography CT that helped to identify smaller hilar or mediastinal involvement and allowed to further investigate those patients, especially in the elderly. Our results confirm how in these sight- and potentially life-threatening diseases a prompt diagnosis is mandatory and benefits from a multidisciplinary approach.
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Affiliation(s)
- Thomas El Jammal
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Olivier Loria
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
- IMER Department, Hospices Civils de Lyon, 69424 Lyon, France
- Department of Formation and Research in Human Biology, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France
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10
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Pirani V, Pelliccioni P, De Turris S, Rosati A, Franceschi A, Pasanisi P, Gesuita R, Nicolai M, Mariotti C. Intraocular Inflammation Control and Changes in Retinal and Choroidal Architecture in Refractory Non-Infectious Uveitis Patients after Adalimumab Therapy. J Clin Med 2020; 9:E510. [PMID: 32069898 PMCID: PMC7074084 DOI: 10.3390/jcm9020510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Non-infectious uveitis represents a leading cause of visual impairment, and inflammation control represents a major priority in tackling visual acuity loss due to complications such as macular edema; different immunomodulatory drugs are currently being used, including anti-TNF-alpha Adalimumab. Methods: This was a monocentric observational study of 18 eyes of 18 patients with non-infectious uveitis treated with Adalimumab. The primary endpoint was the control of ocular inflammation. The secondary endpoints included the study of macular and choroidal thickness and architecture, visual acuity, changes in other treatments, and adverse effects. Results: Ocular inflammation was controlled at 12 months for 83.3% of patients. Central macular thickness improved from a median of 229.75 µm at baseline to 213 µm at 12 months, while choroidal thickness decreased by 11.54% at the end of the follow-up. A reduction of vasculitis on fluorescein angiography and of hyperreflective spots on optical coherence tomography was noted. Visual acuity also improved from 0.51 (logMAR) before treatment to 0.24 at more than 12 months (p = 0.01). A total of 11.1% of patients experienced side effects. Conclusion: Our study confirms the efficacy of adalimumab for the control of ocular inflammation, visual acuity preservation, and for corticosteroid sparing.
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Affiliation(s)
- Vittorio Pirani
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
| | - Paolo Pelliccioni
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
| | - Serena De Turris
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
| | - Alessandro Rosati
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
| | - Alessandro Franceschi
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
| | - Pierangelo Pasanisi
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy;
| | - Michele Nicolai
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
| | - Cesare Mariotti
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126 Ancona, Italy; (V.P.); (S.D.T.); (A.R.); (A.F.); (P.P.); (M.N.); (C.M.)
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