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Snehi S, Bang PH, Mamtani N, Singh K. Galactic vision: asteroid hyalosis in vitreous with moonlit optic disc. BMJ Case Rep 2024; 17:e260387. [PMID: 38719250 PMCID: PMC11085781 DOI: 10.1136/bcr-2024-260387] [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] [Indexed: 05/13/2024] Open
Affiliation(s)
- Sagarika Snehi
- Department of Ophthalmology, All India Institute of Medical Sciences, Nagpur, India
| | - Puja Hingorani Bang
- Department of Ophthalmology, All India Institute of Medical Sciences, Nagpur, India
| | - Nidhi Mamtani
- Department of Ophthalmology, All India Institute of Medical Sciences, Nagpur, India
| | - Kanishk Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Nagpur, India
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Zhang H, Houadj L, Wu KY, Tran SD. Diagnosing and Managing Uveitis Associated with Immune Checkpoint Inhibitors: A Review. Diagnostics (Basel) 2024; 14:336. [PMID: 38337852 PMCID: PMC10855398 DOI: 10.3390/diagnostics14030336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
This review aims to provide an understanding of the diagnostic and therapeutic challenges of uveitis associated with immune checkpoint inhibitors (ICI). In the wake of these molecules being increasingly employed as a treatment against different cancers, cases of uveitis post-ICI therapy have also been increasingly reported in the literature, warranting an extensive exploration of the clinical presentations, risk factors, and pathophysiological mechanisms of ICI-induced uveitis. This review further provides an understanding of the association between ICIs and uveitis, and assesses the efficacy of current diagnostic tools, underscoring the need for advanced techniques to enable early detection and accurate assessment. Further, it investigates the therapeutic strategies for ICI-related uveitis, weighing the benefits and limitations of existing treatment regimens, and discussing current challenges and emerging therapies in the context of their potential efficacy and side effects. Through an overview of the short-term and long-term outcomes, this article suggests recommendations and emphasizes the importance of multidisciplinary collaboration between ophthalmologists and oncologists. Finally, the review highlights promising avenues for future research and development in the field, potentially informing transformative approaches in the ocular assessment of patients under immunotherapy and the management of uveitis following ICI therapy.
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Affiliation(s)
- Huixin Zhang
- Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada;
| | - Lysa Houadj
- Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada;
| | - Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Annamalai R, Mahesh A, Biswas J. Clinical association and visual morbidity in uveitis with systemic diseases: An analysis from a tertiary ophthalmic center. Oman J Ophthalmol 2023; 16:472-477. [PMID: 38059097 PMCID: PMC10697255 DOI: 10.4103/ojo.ojo_250_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/10/2023] [Accepted: 09/03/2023] [Indexed: 12/08/2023] Open
Abstract
AIM The aim of this study was to identify the incidence, etiology, most common presentations, complications, and the causes of visual loss in posterior uveitis (PU). MATERIALS AND METHODS A retrospective study was conducted on a cohort of 125 patients with PU with a minimum follow-up of 6 months. Ocular evaluation consisted of slit-lamp examination, indirect ophthalmoscopy, tonometry, and refraction. Ancillary ophthalmic investigations such as fundus fluorescein angiography, optical coherence tomography, and B-scan ultrasonography were done. Laboratory tests were performed on blood on all patients and in aqueous humor samples obtained by anterior chamber paracentesis in cases of diagnostic dilemmas. All the data were analyzed using SPSS program. RESULTS PU occurred in 61%. Infections were noted in 34% and autoimmune diseases in 27%. The most frequent presentation was choroiditis. The most common etiologies were tubercular uveitis in 50%, Toxoplasma retinochoroiditis in 23%, and autoimmune category of serpiginous choroiditis in 56% of patients. Complications occurred in 27% and were most commonly cystoid macular edema and macular scarring. Polymerase chain reaction (PCR), nested PCR, and real-time PCR on ocular fluids were required for diagnosis in 30%. A combination of laboratory investigations on blood and aqueous humor samples were confirmation in 88%. CONCLUSION PU and its sequelae are known to be sight threatening and are associated with systemic diseases. They have diverse etiologies and presentations. Identification of etiology is important as management is diametrically opposite in infections and autoimmune diseases.
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Affiliation(s)
- Radha Annamalai
- Department of Ophthalmology and Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Abhinav Mahesh
- Department of Ophthalmology and Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Goh EJH, Putera I, La Distia Nora R, Mahendradas P, Biswas J, Chee SP, Testi I, Pavesio CE, Curi ALL, Vasconcelos-Santos DV, Arora A, Gupta V, de-la-Torre A, Agrawal R. Ocular Toxoplasmosis. Ocul Immunol Inflamm 2023; 31:1342-1361. [PMID: 36095008 DOI: 10.1080/09273948.2022.2117705] [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: 03/26/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide, affecting individuals acrossdifferent age groups. The key to reducing vision loss includes prompt diagnosis and treatment. However, despite the prevalence of ocular toxoplasmosis, there has been little consensus regarding its pathophysiology,clinical features, diagnosis, and especially management. METHODS The data sources were literature reviews, including Pub Med and Medline databases. Search terms included toxoplasmosis, retinitis, vasculitis, vitritis, uveitis alone or in combination with, serum, aqueous, vitreous eye, ocular and review. RESULTS In this review paper, we have sought to provide an overview of the pathophysiology, epidemiology, and clinical features of the disease, both based on current literature and our own clinical experience. We have also discussed the use of serology, ocular fluid, and ophthalmic investigations that could further facilitate the diagnosis of ocular toxoplasmosis.Different management strategies have been reported worldwide, including newer approaches such as local therapy. CONCLUSION A better understanding of critical aspects of ocular toxoplasmosis will hopefully lead to reduced morbidity, including blindness associated with this condition.
