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Abstract
PURPOSE OF REVIEW This review paper aims at discussing pathogenesis, etiology, clinical features, management, and prognosis of OPN. RECENT FINDINGS Optic perineuritis (OPN) is an inflammatory process primarily involving the optic nerve sheath. Clinically, OPN usually presents with unilateral, gradual decline of visual function, eye pain, and/or pain on eye movements, disc edema and various features of optic nerve dysfunction, including visual field defects. It can mimic typical optic neuritis. In most cases of OPN, the disease is isolated with no specific etiology being identified, however, it can also occur secondary to a wide range of underlying systemic diseases. OPN is clinically diagnosed and radiologically confirmed based on the finding of circumferential perineural enhancement of the optic nerve sheath on magnetic resonance imaging (MRI). SUMMARY Unlike optic nerve, OPN is not typically self-limited without treatment. High-dose oral corticosteroids are the mainstay of treatment in OPN. The initiation of therapy usually causes rapid and dramatic improvement in signs and symptoms. In general, OPN usually has a relatively good visual prognosis, which is influenced by delays between the onset of visual loss and the initiation of steroid therapy as well as the presence of underlying systemic diseases.
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Affiliation(s)
- George Saitakis
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary/Harvard Medical School, Boston, Massachusetts, USA
- Athens Eye Hospital, Athens, Greece
| | - Bart K Chwalisz
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary/Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts, USA
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Sutra P, Pokawattana I. Retinal vasculopathy following varicella zoster virus infection. Curr Opin Ophthalmol 2022; 33:557-563. [PMID: 36165416 DOI: 10.1097/icu.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Varicella zoster virus (VZV) ocular infection can manifest purely as a vasculopathy that leads to retinal arteriole occlusion, without any retinitis or vasculitis. This review summarizes our current knowledge of such VZV ocular infection phenotype, incorporating initial descriptions from 1988. We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed. RECENT FINDINGS Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely affected, neither in the form of vasculitis nor retinitis. Diagnosis is typically made from positive polymerase chain reaction (PCR) for VZV from extracted intraocular fluid or positive serum or cerebrospinal fluid (CSF) anti-VZV immunoglobulin G antibody in the context of compatible ocular findings. In addition, retinal vasculopathy occurring in the setting of confirmed varicella or zoster rashes could be considered potentially pathognomonic. Pathological concepts, including direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability are also discussed. SUMMARY VZV may produce a wide spectrum of ocular manifestations with isolated VZV retinal vasculopathy being a rarer presentation. A prompt diagnosis followed by an early treatment of systemic acyclovir with or without corticosteroids is the mainstay of treatment.
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Affiliation(s)
- Plern Sutra
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Optic Perineuritis Presenting as the Initial Manifestation of Central Nervous System Involvement in Rai Stage 0 Chronic Lymphocytic Leukemia. J Neuroophthalmol 2022; 42:e187-e191. [DOI: 10.1097/wno.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mirzayev I, Gündüz AK, Özcan G. Varicella-zoster virus infection presenting with unilateral keratouveitis and papillitis in an immunocompetent adult. Photodiagnosis Photodyn Ther 2022; 37:102720. [PMID: 35026426 DOI: 10.1016/j.pdpdt.2022.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
We report a case of unilateral varicella-zoster virus (VZV) related keratouveitis and papillitis. A 54-year-old male presented with headache, left forehead rash, and decreased vision in the left eye. Examination of the left eye showed visual acuity (VA) of 0.15, relative afferent pupillary defect, anterior stromal corneal edema, nongranulomatous keratic precipitates, a swollen and hyperemic optic disc. The patient could read 6/12 of the Ishihara plates in the left eye. Optical coherence tomography (OCT) showed optic disc edema and OCT angiography (OCTA) revealed increased peripapillary vascularity. Computerized visual field testing demonstrated an enlarged blind spot and lower altitudinal defect. Serum anti-varicella-zoster IgM antibody level was elevated. The patient was put on oral acyclovir and prednisone treatment. At 1-month follow-up visit, VA increased to 0.9 and color vision was 11/12 Ishihara plates. OCT showed resolution of optic disc edema and OCTA demonstrated normalization of the increased peripapillary vascularity. Computerized visual field test demonstrated improvement in the lower altitudinal visual field defect and normalization of the enlarged blind spot. Optic nerve involvement in VZV infection occurs rarely, especially in immunocompetent patients as in our case.
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Affiliation(s)
- Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey; Department of Ophthalmology, Dünyagöz Hospital, Ankara, Turkey.
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey; Private Eye Clinic, Ankara, Turkey.
| | - Gökçen Özcan
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.
