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Evans W, Mathew C, Richardson-May J, Arora R. A Case Report of Fedratinib-Associated Uveitis. Cureus 2024; 16:e52373. [PMID: 38361691 PMCID: PMC10867717 DOI: 10.7759/cureus.52373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Drug-induced uveitis is a rare but important subgroup of uveitis particularly among newer drugs in the market. Establishing a diagnosis can be challenging and requires the physician to have a high index of suspicion and a holistic approach with consideration being afforded to history, clinical examination, and investigations. In this case report, we describe a case of hypopyon uveitis in a 64-year-old male with a background of myelofibrosis for which he was started on fedratinib. A thorough history, negative investigation panel, and temporal association between the start of the drug and uveitis helped establish the diagnosis. A literature review showed no other published cases of uveitis secondary to fedratinib. While he could not be withdrawn from the drug, collaboration with the medical team enabled close monitoring and follow-up. He recovered following a course of steroids and remains under observation.
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Affiliation(s)
- William Evans
- Ophthalmology, Salisbury District Hospital, Salisbury, GBR
| | | | | | - Rashi Arora
- Ophthalmology, Salisbury District Hospital, Salisbury, GBR
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2
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Interleukin 18, soluble cluster of differentiation 40, platelet factor 4 variant 1, and neutrophil gelatinase-associated lipocalin can be used as biomarkers to aid activity and diagnosis in ocular Behçet's disease. Int Ophthalmol 2022; 42:3321-3331. [PMID: 35622217 DOI: 10.1007/s10792-022-02331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/18/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The molecules human interleukin (IL-18), the soluble cluster of differentiation (sCD40), platelet factor 4 variant 1 (PF4V1), and neutrophil gelatinase-associated lipocalin (NGAL) are all markers of inflammation in biological systems and are linked to prognosis in several inflammatory diseases as well. Since there is no study in which the above-mentioned molecules are studied together in ocular Behçet's disease (OBD), the aim of this study is to reveal whether these molecules are activity markers in active (OABD) and inactive (OIBD) disease. METHODS 30 OABD and 30 OIBD and 30 healthy individuals were included in the study. IL-18, sCD40, PF4V1, and NGAL molecules were studied in blood samples by the ELISA method. RESULTS When OABD and OIBD were compared to healthy individuals, the levels of IL-18, sCD40, PF4V1, and NGAL molecules were found to be statistically significant. These values were even more significantly higher in patients with OABD. CONCLUSION When ROC values of IL-18, sCD40, PF4V1, and NGAL are evaluated, it is clear that these four molecules can be used as biomarkers to aid activity and diagnosis in OBD.
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3
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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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4
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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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5
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Majzoobi MM, Akbarzadeh S, Ebrahimi G, Ghasemibasir HR, Alirezaei P. Tuberculous Uveitis, Erythema Induratum, and Persistent Genital Warts in a Female Patient: A Rare Case Report. Adv Biomed Res 2019; 8:70. [PMID: 31897408 PMCID: PMC6909546 DOI: 10.4103/abr.abr_154_19] [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: 07/13/2019] [Revised: 10/06/2019] [Accepted: 11/03/2019] [Indexed: 11/05/2022] Open
Abstract
Uveitis and erythema induratum are two uncommon extrapulmonary manifestations of tuberculosis (TB). In most circumstances, we cannot isolate mycobacterium from those sites, so diagnosis is difficult. In the presented case, panuveitis, erythema induratum, and persistent anogenital warts were found concurrently in a 19-year-old girl who had a history of pulmonary TB 10 years ago. Assessment of her immune condition ruled out any immunodeficiency state. Extrapulmonary TB and persistent warts responded dramatically to anti-TB drugs and interferon-gamma, respectively. Our case reveals that a constellation of these clinical manifestations may also occur in immunocompetent individuals.
