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Feo A, Stradiotto E, Sacconi R, Menean M, Querques G, Romano MR. Subretinal hyperreflective material in retinal and chorioretinal disorders: A comprehensive review. Surv Ophthalmol 2024; 69:362-377. [PMID: 38160737 DOI: 10.1016/j.survophthal.2023.10.013] [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: 06/19/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024]
Abstract
Subretinal hyperreflective material (SHRM) is a common and remarkable optical coherence tomography (OCT) biomarker whose importance is emerging in several retinal and chorioretinal diseases, including age-related macular degeneration, central serous chorioretinopathy, polypoidal choroidal vasculopathy, pathologic myopia, posterior uveitis, vitelliform lesions and macular dystrophies, and rarer disorders. Multimodal imaging, also thanks to the introduction of OCT angiography, allowed a deeper characterisation of SHRM components and its morphological changes after treatment, suggesting its usefulness in clinical practice. We discuss and summarize the nature, multimodal imaging characteristics, and prognostic and predictive significance of SHRM in the different retinal and choroidal disorders in which it has been described.
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Affiliation(s)
- Alessandro Feo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
| | - Elisa Stradiotto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Matteo Menean
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, Bergamo, Italy.
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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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Makhoul J, Ben-Arie-Weintrob Y, Ben Ephraim Noyman D. Retinochoroiditis secondary to Rickettsia typhi infection: a case report. BMC Ophthalmol 2024; 24:111. [PMID: 38454387 PMCID: PMC10919007 DOI: 10.1186/s12886-024-03329-5] [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: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND To report a case of unusual presentation of retinochoroiditis caused by Rickettsia typhi in a patient without prior uveitis. CASE PRESENTATION In this case, we describe a 24-year-old male soldier with no previous eye disease, who was referred to our ophthalmology department due to bilateral retinochoroiditis and vitritis. The patient initially presented with a paracentral scotoma in his right eye persisting for 7 days and scattered dark spots in his left eye for 2 days in June 2023. Preceding these ocular symptoms, he experienced a two-week episode of fever, headaches, night sweats, and rapid weight loss of 10 kg. A transient rash covered his body briefly. His mother had a history of recurrent eye inflammation. Physical examination revealed bilateral keratic precipitates on the lower corneal periphery, 1 + anterior vitreous cells, small retinal lesions and mild optic discs elevation. Fluorescein angiography indicated mild discs hyperfluorescence, and the clinically visible round punctate lesions on OCT showed inner retinal hyper-reflective lesion with a depth till outer plexiform layer possibly suggestive of a retinitis lesion. Laboratory tests were normal except thrombocytosis, elevated ESR, liver enzymes and ACE levels, with positive Rickettsia typhi serology tests. Rheumatology and infectious disease consultations ruled out autoimmune diseases, confirming Rickettsia typhi infection. Treatment included systemic doxycycline and prednisone, with improvement of visual acuity, ocular symptoms, OCT abnormalities and resolution of inflammation. Prednisone was discontinued, and after two months, additional improvement was seen clinically, with preserved retinal structures on OCT. CONCLUSION This study explores retinochoroiditis as a rare ocular presentation of Rickettsia typhi, an unusual infection in the Middle East. Previously reported ocular manifestations include conjunctivitis, vitritis, post infectious optic neuropathy and a few cases of uveitis. Ocular symptoms followed systemic illness, highlighting the need for awareness among clinicians. Diagnosis relies on seroconversion, with fluorescein angiography and OCT aiding in assessment. Empiric doxycycline and systemic corticosteroid therapy is recommended. Ocular symptoms resolved in two months. Awareness of these ocular manifestations is essential for timely diagnosis and management. Further research is needed to fully understand this aspect of murine typhus.
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Affiliation(s)
- Joanne Makhoul
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
- Rambam Health Care Campus, Haifa, Israel.
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Sáenz Decker E, García Fernández M, Gómez De la Torre R, Coto Hernández R, Santana García LI. Vitreoretinal lymphoma: a diagnostic challenge. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:718-722. [PMID: 37813184 DOI: 10.1016/j.oftale.2023.10.002] [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: 04/18/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
A 66-year-old man with posterior uveitis and recurrent cystic macular edema related to possible previously treated Lyme disease is presented. Due to the recurrence of macular edema despite systemic and local corticosteroid treatment with intravitreal dexamethasone, biological treatment with Adalimumab was established. During follow-up, the patient developed bilateral subretinal lesions compatible with Vitreoretinal Lymphoma (VRL), so vitrectomy was performed, confirming the diagnosis of large B-cell lymphoma. Treatment with systemic chemotherapy with BRAM-Carmustine, Metrotexate, Ara C, and Rituximab was started with a good answer. Two years later, the patient remains without ocular or systemic recurrences. Vitreoretinal Lymphoma is a rare type of primary central nervous system lymphoma. The diagnosis is frequently delayed due to the nonspecific symptoms, which mimic chronic posterior uveitis, hence the importance with a diagnostic suspicion.