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Affiliation(s)
- Eunice Jin Hui Goh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Soon-Phaik Chee
- Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | - Andre Luiz Land Curi
- Infectious Ophthalmology Laboratory, Evandro Chagas National Institute of Infectious Diseases-FIOCRUZ, Rio de Janeiro, Brazil
| | - Daniel Vitor Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Hospital São Geraldo, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, The Academia, Singapore
- Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Lee Kong Chian School of Medicine, Singapore
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Villamil-Gomez W, Torres JR, Rojas-Hernández J, Reston TJ, Vergara-Corena J, Salgado P, Viloria-Ruiz J, Castro A, Cabrera Lasso AM, Gotuzzo E. HTLV-1 uveitis in Colombia, an underrecognized complication of a hitherto neglected condition: a case series. Ther Adv Infect Dis 2023; 10:20499361231165864. [PMID: 37114190 PMCID: PMC10126695 DOI: 10.1177/20499361231165864] [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: 07/21/2022] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
Three Colombian patients with chronic HTLV-1 infection and severe intermediate and/or posterior uveitis are described. In one case, retinal ablation was necessary due to extensive peripheral degeneration, while the other two were successfully managed with local anti-inflammatory therapy. Gradual resolution of ocular findings was observed in all three patients on follow-up. Uveitis is a rarely recognized late complication of this infection, which represents a diagnostic and therapeutic challenge for clinicians in endemic countries. The real extension of HTLV-1 prevalence in Colombia and the frequency of its ophthalmologic complications remain to be determined.
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Affiliation(s)
| | - Jaime R. Torres
- Infectious Diseases Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Torés Jose Reston
- Dirección Científica, Clinica Oftalmologica de la Costa, Sincelejo, Colombia
| | | | - Patricia Salgado
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Colombia
| | | | - Alvaro Castro
- Departamento de Patología, Universidad de Sucre, Sincelejo, Colombia
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Microvascular changes in the recurrent cystoid macular edema secondary to posterior noninfectious uveitis on optical coherence tomography angiography. Int Ophthalmol 2022; 42:3285-3293. [PMID: 35598227 PMCID: PMC9587930 DOI: 10.1007/s10792-022-02327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/18/2022] [Indexed: 12/03/2022]
Abstract
Background Posterior uveitis represents the second most frequent type of uveitis (15–30% of all uveitis). Noninfectious posterior uveitis complicated with secondary cystoid macular edema (CME) affects the visual prognosis negatively. The objective of the current study is to detect possible microvascular changes causing relapsing uveitis-related CME using optical coherence tomography angiography (OCTA). Methods This is an interventional, observational, retrospective study with 1 year follow-up. Patients with noninfectious, posterior uveitis-related CME undergoing dexamethasone (DEX) implant were evaluated. Following the DEX-implant were carried out control visits after 1 month, 2-months, 4-months, 6-months, and for up 1-year. A total of 76 eyes of 38 consecutive patients with noninfectious posterior uveitis were enrolled (consecutive sample). Complicated noninfectious posterior uveitis with secondary CME was diagnosed in 56 eyes of uveitis patients (73.7%) and reviewed. Results Our investigation showed (1) a reduction in superficial vessel plexus (SVP) measurements within 2-month (84%), reaching 96.4% for up 1-year, (2) an irregular profile of SVP in 69.6% of cases, persisting for up 1-year; relapsing uveitis-related CME eyes with irregular superficial foveal avascular zone (FAZ) profile were in 51%, while the SVP measurements reestablished in 100% of cases. Conversely, (3) the deep vascular plexus (DVP) parameters restored in a lower number of eyes within the 2-month (39.3%), remaining abnormal in 46.4% of cases for up 1-year; despite DVP restored in 53.6% of cases for up 1 year, (4) a capillary rarefaction ring around the FAZ appeared in 80.4% of cases; the relapsing uveitis-related CME eyes with abnormal DVP parameters were present in 41% of cases, of which 92.1% showed a rarefaction ring had abnormal DVP. Conclusions The use of OCTA enabled the evaluation in detail of retinal microvascular changes. We suggested that the possibility of the recurrence of the uveitis-related CME depends on the persistence of modifications of the superficial and deep layers. In this regard, we propose to implement the current imaging armamentarium with OCTA for the follow-up of patients with noninfectious uveitis-related CME.