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Affiliation(s)
- Mohammad Mahdi Majzoobi
- Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Siamak Akbarzadeh
- Department of Ophthalmology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Golnoush Ebrahimi
- Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamid Reza Ghasemibasir
- Department of Pathology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Pedram Alirezaei
- Psoriasis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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6
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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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7
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Sharon Y, Chu DS. Adrenocorticotropic hormone gel for patients with non-infectious uveitis. Am J Ophthalmol Case Rep 2019; 15:100502. [PMID: 31297467 PMCID: PMC6598035 DOI: 10.1016/j.ajoc.2019.100502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 01/23/2019] [Accepted: 06/20/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose To describe the potential role of adrenocorticotropic hormone (ACTH) gel treatment in patients with chronic non-infectious uveitis. Observations We report the clinical course of three patients with bilateral, non-infectious anterior and intermediate uveitis, treated with ACTH gel for ≥12 months. All three patients had chronic and steroid-dependent ocular inflammation with subsequent development of ocular complications. Twice-weekly treatment with subcutaneous 80 unit/day ACTH gel was administered, and clinical outcome measures were observed. After a mean period of 14 months, all patients demonstrated significant improvement in disease activity, stable visual acuity, and an absence of side effects. Systemic steroids dosage was successfully reduced from a mean dose of 16 mg/day upon the initiation of ACTH gel treatment to 2 mg/day at last follow up. Conclusions and Importance Subcutaneous ACTH gel has shown to be a safe and effective therapy in the management of non-infectious uveitis. Specifically, ACTH gel plays a role in refractory and steroid-dependent cases and in those who do not respond to or are unable to tolerate other immunomodulatory therapies.
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Affiliation(s)
- Yael Sharon
- Metropolitan Eye Research and Surgery Institute, Palisades Park, NJ, USA
| | - David S Chu
- Metropolitan Eye Research and Surgery Institute, Palisades Park, NJ, USA.,Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, NJ, USA
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8
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Nien CW, Lee CY, Chao SC, Hsu HJ, Huang JY, Yeh CB, Chen HC, Sun CC, Lin HY, Yang SF. Effect of Uveitis on the Development of Keratopathy: A Population-Based Cohort Study. Invest Ophthalmol Vis Sci 2019; 59:5053-5059. [PMID: 30357399 DOI: 10.1167/iovs.18-25039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the effect of uveitis on the development of various keratopathies via the use of the National Health Insurance Research Database (NHIRD) in Taiwan. Methods Approximately 1 million patients were randomly sampled from the registry of the NHIRD. Patients diagnosed with uveitis by ophthalmologists were enrolled in the study group after exclusion. Each individual in the study group was age and sex matched to four non-uveitis individuals who serve as the control group. In addition to keratopathy, other possible risk factors and medications were included in the multivariate model, and the effects of different subtypes of uveitis for developing keratopathies were also analyzed. Results A total of 4773 uveitis patients (2662 male and 2111 female) and 19,092 non-uveitis patients (10,648 male and 8444 female) were enrolled. There were 406 events of keratopathy in the study group, and another 764 events occurred in the control group. A higher incidence rate was found in the study group after adjustment (adjusted hazard ratio [aHR]: 1.772), with a greater cumulative probability (P < 0.0001). For the subgroup analysis, anterior uveitis (aHR = 1.765) and panuveitis (aHR = 3.386) increased the risk of developing keratopathies. Moreover, male sex was associated with a higher aHR than female sex for developing keratopathies in the study group. Conclusions The presence of uveitis significantly elevates the risk for developing keratopathy.
