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Mahendradas P, Acharya I, Mishra SB, Sanjay S, Kawali A, Shetty R, Ghosh A, Sethu S. Bilateral retinal vasculitis due to presumed sarcoidosis with rickettsial retinitis. Eur J Ophthalmol 2024; 34:NP116-NP121. [PMID: 37957944 DOI: 10.1177/11206721231212776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To describe a case of bilateral retinal vasculitis due to presumed sarcoidosis and rickettsial retinitis complicated with neovascularization with tear biomarker analysis. METHODS A retrospective case report. RESULTS A 16-year-old male presented with bilateral retinal vasculitis and retinitis in both eyes with inferotemporal quadrant neovascularization in the right eye. Multimodal imaging revealed the presence of active inflammation in both eyes. Weil Felix test was positive with raised ACE levels. This patient was treated with local and systemic steroids, doxycycline, and laser photocoagulation followed by oral methotrexate therapy which resulted in clinical resolution with recovery of visual acuity. Tear biomarker analysis showed raised sICAM-1 and MMP-9 levels in both eyes which significantly reduced following treatment. CONCLUSION Ocular sarcoidosis with rickettsial infection is a rare association. Tear biomarkers correlated well with clinical and imaging manifestations. High index of suspicion and aggressive anti-inflammatory therapy can help control inflammation and restore good vision.
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Affiliation(s)
- Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Isha Acharya
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Eye Foundation, Bengaluru, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Eye Foundation, Bengaluru, Karnataka, India
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Tungsattayathitthan U, Jenjanya S, Choopong P, Sanphan W, Tesavibul N, Boonsopon S. Prevalence, clinical characteristics, and independent predictors of uveitic macular edema in an Asian population: a retrospective cohort study. BMC Ophthalmol 2024; 24:181. [PMID: 38649909 PMCID: PMC11036638 DOI: 10.1186/s12886-024-03447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND To determine the prevalence, clinical characteristics, and independent predictors of uveitic macular edema (UME) in patients with intermediate, posterior and panuveitis. METHODS We retrospectively reviewed the records of patients with intermediate, posterior, and panuveitis who underwent macular assessment using optical coherence tomography between January 2015 and February 2020. The prevalence of UME and clinical characteristics of the patients were described. Predictors of UME were identified using multivariate regression analysis. RESULTS A total of 349 patients were included. The mean age was 41 years, female: male ratio was 1.3:1. The prevalence of UME was 51.9%. UME was found in 33.9%, 56.9%, and 54.1% of the intermediate, posterior, and panuveitis cases, respectively. Among patients with UME, 47% had infectious uveitis, 32.6% had idiopathic uveitis, and 20.4% had immune-mediated uveitis. Diffuse macular edema was the most frequently observed pattern (36.5%). Multivariate analysis showed that factors independently associated with UME included age at uveitis onset (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00-1.03, P = 0.036), PU and panuveitis compared with intermediate uveitis (aOR 2.09, 95% CI 1.14-3.86, P = 0.018), and infectious uveitis compared with noninfectious uveitis (aOR 2.13, 95% CI 1.34-3.37, P = 0.001). CONCLUSIONS Increasing age at uveitis onset, posterior/panuveitis, and infectious etiology are predictive factors for UME in patients with intermediate, posterior and panuveitis.
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Affiliation(s)
- Usanee Tungsattayathitthan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Sukanda Jenjanya
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Wilawan Sanphan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand.
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Sidiqi AM, Bhalla M, Khan HM, Chan F, Lowe C, Navajas EV. Treatment outcomes of PCR-positive acute retinal necrosis. Ir J Med Sci 2024; 193:509-516. [PMID: 37365446 DOI: 10.1007/s11845-023-03426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Acute retinal necrosis (ARN) is a progressive necrotizing retinitis caused by viral infection. Optimal management strategies have not been established for this detrimental disease. Previous literature published suggests that Varicella-zoster virus (VZV) and Herpes simplex virus-1 (HSV1) are the most common promoters of acute retinal necrosis (ARN). AIMS The purpose of our study was to investigate the viral distribution, demographic, and treatment outcomes of ARN. METHODS A retrospective chart review evaluated data from PCR-positive ARN patients diagnosed between 2009 and 2018. RESULTS Analysis of fourteen eyes from 12 patients found CMV and VZV as the commonest causes of ARN. Patients on 1 g of valacyclovir three times a day (V1T) had worse vision between first and final visits (mean difference of 1.25 ± 0.65, n = 2) compared with patients treated with 2 g of valacyclovir three times a day (V2T), or 900 mg twice a day of valganciclovir (V9B) (mean difference of - 0.067 ± 0.13, n = 6, and 0.067 ± 0.067, n = 6, respectively). Both V1T patients developed retinal detachments (RD). Both CMV patients treated with intravitreal triamcinolone developed ARN, elevated IOP, and one developed multiple RD. CONCLUSIONS Our review found increased incidence of CMV-positive ARN. Patients with zone 1 disease had worse initial visual acuity. Moreover, patients had more favorable outcomes with V2T and V9B compared to V1T. CMV-positive patients clinically worsened after intravitreal steroid injections, further underscoring the value of a PCR diagnosis to tailor the patients' treatment plan accordingly.
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Affiliation(s)
- Ahmad M Sidiqi
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mahadev Bhalla
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Haaris M Khan
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Forson Chan
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Lowe
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada
| | - Eduardo V Navajas
- Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
- Eye Care Centre, Section C, 2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada.
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Ma Z, Gao X, Zhu S. Late-Onset Panuveitis in a Chinese Girl with Sporadic Blau Syndrome: A Case Report. Case Rep Ophthalmol 2024; 15:388-393. [PMID: 38660583 PMCID: PMC11042796 DOI: 10.1159/000536005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/15/2023] [Indexed: 04/26/2024] Open
Abstract
Introduction Blau syndrome (BS) is a rare autoimmune disease. We report here an atypical case of BS. Case Presentation We present a case of late-onset eye manifestations in a Chinese girl of 18 years old with sporadic BS, presenting with panuveitis. We performed comprehensive ocular examinations including fluorescein fundus angiography and indocyanine green angiography for her. The oral hormone plus local anti-inflammatory eye drops have well controlled the inflammation of her eyes. Conclusion Our case highlights the necessity of systemic medical history inquiry for every eye discomfort.
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Affiliation(s)
- Zicheng Ma
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinxiao Gao
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Siquan Zhu
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Lidder AK, Choi S, Modi YS, Brodie SE, Davis JL, Gregori NZ, Lam BL. Bilateral exudative retinal detachments after subretinal gene therapy with voretigene neparvovec-rzyl for RPE65 Leber Congenital Amaurosis. Am J Ophthalmol Case Rep 2023; 32:101879. [PMID: 37521805 PMCID: PMC10373644 DOI: 10.1016/j.ajoc.2023.101879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To report panuveitis with exudative retinal detachments in a healthy 27-year-old woman with biallelic mutations in the RPE65 gene, who underwent bilateral sequential gene therapy with subretinal administration of voretigene neparvovec-rzyl. Observations Visual acuity improved for 30 days after surgery as oral corticosteroids were tapered. At postoperative week 6, vision declined due to sudden onset uveitis and exudative retinal detachments in both eyes. HLA Class II typing revealed the haplotype associated with sympathetic ophthalmia and Vogt-Koyanagi-Harada (VKH). The inflammation improved after corticosteroid, mycophenolate mofetil, and adalimumab therapy while vision remained poor. Conclusions and Importance Surgically-induced sympathetic ophthalmia is a plausible explanation for the clinical findings; surgery of both eyes within one week would conceal the inciting eye. VKH or inflammation related to the gene therapy are other possible etiologies but severe bilateral panuveitis has not been reported with voretigene neparvovec-rzyl. Informed consent for gene therapy surgery should include a discussion of the rare complication of sympathetic ophthalmia following vitrectomy surgery.
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Affiliation(s)
- Alcina K. Lidder
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stephanie Choi
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
| | - Yasha S. Modi
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
| | - Scott E. Brodie
- Harkness Eye Institute, Columbia University, New York, NY, United States
| | - Janet L. Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ninel Z. Gregori
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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Beltrán Catalán E, Brito García N, Pato Cour E, Muñoz Fernández S, Gómez Gómez A, Díaz Valle D, Hernández Garfella M, Francisco Hernández FM, Trujillo Martín MDM, Silva Fernández L, Villanueva G, Suárez Cuba J, Blanco R. SER recommendations for the treatment of uveitis. Reumatol Clin (Engl Ed) 2023; 19:465-477. [PMID: 37839964 DOI: 10.1016/j.reumae.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/12/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To develop evidence-based expert-consensus recommendations for the management of non-infectious, non-neoplastic, non-demyelinating disease associated uveitis. METHODS Clinical research questions relevant to the objective of the document were identified, and reformulated into PICO format (patient, intervention, comparison, outcome) by a panel of experts selected based on their experience in the field. A systematic review of the available evidence was conducted, and evidence was graded according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. Subsequently, recommendations were developed. RESULTS Three PICO questions were constructed referring to uveitis anterior, non-anterior and complicated with macular edema. A total of 19 recommendations were formulated, based on the evidence found and/or expert consensus. CONCLUSIONS Here we present the first official recommendations of the Spanish Society of Rheumatology for the treatment of non-infectious and non-demyelinating disease associated uveitis. They can be directly applied to the Spanish healthcare system as a tool for assistance and therapeutic homogenisation.
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Affiliation(s)
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
| | | | - Santiago Muñoz Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía. Universidad Europea de Madrid, Madrid, Spain
| | | | - David Díaz Valle
- Unidad de Inflamación Ocular, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Lucía Silva Fernández
- Servicio de Reumatología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Julio Suárez Cuba
- Servicio de Reumatología, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Ricardo Blanco
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
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Iuliano L, Kacerik M, Corbelli E, Miserocchi E, Modorati G, Bandello F, Codenotti M. Panuveitis of undetermined origin after diagnostic pars plana vitrectomy: clinical characterization and long-term outcome from a tertiary referral center. Int Ophthalmol 2023; 43:2841-2849. [PMID: 36913167 DOI: 10.1007/s10792-023-02683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/04/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE To identify the characteristics and outcome of panuveitis of undetermined origin (PUO) after diagnostic vitrectomy. METHODS Retrospective analysis of all patients who underwent vitrectomy for diagnostic/therapeutic purposes from 2013 to 2020, whose vitreous biopsies turned out negative and final diagnoses were not clinically supported. RESULTS Of 122 operated eyes, 36 eyes (29.5%) were defined as PUO (67.8 ± 14.9 years). The presenting clinical picture revealed a predominantly bilateral condition (70% of eyes) with significant posterior segment involvement: 3.1 ± 0.6 vitritis, 61.1% of eyes with retinal vasculitis, 44.4% with macular edema, and 30.6% with exudative retinal detachment. Presenting visual acuity was 1.2 ± 0.7 logMAR, and up to 90% remained stable or improved vision over a ~ 3.5 year observation period. None of the presenting clinical features turned out to be predictive of final visual outcome or survival. CONCLUSIONS PUO is present in up to 30% of cases after diagnostic/therapeutic vitrectomy. This mainly bilateral condition shows chronic and overall stable long-term outcome, generally with retained steady visual function.