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Tian M, Zeng G, Tappeiner C, Zinkernagel MS, Wolf S, Munk MR. Comparison of Indocyanine Green Angiography and Swept-Source Wide-Field Optical Coherence Tomography Angiography in Posterior Uveitis. Front Med (Lausanne) 2022; 9:853315. [PMID: 35586074 PMCID: PMC9108898 DOI: 10.3389/fmed.2022.853315] [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] [Received: 01/12/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To compare indocyanine green angiography (ICGA) and swept-source wide-field optical coherence tomography angiography (SS-OCTA) for the assessment of patients with posterior uveitis. Method SS-OCTA montage images of 5 x 12 x 12 mm or 2 x 15 x 9 mm, covering ~70-90 degree of the retina of consecutive patients with posterior uveitis were acquired. The choriocapillaries and choroidal slabs were compared to findings on ICGA. Results Sixty-eight eyes of 41 patients were included (mean age 47.2 ± 20.4 years; 58.5% female). In 23 (34%) lesions were visible on OCTA, but not discernable on ICGA. In turn, out of the 45 eyes with clearly discernable lesions on ICGA, 22 (49%) and 21 (47%) eyes showed no corresponding areas of flow deficit on OCTA in the CC and choroidal slab, respectively. Lesion size strongly correlated among ICGA and OCTA choriocapillaries- (CC) (r = 0.99, p ≤ 0.0001) and choroidal slabs (r = 0.99, p ≤ 0.0001), respectively. The mean lesion size on the late frames of ICGA (8.45 ± 5.47 mm2) was larger compared to the lesion size on OCTA CC scan (7.98 ± 5.47 mm2, p ≤ 0.0001) and choroidal scan (7.69 ± 5.10 mm2, p = 0.002), respectively. The lesion size on OCTA CC scan was significantly larger than on the OCTA choroidal scan (p ≤ 0.0001). Conclusion SS-wide field OCTA may be a promising tool to assess posterior uveitis patients and may replace ICGA to a certain extent in the future.
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Affiliation(s)
- Meng Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guodong Zeng
- SITEM Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Pallas Klinik, Olten, Switzerland
| | - Martin S. Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marion R. Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Sanjay S, Reddy NG, Kawali A, Mahendradas P, Pulipaka RS, Shetty R, Yadav NK, Venkatesh R. Role of multicolour imaging in post-fever retinitis involving posterior pole. Int Ophthalmol 2021; 41:3797-3804. [PMID: 34263386 DOI: 10.1007/s10792-021-01951-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe composite multicolour (MC) imaging features along with the monocoloured fundus reflectance images in active and resolving stages of post-fever retinitis (PFR). METHODS Retrospective image analysis of cases of PFR who underwent dilated retinal clinical examination followed by optical coherence tomography and MC imaging. RESULTS Twenty-five eyes of 18 patients diagnosed with PFR were included. There were 11 males and 7 females. Mean age of patients was 30.63 years. The retinitis lesion appeared bright white on MC image and white mainly on blue and green reflectance images during the active stages of PFR. The lesion appeared dull-grey to greyish white during the resolving stages and as dull-green in resolved cases. The active stages showed the presence of intraretinal/subretinal fluid which appeared as green colour on MC images and less green to normal during resolving stages. Hard exudates were seen as bright yellow- or orange-coloured spots on MC image during the resolving stages of the disease. CONCLUSION The different stages of PFR show different colour on multicolour image and different reflectance patterns on individual colour reflectance channels. Hence, multimodal fundus imaging with different wavelength can be helpful for differentiation of activity in PFR.
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Affiliation(s)
- Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Nikitha Gurram Reddy
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India.,Department of Vitreo-Retinal Services, Narayana Nethralaya, #121/C, 1st R Block, Chord road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | | | - Ram Snehith Pulipaka
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India.,Department of Vitreo-Retinal Services, Narayana Nethralaya, #121/C, 1st R Block, Chord road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Rohit Shetty
- Department of Cornea-Refractive Services, Narayana Nethralaya, Bangalore, India
| | - Naresh Kumar Yadav
- Department of Vitreo-Retinal Services, Narayana Nethralaya, #121/C, 1st R Block, Chord road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Ramesh Venkatesh
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India. .,Department of Vitreo-Retinal Services, Narayana Nethralaya, #121/C, 1st R Block, Chord road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India.
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Chatziralli IP, Keryttopoulos P, Papazisis L, Moschos MM. Hypopyon in the context of tuberculous uveitis. Clin Exp Optom 2021; 95:241-3. [DOI: 10.1111/j.1444-0938.2011.00680.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Irini P Chatziralli
- 1st Department of Ophthalmology, University of Athens, Athens, Greece
- Departments of Ophthalmology
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10
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Sachan A, Chawla R, Lata S. Large exudative retinal detachment with choroidal granuloma unmasking disseminated tuberculosis: imaging and management. BMJ Case Rep 2021; 14:14/3/e241179. [PMID: 33789862 PMCID: PMC8016067 DOI: 10.1136/bcr-2020-241179] [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: 11/03/2022] Open
Abstract
A 26-year-old man presented with diminution of vision in the left eye associated with malaise and occasional mild fever. On fundus examination, the patient had left eye inferior bullous retinal detachment with choroidal granuloma. Systemic examination revealed a non-tender swelling on the right wrist. Correlating ophthalmic and systemic findings, a presumptive diagnosis of left eye exudative retinal detachment with choroidal tuberculoma and tubercular osteomyelitis of the right wrist was made. On imaging, asymptomatic multiorgan involvement was observed in the chest, abdomen and spine. The patient was started on antitubercular treatment along with peribulbar steroid. A reduction in size of exudative retinal detachment and tuberculoma with improvement in vision was noted on serial follow-ups. This case highlights the importance of thorough systemic evaluation in cases of ocular tuberculosis as the eye may not be the primary site but the early presenting feature of disseminated tuberculosis. Local posterior subtenon can be used for faster resolution of exudative retinal detachment and intraocular inflammation.