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Affiliation(s)
- Chan-Wei Nien
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Shih-Chun Chao
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Hung-Jui Hsu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Chinese Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hung-Yu Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Optometry, Chung Shan Medical University, Taichung, Taiwan.,Department of Optometry, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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9
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Arevalo JF, Lasave AF, Gupta V, Kozak I, Al Shamsi HN, Al Suliman SM, Al Rushood AA, Al-Zahrani YA, Al-Mahmood AM, Al Dhibi HA. Clinical Characteristics and Treatment of 308 Panuveitis Patients over 10 Years: Results from the KKESH Uveitis Survey Study Group. Ocul Immunol Inflamm 2018; 27:1296-1304. [DOI: 10.1080/09273948.2018.1523436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J. Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Andres F. Lasave
- Retina and Vitreous Department, Clinica Privada de Ojos, Buenos Aires, Mar del Plata, Argentina
| | - Vishali Gupta
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Igor Kozak
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hanan Nasser Al Shamsi
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Abdulaziz Adel Al Rushood
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Yahya A. Al-Zahrani
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ammar M. Al-Mahmood
- Anterior Segment and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hassan A. Al Dhibi
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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10
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Agrawal R, Gunasekeran DV, Grant R, Agarwal A, Kon OM, Nguyen QD, Pavesio C, Gupta V. Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)-1. JAMA Ophthalmol 2017; 135:1318-1327. [PMID: 29075752 PMCID: PMC6583556 DOI: 10.1001/jamaophthalmol.2017.4485] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/11/2017] [Indexed: 12/25/2022]
Abstract
Importance Eradication of systemic tuberculosis (TB) has been limited by neglected populations and the HIV pandemic. Whereas ocular TB often presents as uveitis without any prior evidence of systemic TB, the existing uncertainty in the diagnosis of TB uveitis may perpetuate missed opportunities to address systemic TB. Objective To examine the clinical features of TB uveitis and the associations with response to antitubercular therapy (ATT). Design, Setting, and Participants This retrospective multinational cohort study included patients from 25 ophthalmology referral centers diagnosed with TB uveitis and treated with ATT from January 1, 2004, through December 31, 2014, with a minimum follow-up of 1 year. Main Outcomes and Measures Treatment failure, defined as a persistence or recurrence of inflammation within 6 months of completing ATT, inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. Results A total of 801 patients (1272 eyes) were studied (mean [SD] age, 40.5 [14.8] years; 413 [51.6%] male and 388 [48.4%] female; 577 [73.6%] Asian). Most patients had no known history (498 of 661 [75.3%]) of systemic TB. Most patients had bilateral involvement (471 of 801 [58.8%]). Common clinical signs reported include vitreous haze (523 of 1153 [45.4%]), retinal vasculitis (374 of 874 [42.8%]), and choroidal involvement (419 of 651 [64.4%]). Treatment failure developed in 102 of the 801 patients (12.7%). On univariate regression analysis, the hazard ratios (HRs) associated with intermediate uveitis (HR, 2.21; 95% CI, 1.07-4.55; P = .03), anterior uveitis (HR, 2.68; 95% CI, 1.32-2.35; P = .006), and panuveitis (HR, 3.28; 95% CI, 1.89-5.67; P < .001) were significantly higher compared with posterior distribution. The presence of vitreous haze had a statistically significant association (HR, 1.95; 95% CI, 1.26-3.02; P = .003) compared with absence of vitreous haze. Bilaterality had an associated HR of 1.50 (95% CI, 0.96-2.35) compared with unilaterality (HR, 1 [reference]), although this finding was not statistically significant (P = .07). On multivariate Cox proportional hazards regression analysis, the presence of vitreous haze had an adjusted HR of 2.98 (95% CI, 1.50-5.94; P = .002), presence of snow banking had an adjusted HR of 3.71 (95% CI, 1.18-11.62; P = .02), and presence of choroidal involvement had an adjusted HR of 2.88 (95% CI, 1.22-6.78; P = .02). Conclusions and Relevance A low treatment failure rate occurred in patients with TB uveitis treated with ATT. Phenotypes and test results are studied whereby patients with panuveitis having vitreous and choroidal involvement had a higher risk of treatment failure. These findings are limited by retrospective methods. A prospectively derived composite clinical risk score might address this diagnostic uncertainty through holistic and standardized assessment of the combinations of clinical features and investigation results that may warrant diagnosis of TB uveitis and treatment with ATT.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
- Singapore Eye Research Institute, Singapore
| | - Dinesh Visva Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
- School of Medicine, National University of Singapore, Singapore
| | - Robert Grant
- Faculty of Health, Social Care, and Education, Kingston University and St George’s, University of London, London, England
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Healthcare, National Health Service Trust, London, England
| | | | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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11
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Choroidal thickness in non-ocular Behçet's disease - A spectral-domain OCT study. J Curr Ophthalmol 2017; 29:210-213. [PMID: 28913513 PMCID: PMC5587250 DOI: 10.1016/j.joco.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate choroidal thickness in patients with non-ocular Behçet's disease (BD) using spectral domain optical coherence tomography (SD-OCT) and to compare the results to normal eyes. Methods In this retrospective observational comparative study, we collected OCT and clinical data from the charts of 4 patients (7 eyes) with BD who had been referred for a screening eye exam and had a normal ocular examination. Data from 9 healthy volunteers (17 eyes) were collected as age-matched controls. The choroid was manually segmented from volume OCT scans using custom Doheny Image Reading Center OCT grading software (3D-OCTOR). Main outcome measures were choroidal thickness and intensity were compared between eyes of patients with BD and those of healthy controls. Results Eyes of patients with non-ocular BD had significantly thinner mean central subfield choroidal thickness (227.5 ± 56.93 versus 306.85 ± 17.85, P = 0.04) and central subfield choroidal volume (0.18 ± 0.04 vs 0.24 ± 0.02, P = 0.005). There was no significant difference in mean choroidal thickness in the whole ETDRS grid or in mean choroidal intensity in the central subfield and the whole ETDRS grid between eyes of patients with non-ocular BD and those of controls. Conclusion This study demonstrates that BD may have subclinical manifestations in the choroid, resulting in thinning of the choroid relative to normal eyes, even without overt signs of ocular involvement.