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Affiliation(s)
- Lorenzo Iuliano
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
| | - Mirko Kacerik
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Marco Codenotti
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
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Kongwattananon W, Rattanaphong T. Granulomatous panuveitis in disseminated sporotrichosis: case report and review of the literature. J Ophthalmic Inflamm Infect 2023; 13:11. [PMID: 36892661 PMCID: PMC9998770 DOI: 10.1186/s12348-023-00330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/04/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE To report a case of intraocular sporotrichosis presenting with bilateral granulomatous panuveitis. METHODS Observational case report and literature review. CASE PRESENTATION A 62-year-old woman with a history of polycythemia vera presented with a non-healing ulcer at the left index finger, generalized erythematous papules, and bilateral granulomatous panuveitis. Cultures of skin and amputated finger identified Sporothrix schenckii. The diagnosis of intraocular sporotrichosis secondary to disseminated sporotrichosis was made. Intravenous liposomal Amphotericin B and intravitreal Amphotericin B were used to control systemic and ocular disease resulting in resolution of the skin lesions and intraocular inflammation. CONCLUSIONS Intraocular sporotrichosis can manifest as bilateral granulomatous panuveitis in the setting of disseminated sporotrichosis. Treatment with intravenous and intravitreal antifungal therapy is useful for controlling intraocular infection.
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Affiliation(s)
- Wijak Kongwattananon
- Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society 1873,, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Tanavadee Rattanaphong
- Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society 1873,, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
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Kung TPH, Zhang C, Sieminski SF. Acute panuveitis after COVID-19 mRNA booster vaccination following cataract surgery. Am J Ophthalmol Case Rep 2022; 28:101726. [PMID: 36267387 PMCID: PMC9557133 DOI: 10.1016/j.ajoc.2022.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/22/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To report a case of presumed COVID-19 Pfizer third dose (booster) vaccination leading to severe panuveitis mimicking acute endophthalmitis in the early postoperative period following routine cataract extraction and intraocular lens implantation. Observations A 68-year-old female with mild refractive error who previously received 2 doses of the BNT162b2 vaccine underwent routine cataract extraction and intraocular lens implantation in the right eye. On postoperative day (POD) 2 the patient received her BNT162b2 booster vaccination. On POD 3 the patient's vision was hand motion at face with photophobia. Anterior segment examination was significant for 2+ conjunctival injection, mild stromal edema, 4+ cell and flare with trace hypopyon, and 4+ anterior vitreous cell without any wound leak. Subsequent Gram staining, culture for aerobic and anaerobic bacteria, KOH preparation, and PCR testing for infectious organisms were also obtained, all of which were found to be negative. ESR and CRP values were also negative. The patient was started on intravitreal injections of vancomycin and ceftazidime, as well as oral moxifloxacin, fortified vancomycin and tobramycin drops, prednisolone acetate 1%, and atropine 1%. On POD 5 the patient reported significant improvement of her vision and was found to have 20/80 vision. On POD 12 her vision improved to 20/25, and improved further on POD 19 to 20/20 vision with a completely normal examination. Cultures remained negative throughout the entire course. Conclusions and importance This is the first report to suggest a possible association between the BNT162b2 booster vaccination and development of acute panuveitis in the postoperative period after routine cataract extraction and intraocular lens implantation. This condition may mimic acute bacterial postoperative endophthalmitis and may portend a more favorable prognosis, but the authors believe such cases should nonetheless be treated aggressively as presumed infection.
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Affiliation(s)
- Timothy-Paul H. Kung
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 955 Main St, Buffalo, NY, 14203, USA
| | - Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, University at Buffalo, 1176 Main St, Buffalo, NY, 14209, USA
- Corresponding author. 1176 Main St, Buffalo, NY, 14209, USA.
| | - Sandra F. Sieminski
- Department of Ophthalmology, Ross Eye Institute, University at Buffalo, 1176 Main St, Buffalo, NY, 14209, USA
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Rajan RS, Mohamed SO, Salowi MA. Demography and clinical pattern of newly diagnosed uveitis patients in Malaysia. J Ophthalmic Inflamm Infect 2022; 12:28. [PMID: 36048269 PMCID: PMC9437154 DOI: 10.1186/s12348-022-00306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Uveitis is one of the common causes of visual impairment in Malaysia. It remains a challenging entity to diagnose and manage due to variation in its clinical presentation. This study aims to observe the demographic and clinical pattern of cases from the participating ophthalmology units in Malaysia. Methods This study involved prospective and multicentered data collection for patients newly diagnosed with uveitis from 1st January 2018 to 31st December 2018. Variables collected and analyzed included age, gender, ethnicity, nationality, state of origin, laterality, granulomatous or non-granulomatous uveitis, and etiology of uveitis. Results A total of 1199 newly diagnosed uveitis patients were analyzed within the study period. There was a significant association between the anatomical location of uveitis with age at presentation. The percentage of patients with anterior uveitis was higher in the ‘40 to 60’ years and ‘above 60’ years age groups at 52.1% (n = 210) and 61.3% (n = 114) respectively. In contrast the percentage of patients with posterior and panuveitis was higher in the 1 to 20 and 20 to 40 years age groups at 51.4% (n = 54) and 48.7% (n = 246) respectively. Sixty three percent of the patients presented with unilateral uveitis (n = 760, p < 0.001) vs bilateral. Non-granulomatous uveitis comprised 84.5% of all patients (n = 1013, p < 0.001) compared to granulomatous uveitis. Non-infectious etiology contributed to 65.7% of all patients (n = 788, p < 0.001) with the majority being unclassifiable uveitis (n = 686, 57.2%,). Specific inflammatory entities contributed to only 8.5% (n = 102) of the non-infectious causes with Vogt-Koyanagi-Harada (VKH) syndrome being the most common (n = 25, 2.1%,). Infectious uveitis comprised 34.3% (n = 411) with tubercular (TB) uveitis (n = 105, 8.8%) and viral uveitis (n = 107, 8.9%) contributing the most followed by ocular Toxoplasmosis (n = 93,7.8%).] Conclusion This study has highlighted the demographic data and common causes of uveitis in Malaysia.
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Affiliation(s)
| | - Shelina Oli Mohamed
- Medical Retina and Uveitis Department, Hospital Shah Alam, Shah Alam, Malaysia.
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Barchichat I, Thiel M, Job O, Schmid M. Bilateral blindness after uneventful brolucizumab injection for macular degeneration. BMC Ophthalmol 2022; 22:80. [PMID: 35172763 PMCID: PMC8848976 DOI: 10.1186/s12886-022-02305-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background We report a very severe case of bilateral panuveitis and ischemic vasculitis with possible perineural inflammation, which followed bilateral intravitreal brolucizumab administration in a patient with neovascular age-related macular degeneration (nAMD). Case presentation On December 11, 2020, a 81-year-old woman presented with severe bilateral loss of vision. Eight days earlier, she had received uneventful bilateral injection of brolucizumab, a novel anti-vascular endothelial growth factor (VEGF) single-chain variable region (scFv) recombinant protein drug, for treatment of neovascular age-related macular degeneration (nAMD). Slit-lamp examination revealed signs of a bilateral panocular vasculitis with ischemia. Scanning laser ophthalmoscopy of her left eye revealed marked vascular sheathing. T1 fat-saturated post-contrast images of the orbit revealed a higher-than-normal signal of the choroid, with localized choroidal detachment. Additionally, pathologic enhancement was visible around the optic nerve in the orbit, which was interpreted as vasculitis. Due to the severe bilateral panuveitis with vasculitis, an additional vitreous tap was obtained, which revealed elevated levels of interleukin six and interleukin ten. Conclusions To our knowledge, this is the first documented case showing both panuveitis and ischemic vasculitis with possible perineural inflammation. We do not recommend performing bilateral brolucizumab injections until more data is available regarding the mechanism of brolucizumab-induced vasculitis. From a clinical point of view, we find it difficult to justify the use of brolucizumab when there are other well-known agents, such as ranibizumab and aflibercept, which have better safety profiles and comparable efficacy.
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Affiliation(s)
- Ilan Barchichat
- Department of Ophthalmology, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Luzern-16, Switzerland.
| | - Michael Thiel
- Department of Ophthalmology, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Luzern-16, Switzerland
| | - Oliver Job
- Department of Ophthalmology, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Luzern-16, Switzerland
| | - Martin Schmid
- Department of Ophthalmology, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Luzern-16, Switzerland
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Sukon N, Tesavibul N, Choopong P, Panyayingyong N, Boonsopon S. Extranodal natural killer/T-cell lymphoma presenting as hypopyon panuveitis: a case report. BMC Ophthalmol 2022; 22:46. [PMID: 35100995 PMCID: PMC8803407 DOI: 10.1186/s12886-022-02277-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, generally affects the orbit by direct extension. It can even rarely present as severe intraocular inflammation mimicking endophthalmitis. Delayed diagnosis and treatment are frequently reported. Case presentation A 43-year-old woman presented with 2-month blurred vision in her left eye. Ocular examination revealed hypopyon panuveitis. She was initially diagnosed with endogenous endophthalmitis, which proved irresponsive to antimicrobial therapy. High-dose prednisolone was given afterward, but this failed to stop the development and continuous progression of ocular inflammation. The diagnosis of ENKTL was finally confirmed from the pathological findings of oral ulcers and cervical lymph nodes and chemotherapy was prescribed. After the first cycle of chemotherapy, the patient’s ocular inflammation subsided. Unfortunately, her left eye became phthisis with progressive visual loss within 9 months following the diagnosis. Conclusions The diagnosis of intraocular ENKTL is frequently delayed, which can lead to severe problems for treatment as the disease is aggressive with a poor prognosis. It can be found not only in elderly patients but also in a middle-aged individual. In patients with ocular inflammation, a thorough systemic evaluation and histopathological examination of the associated systemic findings is extremely helpful and may reveal the cause of the ocular inflammation, including revealing possible ENKTL.