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Affiliation(s)
- Anusha Sachan
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rohan Chawla
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Suman Lata
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Kang EYC, Hsieh YT, Li CH, Huang YJ, Kuo CF, Kang JH, Chen KJ, Lai CC, Wu WC, Hwang YS. Deep Learning-Based Detection of Early Renal Function Impairment Using Retinal Fundus Images: Model Development and Validation. JMIR Med Inform 2020; 8:e23472. [PMID: 33139242 PMCID: PMC7728538 DOI: 10.2196/23472] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/01/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retinal imaging has been applied for detecting eye diseases and cardiovascular risks using deep learning-based methods. Furthermore, retinal microvascular and structural changes were found in renal function impairments. However, a deep learning-based method using retinal images for detecting early renal function impairment has not yet been well studied. OBJECTIVE This study aimed to develop and evaluate a deep learning model for detecting early renal function impairment using retinal fundus images. METHODS This retrospective study enrolled patients who underwent renal function tests with color fundus images captured at any time between January 1, 2001, and August 31, 2019. A deep learning model was constructed to detect impaired renal function from the images. Early renal function impairment was defined as estimated glomerular filtration rate <90 mL/min/1.73 m2. Model performance was evaluated with respect to the receiver operating characteristic curve and area under the curve (AUC). RESULTS In total, 25,706 retinal fundus images were obtained from 6212 patients for the study period. The images were divided at an 8:1:1 ratio. The training, validation, and testing data sets respectively contained 20,787, 2189, and 2730 images from 4970, 621, and 621 patients. There were 10,686 and 15,020 images determined to indicate normal and impaired renal function, respectively. The AUC of the model was 0.81 in the overall population. In subgroups stratified by serum hemoglobin A1c (HbA1c) level, the AUCs were 0.81, 0.84, 0.85, and 0.87 for the HbA1c levels of ≤6.5%, >6.5%, >7.5%, and >10%, respectively. CONCLUSIONS The deep learning model in this study enables the detection of early renal function impairment using retinal fundus images. The model was more accurate for patients with elevated serum HbA1c levels.
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Affiliation(s)
- Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yi-Jin Huang
- Acer Healthcare Incorporated, New Taipei, Taiwan
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Je-Ho Kang
- Department of Nephrology, Yang Ming Hospital, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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12
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Exploring choroidal angioarchitecture in health and disease using choroidal vascularity index. Prog Retin Eye Res 2020; 77:100829. [PMID: 31927136 DOI: 10.1016/j.preteyeres.2020.100829] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/30/2019] [Accepted: 01/04/2020] [Indexed: 12/21/2022]
Abstract
The choroid is one of the most vascularized structures of the human body and plays an irreplaceable role in nourishing photoreceptors. As such, choroidal dysfunction is implicated in a multitude of ocular diseases. Studying the choroid can lead to a better understanding of disease pathogenesis, progression and discovery of novel management strategies. However, current research has produced inconsistent findings, partly due to the physical inaccessibility of the choroid and the lack of reliable biomarkers. With the advancements in optical coherence tomography technology, our group has developed a novel quantitative imaging biomarker known as the choroidal vascularity index (CVI), defined as the ratio of vascular area to the total choroidal area. CVI is a potential tool in establishing early diagnoses, monitoring disease progression and prognosticating patients. CVI has been reported in existing literature as a robust marker in numerous retinal and choroidal diseases. In this review, we will discuss the current role of CVI with reference to existing literature, and make postulations about its potential and future applications.
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13
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Agrawal R, Jain M, Khan R, Jaisankar D, Xin W, Ding J, Testi I, Raman R, Biswas J. Choroidal Structural Changes in Sympathetic Ophthalmia on Swept-Source Optical Coherence Tomography. Ocul Immunol Inflamm 2019; 29:537-542. [PMID: 31743045 DOI: 10.1080/09273948.2019.1685110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: To analyze choroidal angioarchitecture in sympathetic ophthalmia (SO) using swept-source optical coherence tomography (SS-OCT) images.Methods: Case-control study of six patients with SO. Qualitative changes and quantitative parameters, including choroidal thickness (CT) and choroidal vascularity index (CVI), were analyzed.Results: Qualitative findings in the acute phase of SO on SS-OCT included retinal serous detachment with hyperreflective septa, choroidal folds, alterations in angioarchitecture with loss of vascular lacunae, and Dalen-Fuchs nodules. There was significantly higher CT in SO (284.05 ± 24.12 µm) compared to healthy controls (229.57 ± 46.67 µm, p = 0.04) and also increased CVI in SO (62.06 ± 2.07% vs 56.79 ± 3.15%, p = 0.006).Conclusions: CVI was significantly increased in SO, representing a novel noninvasive biomarker of disease activity. SS-OCT provides a useful qualitative and quantitative parameter, which can be potentially explored in the diagnosis and monitoring of patients with SO.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Medical Retina and Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Mukesh Jain
- Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Rehana Khan
- Medical Research Foundation, Sankara Netralaya, Chennai, India
| | | | - Wei Xin
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jianbin Ding
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ilaria Testi
- Department of Medical Retina and Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rajiv Raman
- Medical Research Foundation, Sankara Netralaya, Chennai, India