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12
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Superoxide Dismutase 1 Nanozyme for Treatment of Eye Inflammation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:5194239. [PMID: 26697135 PMCID: PMC4678082 DOI: 10.1155/2016/5194239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/06/2015] [Accepted: 08/12/2015] [Indexed: 01/16/2023]
Abstract
Use of antioxidants to mitigate oxidative stress during ocular inflammatory diseases has shown therapeutic potential. This work examines a nanoscale therapeutic modality for the eye on the base of antioxidant enzyme, superoxide dismutase 1 (SOD1), termed "nanozyme." The nanozyme is produced by electrostatic coupling of the SOD1 with a cationic block copolymer, poly(L-lysine)-poly(ethyleneglycol), followed by covalent cross-linking of the complexes with 3,3'-dithiobis(sulfosuccinimidylpropionate) sodium salt. The ability of SOD1 nanozyme as well as the native SOD1 to reduce inflammatory processes in the eye was examined in vivo in rabbits with immunogenic uveitis. Results suggested that topical instillations of both enzyme forms demonstrated anti-inflammatory activity; however, the nanozyme was much more effective compared to the free enzyme in decreasing uveitis manifestations. In particular, we noted statistically significant differences in such inflammatory signs in the eye as the intensities of corneal and iris edema, hyperemia of conjunctiva, lens opacity, fibrin clots, and the protein content in aqueous humor. Clinical findings were confirmed by histological data. Thus, SOD1-containing nanozyme is potentially useful therapeutic agent for the treatment of ocular inflammatory disorders.
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13
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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: 12] [Impact Index Per Article: 1.3] [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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Examining the choroid in ocular inflammation: a focus on enhanced depth imaging. J Ophthalmol 2014; 2014:459136. [PMID: 25024846 PMCID: PMC4082870 DOI: 10.1155/2014/459136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/21/2014] [Indexed: 11/25/2022] Open
Abstract
The choroid is the vascular layer that supplies the outer retina and is involved in the pathogenesis of several ocular conditions including choroidal tumors, age related macular degeneration, central serous chorioretinopathy, diabetic retinopathy, and uveitis. Nevertheless, difficulties in the visualization of the choroid have limited our understanding of its exact role in ocular pathology.
Enhanced depth imaging optical coherent topography (EDI-OCT) is a novel, noninvasive technique that is used to evaluate choroidal thickness and morphology in these diseases. The technique provides detailed objective in vivo visualization of the choroid and can be used to characterize posterior segment inflammatory disorders, monitor disease activity, and evaluate efficacy of treatment. In this review we summarize the current application of this technique in ocular inflammatory disorders and highlight its utility as an additional tool in monitoring choroidal involvement in ocular inflammation.