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Affiliation(s)
- Nutchaya Sukon
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Noppakhun Panyayingyong
- Metta Pracharak Hospital (Wat Rai Khing), 52 Moo 2 Rai Khing sub-district, Sampran district, Nakhonpathom, 73210, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Barquet V, Rodríguez E, Fantauzzi A, Ortíz JC, Ulloa-Padilla JP, Vilá-Delgado MS, Fernández CJ, Almodóvar JC, Santos C, Oliver AL. Characteristics, Upon Presentation, of a Cohort of Patients with Vogt-Koyanagi-Harada Disease in Puerto Rico. P R Health Sci J 2021; 40:168-173. [PMID: 35077075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the clinical features, upon initial presentation, of a cohort of patients with Vogt-Koyanagi-Harada (VKH) disease who live in Puerto Rico. METHODS A retrospective medical record review of patients with VKH was performed. The demographic and clinical characteristics were analyzed. RESULTS Twenty-two patients who met the diagnostic criteria for VKH were identified and included in the analysis. The median age at presentation was 41 years; 68.2% were female, and all patients were Hispanics. Bilateral disease was present in 90.9% of patients, and 59.1% of patients were categorized as having probable VKH. A headache was reported in 54.5% of patients and was the most common complaint at the time of presentation; the second most common complaint was tinnitus, which was present in 22.7% of patients. Vitiligo, alopecia, and meningismus were each preset in 9.1% of patients while hearing loss and aseptic meningitis were each reported in 4.5% of patients. Seventy-seven percent of patients had either topical or systemic corticosteroid use prior to the initial encounter. CONCLUSION Our study suggests that in Puerto Rico, patients with Vogt-Koyanagi-Harada disease may have a distinctive prevalence of characteristics at the presentation when compared to other ethnic groups, including other Hispanic cohorts.
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Affiliation(s)
- Viviana Barquet
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR; Department of Ophthalmology, Cook County Health, Chicago, IL
| | - Eduardo Rodríguez
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR
| | - Andres Fantauzzi
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR
| | - Jan C Ortíz
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR
| | | | | | | | - Juan C Almodóvar
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR
| | - Carmen Santos
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR
| | - Armando L Oliver
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR
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Kao CC, Hsu SL, Sheu SJ. Presumed cytomegalovirus retinitis in a non-immune compromised patient with breast carcinoma during treatment: A case report. Am J Ophthalmol Case Rep 2021; 23:101161. [PMID: 34307962 PMCID: PMC8283142 DOI: 10.1016/j.ajoc.2021.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/24/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Cytomegalovirus (CMV) retinitis is one of the most common opportunistic infections in immunocompromised patients, including patients with acquired immunodeficiency syndrome (AIDS). CMV retinitis in non-human immunodeficiency virus (HIV)-infected patients has been reported with variable presentations. Significant intraocular inflammation is common, and visual prognosis is poor if not properly managed. Observations We present a case of presumed CMV retinitis in a non-immunocompromised breast cancer patient that occurred during cancer treatment. The ocular symptoms developed one day after partial mastectomy with intra-operative radiotherapy following five months of chemotherapy treatment. Ocular manifestations included panuveitis with mild peripheral retinitis. Conclusions and Importance Early diagnosis and prompt treatment with oral valganciclovir based on the clinical manifestation and serologic test findings helped to preserve vision.
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Affiliation(s)
- Chia-Chen Kao
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shiuh-Liang Hsu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan
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Kaza H, Tyagi M, Agarwal K, Behera S, Pappuru RR, Mohan S, Saldanha M, Videkar C, Basu S, Pathengay A, Murthy S. Vogt Koyanagi Harada Disease In Paediatric Age Group: Clinical Characteristics, Remission, Recurrences and Complications in Asian Indian Population. Semin Ophthalmol 2021; 37:187-192. [PMID: 34224303 DOI: 10.1080/08820538.2021.1948067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) syndrome in paediatric patients. STUDY DESIGN Retrospective chart analysis. METHODS: A RETROSPECTIVE Analysis of all patients ≤16 years with VKH syndrome was done. Clinical presentations, complications, recurrences and outcomes in cases of paediatric VKH were reviewed. RESULTS 72 eyes of 36 patients with a mean age at presentation of 13.7 ± 2.34 years were assessed. Mean duration of symptoms and follow up were 9.88 ± 17.3 weeks and 55 months respectively. Clinical signs at presentation included anterior chamber cells >2+(34/72eyes, 47.2%), granulomatous keratic precipitates (6 eyes, 8.3%), posterior synechiae (35 eyes,48.6%), disc edema (46 eyes, 63.8%), neurosensory retinal detachments (44 eyes, 61.1%) and 'sunset-glow' fundus (9 eyes, 12.5%). Best corrected visual acuity (BCVA) at the time of presentation was 1.3logMAR or a Snellens equivalent of 20/400 which improved to 0.51logMAR (Snellens equivalent of 20/63) at last follow up. Remission was achieved in 61.1% cases. More than half of our patients developed one or more complications. CONCLUSION VKH in paediatric patients poses a challenge due to a delayed presentation and paediatric VKH patients have a worse visual acuity at the time of presentation as compared to adult age groups. Rates of remission may be low along with high risk of complications and hence there is a need for prolonged immunosuppression.
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Affiliation(s)
- Hrishikesh Kaza
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India.,Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Komal Agarwal
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Shashwat Behera
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Rajeev R Pappuru
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Sashwanthi Mohan
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Merlin Saldanha
- Uveitis and Retina Services, GMRV Campus, L.V. Prasad Eye Institute, Visakhapatnam, India
| | - Chetan Videkar
- Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L.V. Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Uveitis and Retina Services, GMRV Campus, L.V. Prasad Eye Institute, Visakhapatnam, India
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Manandhar A, Paudyal BP. Clinicodemographic pattern and treatment outcome of Behcet's disease cases presenting in a tertiary eye center of Nepal. Int Ophthalmol 2021; 41:2861-2868. [PMID: 34218411 DOI: 10.1007/s10792-021-01845-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To know the clinical and demographic pattern, and the outcome of treatment of Behcet's disease (BD) cases in Nepal METHODS: Retrospective series of all the cases of BD who had come over the period of 12 years (Jan 2007-Dec 2015) Tilganga Institute of Ophthalmology. RESULT Twenty-one cases were included, 17 (81%) male and four (19%) female. Mean age was 28.88 ± 9.18 years. Mean follow-up period was 3.6 ± 2.6 years. All had nongranulomatous panuveitis. Hypopyon was seen in 13 (61.9%) cases. Small retinal infiltrates in 13 (61.9%) cases and retinal vasculitis in ten (47.6%) cases were seen. Cataract (in 13, 61.9%) and optic atrophy (in 11, 52.4%) cases were present. Oral ulcer was present in 20 (95.2%), genital ulcer in 15 (72%), and skin lesions in 13 (62%) cases. CONCLUSION BD affected mainly the most active age group and was predominant in male. Optic atrophy was the leading cause of irreversible vision loss. Despite being a less common condition, BD should be considered in the differential diagnosis of panuveitis cases in the Nepalese population.
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Affiliation(s)
- Anu Manandhar
- Tilganga Institute of Ophthalmology, G.P.O. Box: 561, Gaushala, Bagmati Bridge, Kathmandu, Nepal.
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Abstract
Background: COVID-19 vaccination has been accompanied by reports of inflammatory events. This report details a case of panuveitis following vaccination for COVID-19 Case.Description: A 43 year old female developed panuveitis with decreased vision three days after her second dose of Pfizer-Biontech mRNA vaccine. The choroid was significantly thickened and there was anterior chamber and vitreous inflammation. Shortly after onset of ocular symptoms she was also found have an asymptomatic COVID-19 infection. Treatment with oral and topical corticosteroids resulted in improvement in the panuveitis, with a mild recurrence after the initial attempt to taper these drugs.Conclusion: This report demonstrates a likely occurrence of vaccine-related panuveitis secondary to the Pfizer-Biotech mRNA vaccine for COVID-19.
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Affiliation(s)
- Lucy I Mudie
- Sue Anschutz-Rodgers UCHealth Eye Centers, Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jon D Zick
- Colorado Retina Associates, Englewood, Colorado, USA
| | - Mark S Dacey
- Colorado Retina Associates, Englewood, Colorado, USA
| | - Alan G Palestine
- Sue Anschutz-Rodgers UCHealth Eye Centers, Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Matsou A, Dermenoudi M, Tzetzi D, Rotsos T, Makri O, Anastasopoulos E, Symeonidis C. Peripapillary Choroidal Neovascular Membrane Secondary to Sarcoidosis-Related Panuveitis: Treatment with Aflibercept and Ranibizumab with a 50-month Follow-Up. Case Rep Ophthalmol 2021; 12:186-192. [PMID: 33976680 PMCID: PMC8077472 DOI: 10.1159/000512579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
A case of peripapillary choroidal neovascular membrane (PCNM) secondary to sarcoidosis-related panuveitis successfully treated with anti-vascular endothelial growth factor (anti-VEGF) agents and systemic immunomodulatory therapy is reported. Diagnosis and follow-up were based on fundoscopic, optical coherence tomography as well as fluorescein angiography findings. A 45-year-old female patient presented with sudden onset bilateral blurring of vision. Fundoscopy revealed bilateral granulomatous panuveitis with solitary peripheral granuloma in the right eye and PCNM in the left eye. Diagnostic work-up including conjunctival biopsy confirmed the diagnosis of sarcoidosis. Topical and systemic corticosteroids controlled the inflammation. Within 4 weeks, PCNM showed rapid enlargement (best-corrected visual acuity [BCVA]: 6/60) with foveal involvement. Monthly intravitreal aflibercept injections and systemic methotrexate were administered. After 5 aflibercept injections, anatomical and functional improvement was noted (BCVA: 6/6). Due to aflibercept unavailability, further treatment included ranibizumab injections. During a 50-month follow-up period, every anti-VEGF injection was followed by total NV regression and 6/6 BCVA. Both aflibercept and ranibizumab appear to be effective in the treatment of PCNM secondary to sarcoidosis.
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Affiliation(s)
- Artemis Matsou
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Maria Dermenoudi
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Despina Tzetzi
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Tryfon Rotsos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Olga Makri
- Department of Ophthalmology, University General Hospital of Patras, University of Patras, Patras, Greece
| | - Eleftherios Anastasopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Chrysanthos Symeonidis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Menean M, Marchese A, Bordato A, Battista M, Bandello F, Modorati G, Miserocchi E. Bilateral acute retinal necrosis during treatment with alemtuzumab for multiple sclerosis. Eur J Ophthalmol 2021; 32:NP120-NP122. [PMID: 33789493 DOI: 10.1177/11206721211006576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Alemtuzumab is a humanized monoclonal antibody used as a treatment of multiple sclerosis (MS) and chronic lymphocytic leukemia. It decreases T cell count leading to significant immunosuppression, with increased risk of systemic and ocular infections. Herein, we report a unique case of bilateral acute retinal necrosis (ARN) caused by varicella-zoster virus (VZV) in a patient affected by MS under treatment with alemtuzumab. CASE DESCRIPTION A 36-year-old man with a relapsing-remitting MS under treatment with alemtuzumab developed bilateral visual loss. Anterior segment examination displayed granulomatous keratic precipitates and 3+ cells in the anterior chamber, while fundoscopy showed bilateral 1+ vitritis and peripheral retinal necrosis, complicated by retinal detachment in the left eye. The high viral load for VZV in aqueous humor samples had a univocal interpretation for viral reactivation. In addition to systemic therapy with acyclovir, the patient was treated with bilateral intravitreal injections of foscarnet and underwent pars-plana vitrectomy and silicone oil tamponade for retinal detachment in the left eye. CONCLUSION This report shows a unique case of bilateral ARN caused by VZV associated with alemtuzumab. Any visual loss in MS patients under biologic therapy should not be underestimated, performing an accurate differential diagnosis with optic neuritis.