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Sarpangala S, George NM, Kamath YS, Kulkarni C. Central retinal vein occlusion secondary to varicella zoster retinal vasculitis in an immunocompetent individual during the COVID-19 pandemic - A case report. Indian J Ophthalmol 2021; 69:2532-2535. [PMID: 34427261 PMCID: PMC8544091 DOI: 10.4103/ijo.ijo_1644_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We report the occurrence of unilateral central retinal vein occlusion (CRVO) in a young yoga enthusiast who presented amidst the COVID-19 pandemic. Subtle signs of uveitis when systemically investigated revealed a multitude of causes, but ocular fluid polymerase chain reaction was positive for varicella zoster virus (VZV). The prompt initiation of antivirals resulted in a good visual outcome. Our case describes the rare presentation of VZV retinal vasculitis as CRVO in a young healthy individual and highlights the importance of early antiviral therapy for favorable outcomes.
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Affiliation(s)
- Shailaja Sarpangala
- Department of Ophthalmology, Kasturba Medical College- Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neenu M George
- Department of Ophthalmology, Kasturba Medical College- Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yogish S Kamath
- Department of Ophthalmology, Kasturba Medical College- Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chidanand Kulkarni
- Department of Ophthalmology, Kasturba Medical College- Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Li H, Zhou H, Sun J, Wang H, Wang Y, Wang Z, Li J. Optic Perineuritis and Its Association With Autoimmune Diseases. Front Neurol 2021; 11:627077. [PMID: 33584521 PMCID: PMC7880123 DOI: 10.3389/fneur.2020.627077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/31/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Optic perineuritis (OPN) is a special optic neuropathy that has a distinct etiology from neuromyelitis optica spectrum disorders (NMOSDs) or multiple sclerosis (MS)-related optic neuritis (ON). The mechanisms of how this inflammation developed and invaded the nerve sheath remain unknown. This study is aimed to analyze the etiology and different clinical characteristics of OPN in a Chinese patient population. Methods: Neuro-ophthalmological examination, orbit magnetic resonance imaging (MRI) and a series of blood samples were used in this retrospective observational cohort study to compare characteristics of OPN with idiopathic demyelination optic neuritis (IDON). Results: Forty-four OPN cases (74 eyes) and 61 IDON cases (78 eyes) were analyzed. OPN cases included 33 cases (59 eyes) were associated with specific autoimmune diseases, 10 cases (13 eyes) were associated with infection diseases, 1 case was idiopathic disease. The causes of OPN with CTD were Graves' disease, Immunoglobulin G4-related disease (IgG-4 RD), granulomatosis with polyangiitis (GAP), systemic lupus erythematosus (SLE), Sarcoidosis, Rheumatoid arthritis, scleroderma, Behcet's disease, and gout. All patients received orbital MRI. Overall, 33 cases showed orbit fat infiltration. Specifically, nine cases with IgG-4 RD showed trigeminal nerve branch involvement, 12 cases with Graves' disease showed extraocular muscle belly enlargement, and 4 cases with GAP showed pterygopalatine fossa pseudotumor. Compared to IDON patients, OPN patients were older (p = 0.004) and more likely bilateral involvement 26 (78.79%) patients had bilateral involvement in OPN group vs. 17 (27.87%) in the IDON group (p < 0.001). Visual acuity scores using LogMAR testing was better in OPN patients compared to those with IDON, 0.55 ± 0.91 vs. 1.19 ± 1.24 (p < 0.001). Other ophthalmologic findings unique to the OPN group include 11 (33.33%) cases of ptosis, nine (27.27%) cases of diplopia, and 10 (30.30%) cases of exophthalmos, compared to zero cases of these conditions in the IDON group. Eight (13.11%) IDON patients also had multiple sclerosis (MS) and 7 (11.48%) patients had neuromyelitis which was significantly more than the zero patients in OPN group (p = 0.04). Conclusions: OPN had distinct etiologies and clinical characteristics from IDON and is more often associated with autoimmune diseases. Using OPN characteristics to diagnose autoimmune diseases should prove useful for clinicians when presented with patients that have multiorgan dysfunction that include ophthalmologic findings.
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Affiliation(s)
- Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hang Zhou
- Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Sun
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huihui Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Wang W, Mack HG, Stawell R, White O, Waterston J. HaNDL with bilateral central venous occlusions. BMJ Neurol Open 2020; 2:e000043. [PMID: 33681782 PMCID: PMC7871729 DOI: 10.1136/bmjno-2020-000043] [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] [Accepted: 05/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background The syndrome of Headache and focal Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) is considered a rare, idiopathic and self-limited condition. Methods We present a patient with HaNDL who had unique findings of florid optic disc haemorrhages from bilateral central retinal vein occlusions. Results Our patient made a full recovery with conservative management. Conclusion It is important for medical attendants to recognise that HaNDL syndrome can be associated with neuro-ophthalmic complications.