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Kim L, Li A, Angeles-Han S, Yeh S, Shantha J. Update on the management of uveitis in children: an overview for the clinician. EXPERT REVIEW OF OPHTHALMOLOGY 2019; 14:211-218. [PMID: 32831897 PMCID: PMC7437956 DOI: 10.1080/17469899.2019.1663731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Pediatric uveitis comprises a range of ocular inflammatory diseases that may lead to vision impairment, often due to ocular complications from the disease itself or side effects of therapies. The impact on vision, visual functioning, and vision-related quality-of-life over the lifetime horizon can be substantial, underscoring the importance of appropriate ophthalmic evaluation, diagnostic testing and treatment. This review focuses on the anatomic classification, laboratory diagnosis, associated systemic diseases, and management of pediatric uveitis. AREAS COVERED A review of the literature was performed to synthesize our current understanding of the anatomic classification of pediatric uveitis, disease epidemiology, associated systemic diseases, and management principles. We also review important corticosteroid-sparing strategies including non-biologic and biologic agents such as the anti-tumor necrosis factor (TNF)-alpha family of medications, given their key role in the treatment of pediatric uveitis, particularly juvenile idiopathic arthritis (JIA). Recent advances in the assessment of vision-related quality-of-life using the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) instrument are discussed. EXPERT OPINION Pediatric uveitis can lead to long-term vision impairment if not appropriately screened and treated. JIA is the most common systemic disease associated with uveitis, is typically asymptomatic, and thus requires rigorous screening to detect uveitis and avoid secondary ocular complications. While topical and systemic corticosteroids are useful for the acute treatment of uveitis, the disease chronicity of many pediatric uveitis syndromes including JIA, often warrants early escalation of therapy to immunosuppressive medications including methotrexate (MTX) and anti-TNF-alpha inhibitors. Future directions include an improved understanding of risk factors for uveitis and better metrics to evaluate the impact of disease on vision-related quality-of-life of pediatric uveitis patients.
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Affiliation(s)
- Lucas Kim
- Mercer University School of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alexa Li
- Emory Eye Center, Emory University School of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sheila Angeles-Han
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Steven Yeh
- Emory Eye Center, Emory University School of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jessica Shantha
- Emory Eye Center, Emory University School of Medicine, University of Cincinnati, Cincinnati, Ohio
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Yu A, Ferenczi E, Moussa K, Eliott D, Matiello M. Clinical Spectrum of West Nile Virus Neuroinvasive Disease. Neurohospitalist 2019; 10:43-47. [PMID: 31839864 DOI: 10.1177/1941874419868636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
West Nile virus (WNV) is the most common arbovirus infection in the United States. The diagnosis requires consideration of not only a broad spectrum of presenting symptoms, ranging from a mild febrile illness to severe encephalitis and acute flaccid paralysis, but also public health risk factors and seasonality. There is no approved targeted therapy for WNV, so treatment relies on supportive care, management of neurologic sequelae and airway, treatment of other systems including the eye, and aggressive rehabilitation. Here, we describe a series of 3 cases of WNV encountered in September 2018 at one institution. First, we describe a case of WNV encephalitis with worsened dyskinesias and a relatively good recovery. Second, we describe a severe WNV encephalitis with overlying motor neuron involvement with a poor outcome. Finally, we describe a case of a WNV meningitis with significant bilateral chorioretinitis, an underappreciated complication of WNV infections. Through these cases, we review the epidemiology of WNV, risk factors for infection, the neurologic sequalae and long-term outcomes, and the importance of recognizing ocular involvement to prevent ophthalmologic complications.
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Affiliation(s)
- Andrew Yu
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Ferenczi
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Kareem Moussa
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Marcelo Matiello
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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16
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Nagpal M, Mehrotra N, Juneja R, Vishnoi A, Jain A. Correlation of “Panoramic” Optical Coherence Tomography Angiography With Indocyanine Green Angiography Characteristics of Serpiginous-Like Choroiditis. Ophthalmic Surg Lasers Imaging Retina 2018; 49:859-869. [DOI: 10.3928/23258160-20181101-07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/02/2018] [Indexed: 12/16/2022]
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17
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Agarwal A, Pichi F, Invernizzi A, Gupta V. Disease of the Year: Differential Diagnosis of Uveitic Macular Edema. Ocul Immunol Inflamm 2018; 27:72-88. [DOI: 10.1080/09273948.2018.1523437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science ‘Luigi Sacco’, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Chawla R, Sundar DM, Gupta P, Mittal K. Intravitreal bevacizumab for postviral fever retinitis: a novel approach for early resolution of macular oedema. BMJ Case Rep 2018; 2018:bcr-2017-222410. [PMID: 29351936 DOI: 10.1136/bcr-2017-222410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Severe macular oedema causing marked loss of vision is seen in cases of retinitis developing postviral fever. The use of antivascular endothelial growth factor agents for macular oedema and submacular fluid secondary to viral retinitis has not been studied or well established in the past. We report a case series of two patients of postviral retinitis with severe macular oedema resistant to steroid therapy, treated with intravitreal bevacizumab. The patients showed significant symptomatic improvement in the visual acuity. The retinitis lesions resolved slowly and macular oedema regressed. Bevacizumab appears to be a safe and useful agent to manage macular oedema subsequent to postviral retinitis. An early resolution of macular oedema helps in the preservation of visual acuity which left untreated can cause severe visual loss.