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Affiliation(s)
- Matteo Menean
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Bordato
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Marco Battista
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
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Kawali A, Mahendradas P, Sanjay S, K M P, Yadav J, Panchagnula R, K S S. Diagnostic and Therapeutic Challenges in Ocular Histoplasmosis - A Case Report. Ocul Immunol Inflamm 2020; 30:149-152. [PMID: 32931351 DOI: 10.1080/09273948.2020.1797114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To report a rare case of skin biopsy proven Histoplasma panuveitis.Method: Observational case report of a 76-year-old Asian Indian man presented as panuveitis. Clinical course, diagnostic and treatment difficulties and confocal microscopy findings were studied.Result: Patient presented with mild anterior uveitis, membranous vitritis and large chorio-retinal lesions in peripheral fundus with a small macular scar in the right eye. Positive quantiferon test along with chest and adrenal findings initially misled ophthalmologist and pulmonologist to commence anti-tubercular treatment with steroids which further worsened the inflammation and the fungus involved iris and scleral tissue. Skin biopsy from the lesions on thigh revealed histoplasma spores and confocal microscopy showed similar cystic lesions on endothelium. Prolonged course of anti-fungal with steroids resulted in resolution of the infection.Conclusion: Histoplasma uveitis can worsen with steroids only treatment and may invade iris and scleral tissue which may require prolonged treatment with antifungal agents.
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Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | | | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Prathima K M
- Department of Pathology, Vikram Hospital, Bangalore, India
| | - Jaydev Yadav
- Department of Dermatology, Vikram Hospital, Bangalore, India
| | | | - Sathish K S
- Department of Pulmonology, Vikram Hospital, Bangalore, India
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Gómez-Gómez A, Loza E, Rosario MP, Espinosa G, de Morales JMGR, Herrera JM, Muñoz-Fernández S, Rodríguez-Rodríguez L, Cordero-Coma M. Efficacy and safety of immunomodulatory drugs in patients with non-infectious intermediate and posterior uveitis, panuveitis and macular edema: A systematic literature review. Semin Arthritis Rheum 2020; 50:1299-1306. [PMID: 33065425 DOI: 10.1016/j.semarthrit.2020.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-infectious non-anterior uveitis (NINA) is a sight-threatening condition that often requires immunomodulatory drugs (IMDs) for its management. OBJECTIVES To evaluate the published evidence regarding the use of IMDs in adult patients with NINA uveitis including intermediate (IU) and posterior uveitis (PU), panuveitis (PanU) and macular edema (ME). METHODS We performed a systematic literature review. Search strategies were designed for Medline, Embase, and Cochrane Libraries for articles up to 2019 to evaluate the efficacy and safety of the IMDs. A quality assessment was performed using the Jadad Scale. RESULTS Nineteen randomized clinical trials were selected from the 1,103 articles retrieved. Characteristics of patients, treatment dosages and outcome measures were heterogeneous. The outcomes most frequently analyzed were visual acuity (VA), macular thickness and vitreous haze (VH). Different IMDs were used at their usual dosages. Methotrexate (MTX), micophenolate mofetil, cyclosporine A (CsA), tacrolimus, adalimumab and sarilumab were effective in NINA uveitis. Rituximab combined with MTX was effective in PU. Interferon-β was superior to MTX, albeit with more adverse events in IU with ME. CsA was similar to cyclophosphamide (Cyc) in Behçet uveitis. Tacrolimus was safer and similar to CsA. Cyc was effective in serpiginoid choroiditis, but when combined with azathioprine in PU, but did not improve VA. Secukinumab did not prevent NINA uveitis recurrences, although intravenously it showed a higher response rate than when used subcutaneously. Daclizumab did not show any benefits in Behçet NINA uveitis. CONCLUSION Several IMDs and their combinations can be useful in treating NINA uveitis. The available studies were heterogeneous regarding patient characteristics and outcomes.
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Affiliation(s)
- Alejandro Gómez-Gómez
- Medicine Department, Universidad Complutense de Madrid, Spain; Rheumatology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Estíbaliz Loza
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | | | - Gerard Espinosa
- Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Spain
| | - José M García Ruiz de Morales
- Immunology unit, Complejo Asistencial Universitario e Instituto de Biomedicina Universidad de León (IBIOMED), León, Spain
| | - José M Herrera
- Instituto Universitario de Oftalmobiología (IOBA), University of Valladolid, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Hospital Clínico Universitario de Valladolid, Spain
| | - Santiago Muñoz-Fernández
- Medicine Department, Universidad Complutense de Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - Luis Rodríguez-Rodríguez
- Medicine Department, Universidad Complutense de Madrid, Spain; Rheumatology department, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Cordero-Coma
- Uveitis unit, Complejo Asistencial Universitario e Instituto de Biomedicina University of León (IBIOMED), León, Spain.
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Wade CI, Earley KE, Justin GA, Weber ML. Vogt-Koyanagi-Harada disease presenting secondary to a post-infectious Mycoplasma pneumoniae autoimmune response. Am J Ophthalmol Case Rep 2020; 19:100793. [PMID: 32613142 PMCID: PMC7320312 DOI: 10.1016/j.ajoc.2020.100793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To report a rare case of Vogt-Koyanagi-Harada disease likely secondary to post-infectious Mycoplasma pneumoniae autoimmune response in a 14-year-old Hispanic female. Observations On presentation, visual acuity was 20/400 in the right eye and 20/20 in the left eye. The patient also had bilateral hyperemia, subretinal fluid, and vitreous cell graded at 1+. Fluorescein angiography and indocyanine green chorioangiography showed bilateral peripapillary hypofluorescence consistent with blocking and hyperflourescence consistent with staining. Laboratory testing showed elevated M. pneumoniae IgM and rising IgG antibodies. Topical steroids and oral steroids helped mitigate the systemic disease process and fully restore visual acuity through the 7-week mark. Conclusions and Importance The patient had elevated M. pneumoniae IgM and rising IgG antibodies resulting in ocular inflammation likely secondary to an autoimmune response. In this case of post-infectious M. pneumoniae, topical corticosteroids were beneficial in mitigating ocular manifestations initially, although oral steroids were needed and tapered over 6 weeks.
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Affiliation(s)
- Christian I Wade
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Keith E Earley
- Department of Ophthalmology, Keesler Air Force Base, Biloxi, MS, USA
| | - Grant A Justin
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA.,Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD, USA
| | - Marissa L Weber
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA
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Marín-Noriega MA, Muñoz-Ortiz J, Mosquera C, de-la-Torre A. Ophthalmological treatment of early-onset sarcoidosis/Blau syndrome in a Colombian child: A case report. Am J Ophthalmol Case Rep 2020; 18:100714. [PMID: 32346654 PMCID: PMC7178324 DOI: 10.1016/j.ajoc.2020.100714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/21/2020] [Accepted: 04/13/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To report the ophthalmological approach of a patient with Blau syndrome (BS) in Colombia. Observations We describe a 9-year-old Colombian boy with sporadic BS due to a de novo nucleotide-binding oligomerization domain containing 2 (NOD2) mutation, who presented with joint and dermatologic symptoms. He was referred to the uveitis service with a single functional eye, due to retinal detachment in the other eye. Despite treatment with corticosteroids, methotrexate, and adalimumab, the patient continued to exhibit progressive disease. Conclusion BS-related uveitis is characterized by severe ocular morbidity. Appropriate interdisciplinary treatment is necessary for the correct identification and management of the disease, considering the inherent difficulty in its diagnosis due to its diverse clinical manifestations. The severity of BS-related uveitis in this report highlights the need for more effective therapies.
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Affiliation(s)
- María Alejandra Marín-Noriega
- NeURos Research Group. Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- NeURos Research Group. Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.,Escuela Barraquer Research Group. Escuela Superior de Oftalmología del Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Catalina Mosquera
- Programa de Reumatología Pediátrica. Universidad Del Bosque, Calle 131A #9-2, Bogotá, Colombia
| | - Alejandra de-la-Torre
- NeURos Research Group. Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia
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Dermarkarian CR, Patel NA, Villegas VM, Harbour JW. Bilateral uveitis associated with nivolumab therapy for metastatic non-small cell lung cancer. Am J Ophthalmol Case Rep 2020; 18:100691. [PMID: 32322748 PMCID: PMC7168346 DOI: 10.1016/j.ajoc.2020.100691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 01/31/2019] [Accepted: 04/02/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To report a case of bilateral uveitis secondary to intravenous nivolumab therapy in a patient with stage IV non-small cell lung cancer. Observations A 53-year-old male with stage IV non-small cell lung cancer presented with gradual onset of blurry vision in the left eye for nine days after completion of the first cycle of intravenous nivolumab chemotherapy. At initial presentation, best-corrected visual acuity was 20/25 in the right eye and 20/30 in the left eye. Slit lamp biomicroscopy examination of the left eye showed temporal injection of the conjunctiva and sclera, granulomatous keratic precipitates, and vitreous cells in the posterior segment. Imaging studies, including fundus photography, fluorescein angiography, fundus autofluorescence, optical coherence tomography, iridocyanine green angiography, and B scan ultrasonography, demonstrated acute inflammation in the posterior segment of the right eye and anterior, intermediate and posterior segments of the left eye. Nivolumab was discontinued and the patient received a course of corticosteroids resulting in resolution of visual complaints. The patient subsequently developed elevated and sustained intraocular pressures and decreased visual acuity in the left eye secondary to treatment complications. The patient was then lost to follow-up. Conclusions and Importance To our best knowledge, this is a rare case of bilateral uveitis secondary to intravenous nivolumab use and the sixteenth reported case of nivolumab-induced uveitis. Physicians should be aware of possible ocular complications associated with the use of nivolumab and provide prompt treatment when necessary.
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Affiliation(s)
| | - Nimesh A Patel
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
| | - Victor M Villegas
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
| | - J William Harbour
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
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25
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Toh ZH, Agrawal R. Diagnostic dilemma: Unilateral panuveitis mimicking endophthalmitis in very severe HLA B27-associated uveitis. Am J Ophthalmol Case Rep 2020; 17:100589. [PMID: 31970307 PMCID: PMC6965704 DOI: 10.1016/j.ajoc.2020.100589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/05/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To report a case of a 28-years-old male who presented with a worsening unilateral panuveitis after intensive topical steroid therapy which resulted in a diagnostic and treatment dilemma as to whether the patient should be treated as for infective endophthalmitis despite no immediate known infective risk factors. Observations A patient presented initially with unilateral non-granulomatous acute anterior uveitis which worsened after being started on intensive steroid therapy, developing fibrinous panuveitis. The rapid worsening of inflammation and vision deterioration despite being on intensive steroid therapy resulted in the patient subsequently being treated as for infective endophthalmitis. Anterior chamber and vitreous tap were done and intravitreal antibiotics were administered, along with topical antibiotics therapy. Vitrectomy was withheld due to the lack of conclusive evidence of infective etiology and risk factors. Full uveitis and infective workup were done. Investigations were largely unremarkable, and fluid and vitreous cultures were negative. HLA B27 was positive. The patient was subsequently started on systemic oral corticosteroids and improved in terms of his visual acuity, signs and symptoms. Conclusions HLA B27-associated uveitis can present in a range of clinical spectrum with the extreme being of unusual severity in the form of fibrinous panuveitis that can mimic infective endophthalmitis. This can lead to a dilemma in management and subject patients to unnecessary risks from diagnostic and therapeutic interventions. Patients under this subgroup may require long term systemic immunosuppression therapy for disease remission and will require long term follow up.