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Idiopathic uveitis and familial mediterranean Fever: is there any relationship? Autoimmune Dis 2014; 2014:238931. [PMID: 24592325 PMCID: PMC3926436 DOI: 10.1155/2014/238931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/10/2013] [Accepted: 11/16/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Familial Mediterranean fever (FMF) is an auto-inflammatory disease characterized by attacks of fever and polyserositis. FMF is often associated with other autoimmune diseases such as rheumatoid arthritis, polyarteritis nodosa (PAN), and Behcet. Uveitis is an inflammatory process caused by underlying infectious and inflammatory disorders. This study investigates the probable relationship between idiopathic uveitis and FMF. Methods. Patients with idiopathic uveitis were analyzed for the 12 most common MEFV mutations (P369S, F479L, M680I(G/C), M680I(G/A), I692del, M694V, M694I, K695R, V726A, A744S, R761H, E148Q) by a reverse hybridization assay (FMF StripAssay,Vienna lab,Vienna, Austria). Results. 12 patients with idiopathic uveitis were enrolled in this study. 10 of them were female. The youngest patient was a 7-year-old child and the oldest was 57. The most common complaints of patients were blurred vision and then eye redness. One patient was heterozygous for R761H. Genetic analysis of the 12 most common MEFV mutations in the patients with idiopathic uveitis didnot have any positive results. Conclusion. According to the analysis of the 12 most common MEFV gene mutations, FMF is not an underlying cause of idiopathic uveitis. On the other hand, uveitis merely could not be the first presentation of FMF.
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Fang CB, Zhou DX, Zhan SX, He Y, Lin Z, Huang C, Li J. Amelioration of experimental autoimmune uveitis by leflunomide in Lewis rats. PLoS One 2013; 8:e62071. [PMID: 23626769 PMCID: PMC3633904 DOI: 10.1371/journal.pone.0062071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/17/2013] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the efficacy of leflunomide in experimental autoimmune uveitis (EAU) in rats. Methods Lewis rats were immunized with interphotoreceptor retinoid-binding peptide (IRBP) in order to generate EAU. Rats received three dose of leflunomide through intragastric administration (prevention or treatment protocols) after immunization at three separate doses (3 mg/kg/d; 6 mg/kg/d; 12 mg/kg/d). Cyclosporin A was administered as a positive) control. Rats were euthanized during peak disease activity (day 14 or 15). Treatment effectiveness was evaluated in vivo using clinical EAU scoring (d14) and histopathological evaluation of enucleated eyes after experimental termination. The expression levels of inflammatory cytokines in the serum were quantified by ELISA. Eyeball of rats were harvested and mRNA expression of interleukin 17 (IL17) and IFN-γ were quantified through RT-PCR. Intracellular expression of interleukin (IL)-17 in the activated CD4(+) T cells was assessed by flow cytometry. The effects of leflunomide inhibition on immune responses in rats were investigated in isolated lymphocytes. Results Histopathological and clinical data revealed severe intraocular inflammation in the immunized rat. Inflammation reached its peak on day 14 in this EAU model. Treatment with leflunomide significantly prevented and treated EAU-induced ocular inflammation and decreased clinical and pathological scores compared to vehicle-treated eyes. Gene expression of IL17 and IFN-γwas markedly reduced in leflunomide-treated eyes. Leflunomide significantly decreased the serum levels of IL17 and IFN-γ. The study of IL17+ T cells in peripheral blood and spleen by flow cytometry showed a decreased number of Th17 cell in rats of leflunomide prevented group. Lymphocytes from animals treated with leflunomide had decreased antigen-specific proliferation in vitro compared with lymphocytes from untreated animals. Conclusions Oral administration of leflunomide effectively suppressed IRBP-induced uveitis in rats. These results suggest that leflunomide may be potentially clinical application in uveitis.