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Affiliation(s)
- Wendy Wang
- Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Heather G Mack
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Stawell
- Eye Surgery Associates, The University of Melbourne, Melbourne, Victoria, Australia
| | - Owen White
- Neuro-Ophthalmology, Monash University, Melbourne, Victoria, Australia
| | - John Waterston
- Neurology, Monash University, Melbourne, Victoria, Australia
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Basu S, La Distia Nora R, Rao NA, Jiang X, Fuady A. Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey. Eye (Lond) 2020; 34:1693-1701. [PMID: 31896799 PMCID: PMC7608247 DOI: 10.1038/s41433-019-0743-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background Prognostic factors for TB-associated uveitis (TBU) remain mostly unknown, due to the challenges in interpretation of patient data. We present consensus list of prognostic factors for resolution of inflammation in TBU, by experts across the Asia-Pacific region. Methods We applied a modified Delphi technique to generate consensus on prognostic factors influencing the resolution of inflammation in TB-associated: anterior uveitis (AU), retinal vasculitis (RV), and multifocal serpiginoid choroiditis (MSC). The initial questionnaire was developed through a face-to-face meeting. Sixteen uveitis experts from eleven Asia-Pacific countries were included. A single investigator circulated the questionnaire electronically and received the responses. Participants scored each item on 4-point Likert scale, in three successive rounds. After each round, a number of items were reduced based on response, and summary of responses was provided to participants. At the end of Round 3, items were considered significant if they: (1) achieved a median ≥2, and interquartile range ≤1, and (2) ≥75% of the respondents agreed on whether the item was a positive or negative prognostic factor. Results Forty-two putative questionnaire items were considered. At the end of Rounds 3, 4, 9, and 8 items in AU, RV, and MSC, respectively, met significance criteria. These included duration of disease, previous corticosteroid/immunosuppressive therapy, co-existent HIV, disease-specific imaging features, multidrug resistant TB, and duration of anti-TB therapy. Conclusions Consensus were achieved on multiple ocular and systemic factors that influence resolution of inflammation in TBU. These will form the groundwork for validation in prospective clinical trials.
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Affiliation(s)
- Soumyava Basu
- Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India.
| | - Rina La Distia Nora
- Department of Ophthalmology, Universita Indonesia & Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia
| | - Narsing A Rao
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xuejuan Jiang
- Department of Ophthalmology and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Rahhal-Ortuño M, Fernández-Santodomingo AS, Díaz-Llopis M, García-Gil R, Roca-Ginés J. Coexistent central retinal vein and artery occlusion in a patient with psoriasis receiving ustekinumab. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:304-308. [PMID: 30502969 DOI: 10.1016/j.oftal.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
A 44 year-old Caucasian male with a history of plaque psoriasis currently being treated with ustekinumab presented with sudden loss of vision in his left eye. Fundus examination showed central retinal vein occlusion coexisting with central retinal artery occlusion. Posterior examination revealed mild polycythemia, being the underlying cause unknown.
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Affiliation(s)
- M Rahhal-Ortuño
- Departmento de Oftalmología, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | | | - M Díaz-Llopis
- Departmento de Oftalmología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - R García-Gil
- Departmento de Oftalmología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - J Roca-Ginés
- Departmento de Dermatología, Hospital Universitari i Politècnic La Fe, Valencia, España
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Agarwal A, Aggarwal K, Gupta V. Infectious uveitis: an Asian perspective. Eye (Lond) 2018; 33:50-65. [PMID: 30315262 DOI: 10.1038/s41433-018-0224-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023] Open
Abstract
Several intraocular infections can present with protean manifestations posing major diagnostic and management challenges. Infections such as tuberculosis, dengue and chikungunya fever have continued to remain major endemic diseases that are associated with uveitis in the Asia Pacific region. These entities often require a high index of clinical suspicion and laboratory analysis including assays of ocular fluids and/or tissues for confirmation of the diagnosis. Infectious uveitis caused by tuberculosis, dengue and chikungunya can present with characteristic clinical features and imaging findings on ancillary investigations; that may provide clue to the early diagnosis. Use of modern imaging modalities such as enhanced-depth imaging optical coherence tomography, optical coherence tomography angiography and ultra-wide field fundus photography greatly aid in the evaluation of these conditions. In the current review, we have discussed the epidemiology, clinical phenotypes, imaging characteristics, diagnosis and management of uveitis caused by tuberculosis, dengue and chikungunya.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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