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Affiliation(s)
- Zhi Hong Toh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
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26
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Saincher SS, Gottlieb C. Ozurdex (dexamethasone intravitreal implant) for the treatment of intermediate, posterior, and panuveitis: a systematic review of the current evidence. J Ophthalmic Inflamm Infect 2020; 10:1. [PMID: 31925591 PMCID: PMC6954157 DOI: 10.1186/s12348-019-0189-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background This study aims to determine if the intravitreal dexamethasone implant (DEX implant, Ozurdex; Allergan, Inc., Irvine, California) is effective for treating intermediate, posterior, and panuveitis as a monotherapy or adjunctive treatment to systemic immunomodulatory therapies. Methods A systematic review using MEDLINE, EMBASE, and PubMed database searches was conducted with the Oxford Centre for Evidence-based Medicine Levels of Evidence criteria to select publications. Available background information and patient data from each study was tabulated. Outcomes studied were central retinal thickness (CRT), best corrected visual acuity, intraocular inflammation (anterior chamber cells, vitreous haze), number of patients with prior and concomitant immunomodulatory treatments, intraocular pressure (IOP) elevation (≥ 25 mmHg), and other adverse effects associated with the implant. Results One hundred ninety-five (61.51%) patients had previous immunomodulatory treatment while 232 (64.8%) were treated with concomitant immunomodulatory therapy with the DEX implant. CRT decreased by an average of 198.65 μm (42.74%). Visual acuity improved to an average of 0.451 (logMAR) or 20/57 (Snellen) which is a 43.11% improvement from baseline. One hundred seventy-three (59%) of eyes were quiescent at the end of the trials, of which 40 (13.7%) previously inflamed eyes became quiescent. Elevated IOP occurred in 91 (20.6%). The most common adverse events were cataract/posterior subcapsular opacities in 47 (11.03%) patients and conjunctival hemorrhage in 24 (5.44%) patients. Conclusions The DEX implant is an effective medication for the treatment of posterior segment uveitis, uveitic macular edema, and results in improved visual acuity. Development of elevated IOP and cataract should be closely monitored as they are tangible risks associated with the DEX implant. This study was not able to determine whether the DEX implant was more effective as a monotherapy or as an adjunctive therapy to systemic immunomodulatory treatment.
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Affiliation(s)
- Saanwalshah Samir Saincher
- Department of Health-Sciences, Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK. .,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Chloe Gottlieb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,University of Ottawa Eye Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW Box 307, Ottawa, Ontario, K1H 8L6, Canada
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Rearigh L, Kedar S, Bares SH. Uveomeningeal syndrome in a healthy, young male: an unusual presentation of West Nile virus. J Neurovirol 2019; 26:281-283. [PMID: 31713053 DOI: 10.1007/s13365-019-00808-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
West Nile virus (WNV) is an RNA flavivirus transmitted through a mosquito vector. In 2018 Nebraska reported 242 cases, the highest incidence of WNV since 2003. This included 119 neuroinvasive cases (49%) and 11 deaths (4.5%) (DHHS 2018). Clinical presentation ranges from uncomplicated symptoms including fever, headache, and myalgias to neuroinvasive disease characterized by meningoencephalitis, flaccid paralysis, and other neurologic manifestations. Neuroinvasive WNV usually occurs in elderly and immunocompromised individuals, and ocular involvement is often not detected until later in the disease course. We describe a case of neuroinvasive WNV presenting with uveomeningitis in a young and otherwise healthy patient.
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Affiliation(s)
- Lindsey Rearigh
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE, 68198-5400, USA.
| | - Sachin Kedar
- Department of Neurological Sciences and Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 988435 Nebraska Medical Center, Omaha, NE, 68198-8435, USA.
| | - Sara H Bares
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE, 68198-5400, USA
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28
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Alba-Linero C, Barberi GE, Lloren Ç V, Adán A. Diagnostic vitrectomy: a case series in a single referral center. ACTA ACUST UNITED AC 2019; 94:529-535. [PMID: 31606240 DOI: 10.1016/j.oftal.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. METHODS A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. RESULTS Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. CONCLUSIONS Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.
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Affiliation(s)
- C Alba-Linero
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España.
| | - G Espinosa Barberi
- Ophthalmology Department, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, España
| | - V Lloren Ç
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España
| | - A Adán
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, España
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29
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Chee SP, Afrin M, Tumulak MJ, Siak J. Role of Optical Coherence Tomography in the Prognosis of Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2019; 29:118-123. [PMID: 31577462 DOI: 10.1080/09273948.2019.1655580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To evaluate the prognostic value of OCT in acute VKH diseaseMethods: Retrospective series of consecutive VKH patients seen with the first presentation, a minimum follow-up of 1 year and serial OCT imaging. The primary outcome was the clinical activity phase at 1, 2 and 3 years.Results: Among 29 subjects, 7 resolved, 17 became chronic, and 5 developed chronic recurrent VKH. Median RNFL measurement obtained 2 months post-treatment was higher among subjects who developed chronic VKH (p-value = 0.03) and chronic recurrent disease (p-value = 0.04). Median CRT 1-week post-treatment was lower among subjects who developed PPA (p-value = 0.03). CRT 2 months post-treatment was higher among subjects who developed vitiligo (p-value = 0.02).Conclusion: OCT is helpful in early recognition of the predominantly optic disc swelling variant which carries a poorer prognosis. Lower CRT reading at 1 week and persistently raised CRT at 2 months post-treatment correlated with chronic recurrent disease.
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Affiliation(s)
- Soon-Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Singapore.,Uveitis Research Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Ophthalmology & Visual Sciences Academic Clinical Program, Singapore, Singapore
| | - Mafruha Afrin
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Singapore
| | - Mayjane Jg Tumulak
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Singapore
| | - Jay Siak
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Singapore.,Uveitis Research Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Ophthalmology & Visual Sciences Academic Clinical Program, Singapore, Singapore
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30
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Rogaczewska M, Puszczewicz M, Stopa M. Exclusively ocular and cardiac manifestation of granulomatosis with polyangiitis - a case report. BMC Ophthalmol 2019; 19:139. [PMID: 31253129 PMCID: PMC6599305 DOI: 10.1186/s12886-019-1148-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibodies (ANCA)-associated necrotizing granulomatous vasculitis that affects small to medium size vessels. While the classical form with renal and respiratory tract involvement is mainly seen, a limited form (i.e., with no renal disease) may also occur. We present an unusual case of GPA manifesting merely as a bilateral ocular involvement and complete heart block. CASE PRESENTATION We report a case of a 60-year-old male patient with a limited form of GPA who initially presented with bilateral chronic conjunctivitis and complete atrioventricular block. His visual acuity subsequently declined due to progression to bilateral panuveitis with exudative retinal detachment. The laboratory investigation revealed the elevation of acute phase reactants and strongly positive cytoplasmic ANCA (c-ANCA). Despite negative conjunctival and musculocutaneous biopsy results, the positive c-ANCA, and the clinical manifestation, i.e., heart and ocular involvement, led to the diagnosis of GPA. The remission was achieved with cyclophosphamide and methylprednisolone systemic therapy. CONCLUSIONS A limited form of GPA may be a diagnostic chameleon. Though rare, it is essential to consider even extremely uncommon findings. Our patient is the first case of such a unique demonstration of the limited GPA manifesting as a bilateral ocular involvement and complete heart block.
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Affiliation(s)
- Małgorzata Rogaczewska
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, ul. Grunwaldzka 16/18, 60-780, Poznan, Poland
| | - Mariusz Puszczewicz
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, ul. 28 Czerwca 1956 r. 135/147, 61-545, Poznan, Poland
| | - Marcin Stopa
- Department of Ophthalmology, Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, ul. Grunwaldzka 16/18, 60-780, Poznan, Poland.
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31
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Wang D, Bloomberg JD, Sobrin L, Goldstein D, Skondra D. Atypical herpes simplex virus type 2 acute retinal necrosis presentation with large subretinal lesion. Am J Ophthalmol Case Rep 2019; 15:100501. [PMID: 31304428 PMCID: PMC6599871 DOI: 10.1016/j.ajoc.2019.100501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/06/2022] Open
Abstract
Purpose To report the unique clinical findings of a case of Herpes Simplex Virus Type 2 herpetic retinitis manifesting as a large elevated subretinal lesion. Observations A 26-year-old Hispanic male with no significant past medical history presented with a one-week history of right eye pain and endorsement of worsening vision. Ophthalmic examination of the right eye identified a markedly elevated white subretinal lesion with associated findings of vitritis and hypotony. Ultrasound biomicroscopy demonstrated a diffusely thickened choroid and confirmed the observed subretinal mass. Examination of the fellow left eye was largely unremarkable with the exception of lesions suggestive of inactive chorioretinal scars. Diagnostic vitrectomy and vitreous PCR (polymerase chain reaction) was positive only for HSV-2 (herpes simplex virus type 2) and verified by two independent laboratories. The observed subretinal lesion of right eye improved on intravenous acyclovir and intravitreal foscarnet treatment. Conclusions and Importance Presented here is an unusual, novel clinical presentation of HSV-2 acute retinal necrosis manifesting as an elevated subretinal lesion along with findings of panuveitis. This case suggests that consideration should be given to the diagnosis of HSV ARN (acute retinal necrosis) when a subretinal elevation is concomitantly appreciated in the setting of vitritis and chorioretinal lesions.