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Affiliation(s)
- Cheng-bo Fang
- School of Pharmacy, Anhui Key Laboratory of Bioactivity of Natural Products, Anhui Medical University, Hefei, China
- Department of Ophthalmology, The 1st Affiliated Hospital of Anhui Medical University, Hefei, China
| | - De-xi Zhou
- School of Pharmacy, Anhui Key Laboratory of Bioactivity of Natural Products, Anhui Medical University, Hefei, China
| | - Shu-xiang Zhan
- School of Pharmacy, Anhui Key Laboratory of Bioactivity of Natural Products, Anhui Medical University, Hefei, China
| | - Yong He
- School of Pharmacy, Anhui Key Laboratory of Bioactivity of Natural Products, Anhui Medical University, Hefei, China
| | - Zhen Lin
- School of Pharmacy, Anhui Key Laboratory of Bioactivity of Natural Products, Anhui Medical University, Hefei, China
| | - Cheng Huang
- School of Pharmacy, Anhui Key Laboratory of Bioactivity of Natural Products, Anhui Medical University, Hefei, China
| | - Jun Li
- School of Pharmacy, Anhui Key Laboratory of Bioactivity of Natural Products, Anhui Medical University, Hefei, China
- * E-mail:
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Yadav UCS, Shoeb M, Srivastava SK, Ramana KV. Amelioration of experimental autoimmune uveoretinitis by aldose reductase inhibition in Lewis rats. Invest Ophthalmol Vis Sci 2011; 52:8033-41. [PMID: 21900376 PMCID: PMC3208000 DOI: 10.1167/iovs.11-7485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 07/06/2011] [Accepted: 08/30/2011] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Recently, the authors showed that the inhibition of aldose reductase (AR) prevents bacterial endotoxin-induced uveitis in rats. They have now investigated the efficacy of AR inhibitors in the prevention of experimental autoimmune-induced uveitis (EAU) in rats. METHODS Lewis rats were immunized with bovine interphotoreceptor retinoid-binding peptide (IRBP) to develop EAU. Two or 8 days after immunization, the rats started receiving the AR inhibitor fidarestat (7 mg/kg/d; intraperitoneally). They were killed when the disease was at its peak; aqueous humor (AqH) was collected from one eye, and the other eye of each rat was used for histologic studies. The protein concentration and the levels of inflammatory markers were determined in AqH. Immunohistochemical analysis of eye sections was performed to determine the expression of inflammatory markers. The effect of AR inhibition on immune response was investigated in isolated T lymphocytes. RESULTS Immunization of rats by IRBP peptide resulted in a significant infiltration of leukocytes in the posterior and the anterior chambers of the eye. Further, EAU caused an increase in the concentration of proteins, inflammatory cytokines, and chemokines in AqH, and the expression of inflammatory markers such as inducible-nitric oxide synthase and cycloxygenase-2 in the rat eye ciliary bodies and retina. Treatment with fidarestat significantly prevented the EAU-induced ocular inflammatory changes. AR inhibition also prevented the proliferation of spleen-derived T cells isolated from EAU rats in response to the IRBP antigen. CONCLUSIONS These results suggest that AR could be a novel mediator of bovine IRBP-induced uveitis in rats.
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Affiliation(s)
- Umesh C. S. Yadav
- From the Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas
| | - Mohammad Shoeb
- From the Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas
| | - Satish K. Srivastava
- From the Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas
| | - Kota V. Ramana
- From the Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas
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Abstract
PURPOSE OF REVIEW To review current advances in the diagnosis and therapy of Vogt-Koyanagi-Harada (VKH) disease. RECENT FINDINGS A new T-cell subset (Th17) may play an important role in the initiation and maintenance of inflammatory disease when stimulated by the interleukin (IL)-23, thus producing IL-17. Recent developments of new imaging techniques, such as high-resolution optical coherence tomography 3 scanner (OCT3), have allowed greater accuracy in VKH disease diagnosis. The OCT3 examinations have shown that cystoid spaces appear in the neurosensory layer (between the inner and outer segments of photoreceptors) and not in the subretinal space. This structural finding was also supported by functional studies with multifocal electroretinography that measured the photoreceptors activity. Antimetabolites (azathioprine, mycophenolate mofetil and methotrexate), T-cell inhibitors (cyclosporine and tacrolimus) and biologic agents, associated with the well known glucocorticosteroids therapy, showed good results in acute and chronic phases of the disease. Intravitreal triamcinolone and bevacizumab were reported to have encouraging results for progressive or stubborn cases of VKH disease. SUMMARY To uphold visual acuity, an early, fast and accurate diagnosis is necessary, followed by an aggressive and lengthy immunosuppressive treatment.
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