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Affiliation(s)
- Rohan Chawla
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dheepak M Sundar
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prasad Gupta
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Kanhaiya Mittal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Van Hove I, Lefevere E, De Groef L, Sergeys J, Salinas-Navarro M, Libert C, Vandenbroucke R, Moons L. MMP-3 Deficiency Alleviates Endotoxin-Induced Acute Inflammation in the Posterior Eye Segment. Int J Mol Sci 2016; 17:ijms17111825. [PMID: 27809288 PMCID: PMC5133826 DOI: 10.3390/ijms17111825] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 01/04/2023] Open
Abstract
Matrix metalloproteinase-3 (MMP-3) is known to mediate neuroinflammatory processes by activating microglia, disrupting blood-central nervous system barriers and supporting neutrophil influx into the brain. In addition, the posterior part of the eye, more specifically the retina, the retinal pigment epithelium (RPE) and the blood-retinal barrier, is affected upon neuroinflammation, but a role for MMP-3 during ocular inflammation remains elusive. We investigated whether MMP-3 contributes to acute inflammation in the eye using the endotoxin-induced uveitis (EIU) model. Systemic administration of lipopolysaccharide induced an increase in MMP-3 mRNA and protein expression level in the posterior part of the eye. MMP-3 deficiency or knockdown suppressed retinal leukocyte adhesion and leukocyte infiltration into the vitreous cavity in mice subjected to EIU. Moreover, retinal and RPE mRNA levels of intercellular adhesion molecule 1 (Icam1), interleukin 6 (Il6), cytokine-inducible nitrogen oxide synthase (Nos2) and tumor necrosis factor α (Tnfα), which are key molecules involved in EIU, were clearly reduced in MMP-3 deficient mice. In addition, loss of MMP-3 repressed the upregulation of the chemokines monocyte chemoattractant protein (MCP)-1 and (C-X-C motif) ligand 1 (CXCL1). These findings suggest a contribution of MMP-3 during EIU, and its potential use as a therapeutic drug target in reducing ocular inflammation.
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Affiliation(s)
- Inge Van Hove
- Neural Circuit Development and Regeneration Research Group, Department of Biology, Katholieke Universiteit Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Laboratory of Experimental Ophthalmology, Department of Neurosciences, KU Leuven, B-3000 Leuven, Belgium.
| | - Evy Lefevere
- Neural Circuit Development and Regeneration Research Group, Department of Biology, Katholieke Universiteit Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Laboratory of Experimental Ophthalmology, Department of Neurosciences, KU Leuven, B-3000 Leuven, Belgium.
| | - Lies De Groef
- Neural Circuit Development and Regeneration Research Group, Department of Biology, Katholieke Universiteit Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Laboratory of Experimental Ophthalmology, Department of Neurosciences, KU Leuven, B-3000 Leuven, Belgium.
| | - Jurgen Sergeys
- Neural Circuit Development and Regeneration Research Group, Department of Biology, Katholieke Universiteit Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Laboratory of Experimental Ophthalmology, Department of Neurosciences, KU Leuven, B-3000 Leuven, Belgium.
| | - Manuel Salinas-Navarro
- Neural Circuit Development and Regeneration Research Group, Department of Biology, Katholieke Universiteit Leuven (KU Leuven), B-3000 Leuven, Belgium.
| | - Claude Libert
- Inflammation Research Center, VIB, B-9052 Ghent, Belgium.
- Department of Biomedical Molecular Biology, Ghent University, B-9052 Ghent, Belgium.
| | - Roosmarijn Vandenbroucke
- Inflammation Research Center, VIB, B-9052 Ghent, Belgium.
- Department of Biomedical Molecular Biology, Ghent University, B-9052 Ghent, Belgium.
| | - Lieve Moons
- Neural Circuit Development and Regeneration Research Group, Department of Biology, Katholieke Universiteit Leuven (KU Leuven), B-3000 Leuven, Belgium.
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Martínez-Pulgarín DF, Chowdhury FR, Villamil-Gomez WE, Rodriguez-Morales AJ, Blohm GM, Paniz-Mondolfi AE. Ophthalmologic aspects of chikungunya infection. Travel Med Infect Dis 2016; 14:451-457. [PMID: 27238905 DOI: 10.1016/j.tmaid.2016.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/05/2016] [Accepted: 05/17/2016] [Indexed: 12/29/2022]
Abstract
Chikungunya fever, a viral disease epidemic in some parts of the world is newly introduced in the Americas. This is of considerable international concern, with a growing incidence owing to developing urbanization, tourism, and trade. Ocular manifestations of chikungunya fever are not frequent, but of great relevance. Common manifestations include conjunctivitis, optic neuritis, iridocyclitis, episcleritis, retinitis and uveitis. Diagnostic and monitoring investigations would include optical coherence tomography, fundus fluorescein and indocyanine green angiography, visual field analysis, and electrophysiologic tests. There have been no prospective, randomized therapeutic trials, and it is unclear if the disease is self-limiting or if treatment is actually beneficial. Prognosis varies, ranging from full resolution to permanent vision loss despite intervention.