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Affiliation(s)
- Daniel Wang
- Department of Ophthalmology, New York Eye and Ear Infirmary, 310 E. 14th Street, New York, NY, USA
| | - Justin D Bloomberg
- Department of Ophthalmology, John H Stroger Jr. Hospital of Cook County, 1969 Ogden Avenue, Chicago, IL, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, USA
| | - Debra Goldstein
- Department of Ophthalmology, Northwestern University, 645 N. Michigan Avenue, Chicago, IL, USA
| | - Dimitra Skondra
- Department of Ophthalmology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, USA
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Arevalo JF, Lasave AF, Al Ghamdi TA, Gupta V, Kozak I, Al Dhibi HA; KKESH Uveitis Survey Study Group. Retinal detachment and uveitis at a tertiary center over 10 years: the King Khaled Eye Specialist Hospital (KKESH) Uveitis Survey Study Group. Graefes Arch Clin Exp Ophthalmol 2019; 257:1857-61. [PMID: 31177301 DOI: 10.1007/s00417-019-04378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 04/24/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the frequency, etiology, treatment, and visual prognosis of retinal detachment (RD) in patients with uveitis. METHODS A retrospective review was performed in 707 consecutive patients (1042 eyes) with uveitis, of whom 97 (13.7%) (157 eyes [15.1%]) had RD. RESULTS There were 126 (12.1%) eyes with exudative retinal detachment (ERD), 16 (1.5%) with tractional retinal detachment (TRD), and 15 (1.4%) with rhegmatogenous retinal detachment (RRD). Panuveitis was most commonly associated with RD (144 (91.1%) eyes). Infectious causes were more common in RRD, and non-infectious etiologies were most common in ERD and TRD. Oral prednisone was the initial therapy in ERD. Additionally, in these cases, cyclosporine was prescribed most frequently (47.1% patients), followed by azathioprine (26.4% patients). Fourteen (87.5%) eyes with TRD and all RRD cases underwent surgery. In patients with ERD, the mean best-corrected visual acuity (BCVA) was 1.1 ± 0.7 LogMAR at baseline and 0.6 ± 0.2 LogMAR at last visit (p = 0.001). In patients with TRD, mean BCVA was 0.7 ± 0.4 LogMAR at baseline and 0.6 ± 0.4 LogMAR at last visit (p = 0.056). In patients with RRD, mean BCVA was 1.6 ± 0.9 LogMAR at baseline and 20 1.3 ± 0.9 LogMAR at last visit (p = 0.185). CONCLUSION In Saudi Arabia, ERD is observed in 12.1% of the eyes with uveitis, and less than 2% of eyes had TRD or RRD. Visual prognosis is usually good after ERD. Infection is the most frequent cause of RRD associated with uveitis and the visual prognosis is poor.
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Hart CT, Zhu EY, Crock C, Rogers SL, Lim LL. Epidemiology of uveitis in urban Australia. Clin Exp Ophthalmol 2019; 47:733-740. [PMID: 30972887 DOI: 10.1111/ceo.13517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Few prior studies have described the epidemiology of uveitis in the Australian population. BACKGROUND To report the incidence and period prevalence of active uveitis in Melbourne and detail their subtypes and aetiologies. DESIGN Cross-sectional study using retrospective medical record review in a tertiary hospital. PARTICIPANTS Patients with a coded diagnosis of uveitis who attended the emergency department or specialist ocular immunology clinic at the Royal Victorian Eye and Ear Hospital between November 2014 through October 2015 (N = 1752). METHODS Medical records were reviewed to confirm the date of diagnosis and subtype of uveitis. Incidence and prevalence rates were calculated utilizing estimates of the adult population residing in areas of greater Melbourne with more than 30 ocular-related presentations to the emergency department annually. MAIN OUTCOMES AND MEASURES Presence and date of onset, anatomical distribution and aetiology of uveitis. RESULTS During the study period, 734 new cases of uveitis and 502 cases of pre-existing uveitis requiring active treatment were confirmed. These figures yielded an incidence of 21.54 (CI 20.03, 23.15) per 100 000 person-years and a period prevalence of 36.27 (CI 34.30, 38.35) per 100 000 persons. The distribution of prevalent uveitis cases was anterior (75%), intermediate (6%), posterior (15%) and panuveitis (4%). An infectious aetiology accounted for 13.4% of cases, a systemic associated disease for 26.4% of cases, and no cause was identified in 60.2% of cases. CONCLUSION AND RELEVANCE The incidence and prevalence rates of uveitis in urban Australia were lower than recent studies from the United States and Europe.
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Affiliation(s)
- Colby T Hart
- Clinical trials research centre, Centre for Eye Research Australia, Melbourne, Victoria, Australia.,Ophthalmology Department, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Elena Y Zhu
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Carmel Crock
- Ophthalmology Department, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Sophie L Rogers
- Clinical trials research centre, Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Lyndell L Lim
- Clinical trials research centre, Centre for Eye Research Australia, Melbourne, Victoria, Australia.,Ophthalmology Department, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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DeSouza PJ, Shah R. Characterization of Blau syndrome panuveitis with wide-field fluorescein angiography. Am J Ophthalmol Case Rep 2019; 14:92-94. [PMID: 30989150 PMCID: PMC6447728 DOI: 10.1016/j.ajoc.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To describe a case of Blau panuveitis, characterized on both portable and tabletop wide-field fluorescein angiography, which resolved on systemic immunosuppression. Observations A 5-year-old female presented with bilateral eye pain, redness, and decreased visual acuity due to panuveitis and had a history of arthritis, tenosynovitis, and dermatitis. Similar ocular and systemic findings in the patient's mother and maternal half-brother prompted genetic testing that confirmed the diagnosis of the rare Blau syndrome. Portable Retcam and tabletop Optos wide-field fluorescein angiography congruently demonstrated retinal vascular and peripapillary leakage. The uveitis dramatically resolved after the addition of adalimumab to methotrexate. Quiescence was maintained with the substitution of infliximab for adalimumab. Conclusions and Importance To our knowledge, we are first to characterize Blau panuveitis retinal findings on wide-field fluorescein angiography and with the use of two different photography systems. Additionally, this report underscores the salient clinical findings of a rare disorder and suggests that robust systemic immunosuppression can effectively treat refractory ocular inflammation.
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Affiliation(s)
- Philip J DeSouza
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rajiv Shah
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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35
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Chawla R, Kapoor M, Mehta A, Tripathy K, Vohra R, Venkatesh P. Sympathetic Ophthalmia: Experience from a Tertiary Care Center in Northern India. J Ophthalmic Vis Res 2018; 13:439-446. [PMID: 30479714 PMCID: PMC6210884 DOI: 10.4103/jovr.jovr_86_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To describe our clinical experience with sympathetic ophthalmia (SO) at a tertiary eye care center in north India. Methods: In this retrospective case series, analysis of the clinical features and visual outcomes of patients diagnosed with SO between March 2012 and March 2016 were performed. Results: Ten male and four female patients (median age, 15.5 years) with SO following penetrating trauma (10 patients) or ocular surgery (four patients) were included. SO developed 2 weeks to 3 years after the insult. Mean presenting visual acuity of the sympathizing eyes was 1.086 (LogMAR). Anterior chamber reaction was documented in all eyes in which it could be assessed (14 sympathizing eyes; five exciting eyes). Neurosensory detachment was seen in 10 of 14 patients (71.5%). Five patients (35.7%) were managed with oral steroids alone, whereas nine (64.3%) were treated with intravenous pulse dexamethasone followed by oral steroids. Inflammation recurred in three patients during steroid tapering, necessitating restarting of steroid therapy with or without additional immunosuppressants. At the last follow-up, all 14 patients were in remission with low-dose oral steroids; seven patients were also on immunosuppressants. At the final follow-up, 12 of 14 (85.7%) sympathizing eyes achieved 20/40 or better visual acuity and three exciting eyes achieved at least 6/24 visual acuity. Conclusion: Although SO is a potentially blinding disorder, early detection and individualized treatment allow most patients achieve good final visual acuity.
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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
| | - Monika Kapoor
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Mehta
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Koushik Tripathy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Rueda-Rueda T, Sánchez-Vicente JL, Moruno-Rodríguez A, Molina-Socola FE, Martínez-Borrego AC, López-Herrero F. Uveitis and serous retinal detachment secondary to systemic dabrafenib and trametinib. Arch Soc Esp Oftalmol (Engl Ed) 2018; 93:458-462. [PMID: 29580759 DOI: 10.1016/j.oftal.2018.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/07/2018] [Accepted: 01/13/2018] [Indexed: 06/08/2023]
Abstract
CASE REPORT The case is presented of a 39-year-old woman with metastatic melanoma treated with dabrafenib and trametinib. She presented with a severe acute panuveitis with granulomatous anterior uveitis, vitritis, and multiple serous retinal detachments. Dabrafenib and trametinib were suspended, and treatment with a systemic and topical corticosteroid was started. A good response was obtained, with a recovery of visual acuity of 1.0 in both eyes within two weeks. DISCUSSION Dabrafenib and trametinib can lead to severe uveitis. Treatment with corticosteroids and discontinuation of therapy with dabrafenib and trametinib led to an anatomical and functional improvement, and resolved the episode rapidly. Ophthalmologists must be aware of this toxicity, given the increasing use of those drugs.
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Affiliation(s)
- T Rueda-Rueda
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L Sánchez-Vicente
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Moruno-Rodríguez
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - F E Molina-Socola
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A C Martínez-Borrego
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F López-Herrero
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Lwowski C, Kohnen T. [ Panuveitis of infectious genesis]. Ophthalmologe 2019; 116:572-5. [PMID: 30109426 DOI: 10.1007/s00347-018-0773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In a patient with sub-acute loss of vision a panuveitis with papillitis and chorioretinitis was diagnosed within an initial diagnosis of lues and human immunodeficiency virus (HIV). Epidemiological data show an increasing incidence of HIV and lues infections in recent years. Therefore, ophthalmologists need to bear an infectious etiology of inflammation of the eye in mind.
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Masuda N, Nishikawa R, Ueda T, Ogata N. Severe panuveitis with relapsing polychondritis. Am J Ophthalmol Case Rep 2018; 11:3-5. [PMID: 30050999 PMCID: PMC6058060 DOI: 10.1016/j.ajoc.2018.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/14/2018] [Accepted: 04/18/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose Relapsing polychondritis is a rare multiorgan disease characterized by repeated episodes of inflammation and deterioration of cartilages. We report a case of relapsing polychondritis that presented with severe panuveitis. Observations A 53-year-old man visited our hospital because of ocular pain in both eyes of 2 weeks' duration. His best-corrected visual acuity was 20/20 in both eyes but he had severe hyperemia of the conjunctiva bilaterally. Inflammation in the anterior segment and vitreous opacity had been getting worse in his right eye. Systemic and topical treatments were not effective, and the visual acuity of the right eye was reduced to hand motion. Thus, pars plana vitrectomy with silicone oil tamponade was performed. After the operation, the vitreous opacities and white lesions in the retina were completely resolved. His visual acuity was improved to 20/20.Three years later, he developed dizziness and swelling of both auricles of his ears, and he was found to have sensorineural deafness. He was diagnosed with relapsing polychondritis after a laryngoscopic examination.Twelve months after the diagnosis, scleritis and panuveitis developed in his left eye, and his visual acuity fell to 20/2000. We performed pars plana vitrectomy with silicone oil tamponade on his left eye. After the vitrectomy, the inflammation of the left eye was resolved. Conclusion and importance: Ophthalmologist should be aware that severe panuveitis with vitreous opacities may be the initial signs of relapsing polychondritis. In addition, vitrectomy was effective for the treatment of the ocular complications.
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Affiliation(s)
- Naonori Masuda
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
| | - Ryoko Nishikawa
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
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Sakai M, Takase H, Namba K, Mizuuchi K, Iwata D, Ishida S. Two cases of cytomegalovirus panuveitis in immunocompetent patients. Am J Ophthalmol Case Rep 2018; 10:189-191. [PMID: 29780935 PMCID: PMC5956625 DOI: 10.1016/j.ajoc.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/09/2017] [Accepted: 01/10/2018] [Indexed: 10/27/2022] Open
Abstract
Purpose To report two cases of panuveitis in immunocompetent patients in which cytomegalovirus was involved. Observation Case 1 was a 46-year-old man who had a history of recurrent anterior chamber inflammations in his left eye. After Nd:YAG laser posterior capsulotomy, he developed panuveitis with vitreous haze and periphlebitis. Polymerase chain reaction (PCR) examination revealed the presence of cytomegalovirus (CMV) DNA in the anterior chamber (AC). He responded well to a series of intravitreal injections of ganciclovir (GCV). Case 2 was a 63-year-old woman who had a history of recurrent anterior uveitis in her left eye. Two years after cataract surgery, AC inflammation, diffuse vitreous haze, and periphlebitis had developed. CMV DNA was detected in the AC. Intravitreal injections of GCV and oral valganciclovir were administered, and ocular inflammation finally improved. Conclusions and importance: We experienced two cases of CMV panuveitis in immunocompetent adults, both of which responded well to anti-viral therapies.
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Affiliation(s)
- Masato Sakai
- Departments of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Takase
- Department of Ophthalmology &Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Namba
- Departments of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Departments of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daiju Iwata
- Departments of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Departments of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Mistry S, Sudharshan S, Ganesan S, Akbar AB, Biswas J. Vogt-Koyanagi-Harada disease like presentation in patients with chronic myeloid leukemia. Am J Ophthalmol Case Rep 2018; 10:221-225. [PMID: 29780937 PMCID: PMC5956718 DOI: 10.1016/j.ajoc.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/08/2018] [Accepted: 03/08/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose To report two rare cases of chronic myeloid leukemia (CML) on tyrosine kinase inhibitors presenting as bilateral serous retinal detachment and ocular inflammation, simulating Vogt-Koyanagi-Harada (VKH) disease. Methods Case series and review of literature. Result Two young patients (one male and one female) with CML on treatment with tyrosine kinase inhibitors (imatinib and dasatanib) under remission presented with bilateral sudden vision loss. One patient had bilateral multiple pockets of serous retinal fluid while the other had panuveitis with exudative retinal detachment. There was neither prodromal symptoms nor systemic signs and symptoms suggestive of VKH in both cases. They responded well to systemic steroid therapy without recurrences with complete visual recovery. Conclusion and importance CML patients can have features similar to VKH even during stable hematological phase and may be possibly associated with the use of tyrosine kinase inhibitors. Hence it is important not to misdiagnose and treat such patients with long term immunomodulators.
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Affiliation(s)
- Saurabh Mistry
- Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - S Sudharshan
- Sankara Nethralaya, Medical Research Foundation, Chennai, India
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Schlaen A, Ingolotti M, Couto C, Saravia M. Spectral optical coherence tomography findings in an elderly patient with syphilitic bilateral chronic panuveitis. Am J Ophthalmol Case Rep 2018; 9:56-61. [PMID: 29468221 PMCID: PMC5786878 DOI: 10.1016/j.ajoc.2018.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the spectral domain optical coherence tomography (SD-OCT) features of a focal retinitis in an elderly male patient with bilateral syphilitic panuveitis. Observations In the left eye (LE), spectral domain SD-OCT images during the active period revealed hyperreflectivity extending through the full thickness of the retina with no individualization of the layers, except for the retinal pigment epithelium. Once the lesion healed, SD-OCT imaging revealed an inner retinal atrophy and a mild disruption of the retinal pigment epithelium. Conclusions and importance In our patient, treponemal infection seemed to produce full-thickness retinal damage with partial involvement of the retinal pigment epithelium. The severe retinal damage, in this case, led to a poorer visual outcome than in other forms of syphilitic retinal involvement.
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Affiliation(s)
- Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Argentina
- Department of Ophthalmology, University of Buenos Aires, Argentina
- Corresponding author. Arenales 981 2P C1061AAE, Buenos Aires, Argentina.Arenales 981 2P C1061AAEBuenos AiresArgentina
| | - Mariana Ingolotti
- Department of Ophthalmology, Hospital Universitario Austral, Argentina
| | - Cristobal Couto
- Department of Ophthalmology, University of Buenos Aires, Argentina
| | - Mario Saravia
- Department of Ophthalmology, Hospital Universitario Austral, Argentina
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Abstract
Purpose To describe the demographic and clinical patterns of patients with uveitis referred to a tertiary center in northeastern Iran. Methods This cross-sectional retrospective study included 235 patients with uveitis who had been referred to the uveitis clinic of Khatam-Al-Anbia eye hospital, affiliated to Mashhad University of Medical Sciences, from February 2013 to March 2014. Data regarding patient age, sex, anatomical location of the disease, and etiologic and clinical features were analyzed. Results Mean patient age at the onset of uveitis was 35.75 ± 16.3 (range: 3-82) years. The ratio of females to males was 1.5 to 1. Sixty-four percent had bilateral involvement. The predominant type of inflammation was non-granulomatous (76%). Panuveitis (46.8%, 110 cases) was the most common form of uveitis followed by anterior (37%, 87 cases), intermediate (11.9%, 28 cases), and posterior uveitis (4.25%, 10 cases). The most common diagnoses were "idiopathic" in anterior and intermediate uveitis cases, toxoplasmosis in posterior uveitis group, and Behçet and Vogt-Koyanagi-Harada diseases in panuveitis cases. Overall, noninfectious causes (80.42%) of uveitis were more frequent than infectious causes (19.57%). The proportion of noninfectious uveitis was 82.75% in anterior uveitis, 78.18% in panuveitis, 92.85% in intermediate uveitis, and 50% in posterior uveitis. The most common associated systemic disease was Behçet disease. Conclusion In contrast to most epidemiologic studies of uveitis, the clinical and etiologic patterns of uveitis were different in a tertiary referral center in northeastern Iran. Panuveitis was the most common clinical pattern in this study, and the most common associated systemic disease was Behçet disease.
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Affiliation(s)
| | - Nasser Shoeibi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Raheleh Ebrahimi
- Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Ghasemi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Cocho L, Urbaneja E, Herreras JM. Vision-threatening bilateral panuveitis and TRAPS in a child: an uncommon association. Int Ophthalmol 2017; 39:219-223. [PMID: 29256170 DOI: 10.1007/s10792-017-0785-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/11/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE To report a childhood case of tumor necrosis factor receptor-associated periodic syndrome (TRAPS) carrying the R92Q variant with a vision-threatening bilateral panuveitis. METHODS Case report and review of the literature. RESULTS A 7-year-old boy presented with an active bilateral panuveitis and a macular rash associated with fever. Fundus examination showed two choroidal lesions on the posterior pole of the right eye, and fluorescein angiography revealed early hypofluorescence and late hyperfluorescence of the lesions, which were hyper-autofluorescent. Extensive clinical laboratory analyses ruled out autoimmune diseases and systemic infection. The only remarkable finding was a positive IgG for herpes simplex 1. He underwent two successive diagnostic pars plana vitrectomies as well as cataract and glaucoma surgeries. Genetic analysis revealed a mutation in the TNFRSF1A gene, and the patient was diagnosed with TRAPS-associated bilateral panuveitis. He was treated with adalimumab and has been free of active inflammation since then. CONCLUSIONS We present here the first case reported of panuveitis in a patient with TRAPS. This finding stresses the increasing importance of genetic analysis in search of autoinflammatory diseases to establish an adequate diagnosis and treatment in cases of uveitis of unknown etiology.
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Affiliation(s)
- Lidia Cocho
- IOBA (Institute of Applied OphthalmoBiology), University of Valladolid, Paseo de Belén 17, 47011, Valladolid, Spain. .,Hospital Clínico Universitario de Valladolid, Avda Ramón y Cajal 3, 47003, Valladolid, Spain.
| | - Elena Urbaneja
- Hospital Clínico Universitario de Valladolid, Avda Ramón y Cajal 3, 47003, Valladolid, Spain
| | - José M Herreras
- IOBA (Institute of Applied OphthalmoBiology), University of Valladolid, Paseo de Belén 17, 47011, Valladolid, Spain.,Hospital Clínico Universitario de Valladolid, Avda Ramón y Cajal 3, 47003, Valladolid, Spain
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Najem K, Derzko-Dzulynsky L, Margolin EA. IgG4-related disease presenting as panuveitis without scleral involvement. J Ophthalmic Inflamm Infect 2017; 7:7. [PMID: 28243891 PMCID: PMC5328900 DOI: 10.1186/s12348-017-0125-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/16/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The following case emphasizes the importance of including IgG4-related disease (RD) in the differential diagnosis of intraocular inflammation and multiple cranial nerve palsies. RESULTS A 33-year-old man, with a history of idiopathic bilateral panuveitis, presented with a new right pupillary-sparing partial third nerve palsy, which spontaneously resolved in 2 weeks, but was followed 1 month later, by a right sixth nerve palsy, which also resolved within a few weeks. Motility disturbance was accompanied by a decrease in the central acuity in the right eye. Magnetic resonance imaging/angiography (MRI/MRA) demonstrated a densely enhancing osteodestructive skull base process extending through the cavernous sinus and into the right superior orbital fissure. Biopsy of the lesion was consistent with IgG4-related disease (RD). CONCLUSIONS This is the first reported case of IgG4-RD associated panuveitis without scleral involvement, expanding the list of clinical manifestations of the IgG4-RD.
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Affiliation(s)
- Kinda Najem
- Department of Ophthalmology, Université de Montréal, 5415 de l’Assomption Boulevard, Montreal, Quebec H1T 2M4 Canada
| | - Larissa Derzko-Dzulynsky
- Department of Ophthalmology, University of Toronto, 340 College Street Suite 501, Toronto, Ontario M5T 3A9 Canada
| | - Edward A. Margolin
- Department of Ophthalmology, University of Toronto, 340 College Street Suite 501, Toronto, Ontario M5T 3A9 Canada
- 801 Eglinton Avenue West, Suite 301, Toronto, Ontario M5N 1E3 Canada
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Sood AB, Pearce WA, Workowski KA, Lockwood J, Yeh S. Combined Intravitreal and Systemic Antibiotic Therapy in a Patient with Syphilitic Uveitis. Ocul Immunol Inflamm 2017; 27:131-133. [PMID: 29053397 DOI: 10.1080/09273948.2017.1385817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To report the novel use of combined intravitreal and systemic antibiotic therapy in a patient with syphilitic panuveitis and discuss the management of ocular syphilis. METHODS Case report Results: A 45-year old heterosexual male with human immunodeficiency virus (HIV) presented with 1 month of blurry vision in both eyes. Clinical examination revealed a bilateral panuveitis. The patient denied history of genital lesions or rash, but did complain of difficulty hearing bilaterally. Treponemal EIA was positive, the RPR titer greater than 1:512 dilution, and CSF VDRL 1:4. A diagnosis of neurosyphilis and ocular syphilis was made based on the clinical and laboratory findings. The patient was admitted for systemic intravenous antibiotic therapy, but was noted to have a penicillin allergy. Intravitreal ceftazidime was promptly administered bilaterally to achieve treponemacidal levels of antibiotic therapy. After penicillin desensitization protocol, the patient received 14 days of intravenous penicillin with clinical resolution. CONCLUSIONS There are increasing reports of ocular syphilis in the United States and delay in diagnosis and management can lead to severe visual impairment and blindness. We report the first case of adjunct intravitreal antibiotic therapy in a penicillin allergic patient. As ocular syphilis is a form of bacterial endophthalmitis, combination intravitreal and systemic antibiotics may be considered.