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Affiliation(s)
- Dayron F Martínez-Pulgarín
- Research Group and Incubator Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia
| | - Fazle Rabbi Chowdhury
- Department of Medicine, Sylhet M. A. G. Osmani Medical College Hospital, Sylhet, Bangladesh
| | - Wilmer E Villamil-Gomez
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia; Programa del Doctorado de Medicina Tropical, Universidad de Cartagena, Cartagena, Universidad del Atlántico, Barranquilla, Colombia; Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia
| | - Alfonso J Rodriguez-Morales
- Research Group and Incubator Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia; Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia; Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogotá, DC, Colombia; Organización Latinoamericana para el Fomento de la Investigación en Salud (OLFIS), Bucaramanga, Santander, Colombia.
| | - Gabriela M Blohm
- Department of Biology, University of Florida, Gainesville, FL, USA
| | - Alberto E Paniz-Mondolfi
- Department of Pathology and Laboratory Medicine, Hospital Internacional, Barquisimeto, Venezuela; Laboratory of Biochemistry, Instituto de Biomedicina/IVSS, Caracas, Venezuela
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21
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Agrawal R, Salman M, Tan KA, Karampelas M, Sim DA, Keane PA, Pavesio C. Choroidal Vascularity Index (CVI)--A Novel Optical Coherence Tomography Parameter for Monitoring Patients with Panuveitis? PLoS One 2016; 11:e0146344. [PMID: 26751702 PMCID: PMC4713828 DOI: 10.1371/journal.pone.0146344] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 12/16/2015] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compute choroidal vascularity index (CVI) using an image binarization tool on enhanced depth imaging (EDI)-optical coherence tomography (OCT) scans as a non-invasive optical tool to monitor progression in panuveitis and to investigate the utility of volumetric data from EDI-OCT scans using custom image analysis software. MATERIALS AND METHODS In this retrospective cohort study, segmented EDI-OCT scans of both eyes in 19 patients with panuveitis were taken at baseline and at 3-month follow-up and were compared with EDI-OCT scans of normal eyes. Subfoveal choroidal area was segmented into luminal (LA) and stromal interstitial area (SA). Choroidal vascularity index (CVI) was defined as the proportion of LA to the total circumscribed subfoveal choroidal area (TCA). RESULTS The mean choroidal thickness was 265.5±100.1μm at baseline and 278.4±102.6μm at 3 months follow up (p = 0.06). There was no statistically significant difference in TCA between study and control eyes (p = 0.08). CVI in the control group was 66.9±1.5% at baseline and 66.4±1.5% at follow up. CVI was 74.1±4.7% at baseline and 69.4±4.8% at 3 months follow up for uveitic eyes (p<0.001). The % change in CVI was 6.2 ±3.8 (4.3 to 8.0) for uveitic eyes, which was significantly higher from % change in CVI for control eyes (0.7±1.1, 0.2 to 1.3, p<0.001). CONCLUSION The study reports composite OCT-derived parameters and CVI as a possible novel tool in monitoring progression in panuveitis. CVI may be further validated in larger studies as a novel optical tool to quantify choroidal vascular status.
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Affiliation(s)
- Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- University College London, Institute of Ophthalmology, London, United Kingdom
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- * E-mail:
| | - Mohammed Salman
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Kara-Anne Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michael Karampelas
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- West Hertfordshire NHS Trust, London, United Kingdom
| | - Dawn A. Sim
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Pearse A. Keane
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- University College London, Institute of Ophthalmology, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- University College London, Institute of Ophthalmology, London, United Kingdom
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22
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Kuo A, Ziaee SM, Hosseini H, Voleti V, Schwartz SD, Kim NU, Ge PS. The Great Imitator: Ocular Syphilis Presenting as Posterior Uveitis. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:434-7. [PMID: 26151369 PMCID: PMC4500594 DOI: 10.12659/ajcr.893907] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 34 Final Diagnosis: Ocular syphilis Symptoms: Painful unilateral vision loss Medication: Benzylpenicillin Clinical Procedure: Lumbar puncture Specialty: Infectious Diseases • Ophthalmology
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Affiliation(s)
- Alan Kuo
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, USA
| | - Saba M Ziaee
- Department of Medicine, Olive-View University of California Los Angeles (UCLA) Medical Center, Sylmar, USA
| | - Hamid Hosseini
- Jules Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, USA
| | - Vinod Voleti
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Steven D Schwartz
- Jules Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, USA
| | - Nam U Kim
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, USA
| | - Phillip S Ge
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, USA
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23
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Annamalai R, Biswas J. Bilateral choroidal tuberculoma in miliary tuberculosis - report of a case. J Ophthalmic Inflamm Infect 2015; 5:4. [PMID: 25861395 PMCID: PMC4384973 DOI: 10.1186/s12348-014-0032-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/01/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A choroidal mass or granuloma is a feature of ocular tuberculosis (TB). Tubercles can arise in the early stages of progression of TB and indicate hematogenous dissemination before the development of symptomatic disease. Tubercular subretinal granuloma is responsive to treatment with anti-tuberculosis therapy, and prompt treatment helps resolve the lesion completely. FINDINGS We report a case of a solitary large active choroidal tuberculoma in one eye and multiple healed tubercles in the other. The patient was an immunocompetent girl with splenic and miliary TB and had a relatively asymptomatic systemic status. Aqueous humor analysis by polymerase chain reaction (PCR) and real-time PCR (RT-PCR) was negative for the Mycobacterium tuberculosis genome. Based on clinical history and investigations, treatment with four-drug regimen of anti-tubercular treatment with concomitant corticosteroids was started, and total healing of the lesion occurred in 3 months. CONCLUSIONS This case highlights the fact that in some patients, analysis of the aqueous may not provide any clue to the confirmation of an active tubercular choroidal granuloma and an association between splenic tuberculosis and choroidal tubercles has never been reported in the past.