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Affiliation(s)
- Arjun B Sood
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA
| | - William A Pearce
- b Department of Ophthalmology , Emory University School of Medicine, Emory Eye Center , Atlanta , Georgia , USA
| | - Kimberly A Workowski
- c Department of Medicine, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , Georgia , USA
| | - James Lockwood
- b Department of Ophthalmology , Emory University School of Medicine, Emory Eye Center , Atlanta , Georgia , USA
| | - Steven Yeh
- b Department of Ophthalmology , Emory University School of Medicine, Emory Eye Center , Atlanta , Georgia , USA
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Abstract
BACKGROUND Echinococcosis is a dangerous zoonotic parasitic disease. Ocular echinococcosis is very rare, especially the hydatid cysts in subretinal space. We present a case of subretinal echinococcosis and management. CASE PRESENTATION A 37-year-old man with subretinal echinococcosis who developed panuveitis and visual impairment. The patient lives on agriculture and animal husbandry, which made him susceptible to parasitic infection. He had severe panuveitis and blurred vision on arrival at hospital. According to his ocular examination and systemic review, the subretinal echinococcosis diagnosis was made. The patient received pars plana lensectomy and pars plana vitrectomy. The lesion underneath his retina was removed, and histopathology examination confirmed the subretinal echinococcosis diagnosis. CONCLUSIONS Echinococcosis is a dangerous zoonotic parasitic disease in pastoral areas. Ocular echinococcosis is usually secondary to systemic infection. Although the incidence is rare, the disease could lead to destructive visual function impairment.
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Affiliation(s)
- Chunying Guo
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, No. 8 Xi Shi Ku Street, Xicheng District, Beijing, 100034, China
| | - Ruilin Zhu
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, No. 8 Xi Shi Ku Street, Xicheng District, Beijing, 100034, China
| | - Jianxing Qiu
- Department of Radiology, Peking University First Hospital, Beijing, 100034, China
| | - Lina Zhu
- Department of Radiology, Peking University First Hospital, Beijing, 100034, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, No. 8 Xi Shi Ku Street, Xicheng District, Beijing, 100034, China.
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Albaroudi N, Tijani M, Boutimzine N, Cherkaoui O, Laghmari M. [Prognostic factors in uveitis]. J Fr Ophtalmol 2017; 40:751-757. [PMID: 28882393 DOI: 10.1016/j.jfo.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/19/2017] [Accepted: 04/03/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate prognostic factors of vision loss among patients with uveitis. MATERIAL AND METHODS This descriptive and retrospective study included all patients diagnosed with uveitis who were seen at the teaching hospital of Rabat, Morocco, over a 5-year period. Information regarding demographic data, uveitis type, bilaterality of the disease, etiology and complications were gathered from patients' records. Statistical analysis was performed using SPSS software. RESULTS One hundred and thirty-nine eyes of 89 patients were included. There were 60.7 % men and 39.3 % women. The mean age (years) was 31.1±16.8. Median follow-up was 11 months. Median visual acuity (logMAR) on admission was 1.7 [0.7-2] and 1 [0.4-1.7] on the last visit (P<0.001). Fifty-nine percent of eyes had final visual acuity (VA) equal to or less than 1/10. Panuveitis (85.4 %) and posterior uveitis (72.7 %) were responsible for final VA equal to or less than 1/10 (P<0.001). Cataract, posterior synechiae, vitreous opacities, epimacular membrane (ERM) and cystoid macular edema (CME) were the most frequent complications. Using multivariate logistic regression, the prognostic factors associated with severe vision loss were the type of uveitis (posterior and panuveitis), CME, ERM, macular scarring and optic atrophy (P<0.05). CONCLUSION Although this study included a limited number of subjects, the results showed that final VA was equal or less than 1/10 in 59 % of eyes diagnosed with uveitis and was associated with risk factors including posterior segment involvement (panuveitis and posterior uveitis), CME and ERM.
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Affiliation(s)
- N Albaroudi
- Service d'ophtalmologie A, hôpital des spécialités, université Mohammed V, centre hospitalier universitaire, Rabat, Maroc.
| | - M Tijani
- Service d'ophtalmologie A, hôpital des spécialités, université Mohammed V, centre hospitalier universitaire, Rabat, Maroc
| | - N Boutimzine
- Service d'ophtalmologie A, hôpital des spécialités, université Mohammed V, centre hospitalier universitaire, Rabat, Maroc
| | - O Cherkaoui
- Service d'ophtalmologie A, hôpital des spécialités, université Mohammed V, centre hospitalier universitaire, Rabat, Maroc
| | - M Laghmari
- Service d'ophtalmologie A, hôpital des spécialités, université Mohammed V, centre hospitalier universitaire, Rabat, Maroc
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Oray M, Cebeci Z, Kir N, Turgut Ozturk B, Oksuz L, Tugal-Tutkun I. Endogenous Brucella endophthalmitis: A case report. Saudi J Ophthalmol 2017; 31:106-108. [PMID: 28559723 PMCID: PMC5436384 DOI: 10.1016/j.sjopt.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 01/26/2017] [Accepted: 03/05/2017] [Indexed: 02/04/2023] Open
Abstract
Brucellosis may be associated with a wide range of ophthalmic manifestations including endophthalmitis, which is a sight-threatening condition that needs to be rapidly recognized and treated to avoid permanent visual loss. A 26-year-old female with a 6-month history of vision loss in the left eye was treated with high dose systemic corticosteroids and azathioprine with an initial misdiagnosis elsewhere. A dense vitreous haze with opacities at the posterior hyaloid and a wide area of retinochoroiditis led to the diagnosis of endogenous endophthalmitis at presentation to us. The vitreous sample and blood cultures demonstrated growth of Brucella melitensis. She received 6 months of systemic antibiotherapy, which resulted in resolution of inflammation; however, visual acuity remained poor due to irreversible damage. Infectious etiology, including brucellosis in endemic countries, has to be considered in the differential diagnosis before administering immunomodulatory therapy in patients with panuveitis of unknown origin.
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Affiliation(s)
- Merih Oray
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Zafer Cebeci
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Nur Kir
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Banu Turgut Ozturk
- Selcuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Lutfiye Oksuz
- Istanbul University, Istanbul Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
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Agarwal A, Hassan M, Sepah YJ, Do DV, Nguyen QD. Subcutaneous repository corticotropin gel for non-infectious panuveitis: Reappraisal of an old pharmacologic agent. Am J Ophthalmol Case Rep 2016; 4:78-82. [PMID: 29503933 PMCID: PMC5757479 DOI: 10.1016/j.ajoc.2016.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/18/2016] [Accepted: 09/27/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the clinical course of a patient with non-infectious idiopathic unilateral panuveitis and retinal vasculitis treated with subcutaneous repository adrenocorticotropic hormone (ACTH) gel. Observations A 33-year-old male presented with blurry vision and floaters in the left eye (OS). The best-corrected visual acuity was 20/20 in the right eye (OD) and 20/50 in OS at the time of initial presentation. Slit-lamp examination revealed mild anterior segment inflammation in OS. There were 1 + vitreous haze and 2 + cells noted in OS. Clinical examination and ancillary imaging assessment including fluorescein angiography revealed retinal vasculitis and optic nerve head inflammation. After infectious etiologies were ruled out, the patient was started on oral corticosteroids and enrolled in a clinical trial employing intravenous tocilizumab therapy. Six months after completion of the tocilizumab trial, the patient demonstrated recurrence of disease. Twice weekly subcutaneous ACTH gel was initiated and the patient demonstrated improvement of retinal vascular inflammation. Conclusions and importance Repository subcutaneous ACTH gel formulation may be a safe and viable therapeutic option for patients with non-infectious uveitis and retinal vasculitis. Clinical trials using this formulation in a larger patient cohort with longer monitoring are indicated to evaluate its tolerability and bioactivity.
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Affiliation(s)
- Aniruddha Agarwal
- Ocular Imaging Research and Reading Center (OIRRC), Omaha, NE, 68198-5540, USA
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Muhammad Hassan
- Ocular Imaging Research and Reading Center (OIRRC), Omaha, NE, 68198-5540, USA
| | - Yasir J. Sepah
- Ocular Imaging Research and Reading Center (OIRRC), Omaha, NE, 68198-5540, USA
| | - Diana V. Do
- Ocular Imaging Research and Reading Center (OIRRC), Omaha, NE, 68198-5540, USA
| | - Quan Dong Nguyen
- Ocular Imaging Research and Reading Center (OIRRC), Omaha, NE, 68198-5540, USA
- Corresponding author.
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Bhandari V, ᅟ SG, Raj M, Batra A. A rare case of atypical sympathetic ophthalmia post therapeutic keratoplasty. J Ophthalmic Inflamm Infect 2016; 6:34. [PMID: 27638462 PMCID: PMC5023642 DOI: 10.1186/s12348-016-0104-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/31/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction Sympathetic ophthalmia (SO) is a rare, bilateral, diffuse granulomatous uveitis that usually occurs after open globe injury or intraocular surgery. Methods A patient developed SO following therapeutic penetrating keratoplasty (TPK) with cataract extraction in the exciting eye following fungal keratitis. The sympathizing eye presented with only posterior segment findings (exudative retinal detachment) and responded well with oral corticosteroids. Results Graft remained clear in the left eye and the right eye; the best-corrected visual acuity (BCVA) improved to 0.2 log MAR. Conclusion SO presenting after TPK for fungal keratitis is a rare occurrence but if detected early can be managed effectively.
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Affiliation(s)
- Vipul Bhandari
- Nethradhama Superspeciality Eye Hospital, 256/14, Kanakapura Main Road, 7th Block, Jayanagar, Bangalore, Karnataka, 560082, India.
| | - Sri Ganesh ᅟ
- Nethradhama Superspeciality Eye Hospital, 256/14, Kanakapura Main Road, 7th Block, Jayanagar, Bangalore, Karnataka, 560082, India
| | - Mohan Raj
- Department of Vitreo-Retina, Nethradhama Eye Hospital, Kanakapura Road, Bangalore, 560070, India
| | - Akanksha Batra
- Department of Phaco-Refractive, Nethradhama Eye Hospital, Kanakapura Road, Bangalore, 560070, India
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