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Affiliation(s)
| | - Jyotirmay Biswas
- />Uveitis & Ocular Pathology Department, Sankara Nethralaya, 18, College Road, Nungambakkam, Chennai, 600006 India
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24
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Kipersztok L, Masukume G. Table of pediatric medical conditions and findings named after foods. WIKIJOURNAL OF MEDICINE 2015. [DOI: 10.15347/wjm/2015.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Anaya-Pava EJ, Cárdenas-Hernández RI. [Charcot-Marie-Tooth disease and bilateral vitritis]. ACTA ACUST UNITED AC 2014; 90:185-9. [PMID: 25443200 DOI: 10.1016/j.oftal.2014.04.012] [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: 10/11/2013] [Revised: 03/30/2014] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
Abstract
CASE REPORT We describe a patient diagnosed with Charcot-Marie-Tooth disease, with a 4 months history of bilateral decreased visual acuity and floaters. On examination, he had severe bilateral vitreous opacity and sectoral diffuse vascular sheathing. It could not be linked to some underlying aetiology and did not respond to oral steroids. CONCLUSIONS Publications relating to ocular findings in patients with Charcot-Marie-Tooth disease exclude bilateral vitritis. In this case we were unable to test the association with another disease as the cause of vitritis.
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Affiliation(s)
- E J Anaya-Pava
- Servicio de Oftalmología, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad No. 71, Torreón, Coahuila, México.
| | - R I Cárdenas-Hernández
- Servicio de Oftalmología, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad No. 71, Torreón, Coahuila, México; Servicio de Retina, Instituto de la Visión, Torreón, Coahuila, México
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26
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Sepah YJ, Michelle EH, Metcalf B, Khwaja A, Channa R, Ibrahim M, Hatef E, Heo J, Hee JL, Rentiya ZS, Do DV, Nguyen QD. Voclosporin: a potentially promising therapeutic agent for noninfectious uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.11.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Natarajan S. Meet the challenge. Indian J Ophthalmol 2013; 61:251-2. [PMID: 23803474 PMCID: PMC3744775 DOI: 10.4103/0301-4738.114088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sundaram Natarajan
- Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt Ltd, Wadala (W), Mumbai, Maharashtra, India. E-mail:
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Annamalai R, Sudharshan S, Biswas J. Clinical Features, Investigations, Management, and Prognosis of Serpiginous Choroiditis. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:287-95. [PMID: 26107600 DOI: 10.1097/apo.0b013e31826f68a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Serpiginous choroiditis is an inflammatory form of posterior uveitis that affects the choroid, retinal pigment epithelium, and choriocapillaries. Known to be recurrent and progressive in nature, this bilateral disease can result in severe visual loss both during the active and healed stages. The age at onset is 40 to 50 years, but it can affect younger Indian population. It can be further classified into 3 types based on its clinical presentation, and they are, namely, peripapillary, macular, and ampiginous. Histological features further qualify the site of inflammation as evidenced by lymphocytic infiltration within the choroid and atrophy of choriocapillaries and retinal pigment epithelium. Despite a multitude of etiologies such as autoimmunity, infection, and degeneration, autoimmune causes remain the mainstay. Laboratory investigations can help rule out infections, whereas angiography can provide further insights into the progression of the disease. Newer investigations such as optical coherence tomography and fundus autofluorescence can help locate the lesion and identify the phase of the disease. Corticosteroids with immunosuppressives are the major management modality. Treatment of complications may require intravitreal injections, laser photocoagulation, or even vitreoretinal surgery.
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Affiliation(s)
- Radha Annamalai
- From the *Sri Ramachandra University, Porur; and †Department of Uveitis Services, Sankara Nethralaya and ‡Uveitis & Ocular Pathology Department, Sankara Nethralaya, Nungambakkam, Chennai, India
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Regatieri CV, Alwassia A, Zhang JY, Vora R, Duker JS. Use of optical coherence tomography in the diagnosis and management of uveitis. Int Ophthalmol Clin 2012; 52:33-43. [PMID: 22954927 PMCID: PMC4131430 DOI: 10.1097/iio.0b013e318265d439] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Caio V. Regatieri
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Federal University of São Paulo, São Paulo, Brazil
| | - Ahmad Alwassia
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Jason Y. Zhang
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Robin Vora
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
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Balaskas K, Sergentanis TN, Giulieri S, Guex-Crosier Y. Fluorescein and indocyanine-green angiography in ocular syphilis: an exploratory study. Graefes Arch Clin Exp Ophthalmol 2011; 250:721-30. [DOI: 10.1007/s00417-011-1893-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 11/27/2011] [Accepted: 11/30/2011] [Indexed: 01/28/2023] Open
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Natarajan S. From the editor's desk - vasculitis my brief synopsis. Indian J Ophthalmol 2011; 59:271-2. [PMID: 21666309 PMCID: PMC3129749 DOI: 10.4103/0301-4738.81992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chhablani JK. Autofluorescence findings and role of anti-vascular endothelial growth factor in inflammatory choroidal neovascular membrane. Indian J Ophthalmol 2010; 58:443-4. [PMID: 20689208 PMCID: PMC2992928 DOI: 10.4103/0301-4738.67041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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