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Affiliation(s)
- E Sáenz Decker
- Servicio de Oftalmologia, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - M García Fernández
- Servicio de Oftalmologia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - R Gómez De la Torre
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - R Coto Hernández
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L I Santana García
- Servicio de Oftalmologia, Hospital Universitario Central de Asturias, Oviedo, Spain
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Saturno MC, Neri P, Pichi F. Fundus autofluorescence in uveitis: from pathogenesis to imaging interpretation. Int Ophthalmol 2023; 43:4359-4371. [PMID: 37418226 DOI: 10.1007/s10792-023-02803-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE This review aims to summarize the current fundus autofluorescence (FAF) ailment for diagnosis and follow-up of uveitis. METHODS A thorough literature search was performed in the PubMed database. RESULTS FAF maps the retinal pigment epithelium's (RPE) health. Therefore, several posterior infectious and non. This fast, easy-to-perform, noninvasive technique can detect and manage infectious uveitis. CONCLUSIONS FAF serves to understand pathophysiologic mechanisms of uveitis and is a valuable prognostic indicator of themselves.
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Affiliation(s)
| | - Piergiorgio Neri
- Eye Insitute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Francesco Pichi
- Eye Insitute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Hernanz I, Moll-Udina A, Garcia-Tirado A, Garcia-Fernandez M, Gutierrez-Ezquerro R, Garcia-Arumi C, Llorenç V, Cuadros C, Fonollosa A, Sainz-de-la-Maza M, Adán A. The retinal bacillary layer detachment: Clinical features and outcomes in posterior uveitis. J Fr Ophtalmol 2023; 46:916-920. [PMID: 37210295 DOI: 10.1016/j.jfo.2022.12.031] [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: 11/09/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 05/22/2023]
Abstract
PURPOSE To describe the clinical characteristics, presentation and response to treatment in posterior uveitis patients with bacillary layer detachment (BLD) seen on optical coherence tomography (OCT). MATERIALS AND METHODS Retrospective review of patients with posterior uveitis and SD-OCT scans consistent with BLD. Data collected included demographics, uveitic etiology, treatment and duration of follow-up. Outcome measures included macular volume, central subfoveal thickness and visual acuity. RESULTS Sixteen patients (20 eyes) were included. Twelve were female (75%). The mean age was 43.68 ± 14.7 years. The most frequent etiology of the uveitis was Vogt-Koyanagi-Harada (VKH) disease (n=10), followed by sympathetic ophthalmia (n=2). BLD was bilateral in four patients. Eight patients were treated with intravenous methylprednisolone boluses. Immunosuppressive therapies were required in 8 patients. The mean follow-up was 70 months (range: 2.0-216.0). CONCLUSION BLD was observed in a series of posterior uveitis cases of various etiologies, showing functional and structural resolution with treatment in most cases.
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Affiliation(s)
- I Hernanz
- Department of ophthalmology, Fundación Jiménez Diaz Hospital, Avenue Reyes Católicos 2, 28003 Madrid, Spain.
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Garcia-Tirado
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | | | - C Garcia-Arumi
- Departmentofophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - C Cuadros
- Department of ophthalmology, Oviedo University Hospital, Oviedo, Spain
| | - A Fonollosa
- Department of ophthalmology, Cruces University Hospital, Bilbao, Spain
| | - M Sainz-de-la-Maza
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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7
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Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Abstract
PURPOSE To report a case of Hodgkin lymphoma (HL) associated retinopathy. METHOD Single-case, retrospective review of ophthalmological and systemic manifestations. RESULTS A bilateral panuveitis in a 17-year-old Caucasian woman led to the diagnosis of HL. The ocular findings were characterized by anterior uveitis, vitritis, white chorioretinal lesions, papillitis and vasculitis. The diagnosis of nodular sclerosis stage IIA HL was confirmed by a cervical ganglion biopsy. Other causes of uveitis were excluded. The remission of HL was obtained by chemotherapy and the ocular lesions became quiescent, with pigmented chorioretinal scars, predominating along retinal vessels. Recurring visual symptoms one year later led to the diagnosis of the relapse of the HL. The remission of the HL was again obtained by a second line of chemotherapy while ocular symptoms subsided. CONCLUSIONS Hodgkin lymphoma may be added to the list of diseases that can occasionally be revealed by ocular paraneoplastic syndromes.
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Affiliation(s)
- Daphné Dedieu
- Université de Paris, Department of Ophthalmology, Hôpital Cochin, Paris, France
| | - Emna Bouayed
- Université de Paris, Department of Ophthalmology, Hôpital Cochin, Paris, France
| | - Antoine P Brézin
- Université de Paris, Department of Ophthalmology, Hôpital Cochin, Paris, France
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Nguyen NV, Karkhur S, Yuksel M, Hassan M, Halim MS, Nguyen QD, Hasanreisoglu M. Posterior Uveitis Associated with Large Vessel Giant Cell Arteritis. Ocul Immunol Inflamm 2022; 30:2019-2022. [PMID: 34270381 PMCID: PMC10863990 DOI: 10.1080/09273948.2021.1952274] [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: 11/28/2020] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To report a case of acute unilateral posterior uveitis as a rare manifestation of giant cell arteritis (GCA). OBSERVATION A 62-year-old male presented to the clinic for evaluation of decreased vision in the right eye (OD). BCVA in OD was 20/60, and fundus examination revealed 3+ vitreous cells along with several inflammatory precipitates located in posterior vitreous and on surface of retina. Although TAB was inconclusive for GCA, the clinical diagnosis of GCA was made according to the GCA diagnostic criteria. This diagnosis was further supported by 18FDG-PET scan. The patient was started on corticosteroids, and the symptoms improved significantly after first week of treatment. At follow-up visit one month and half later, BCVA improved to 20/40 in the right eye. CONCLUSION Although GCA is rarely present with uveitis, in case of unilateral posterior uveitis in elderly patient, it should be considered in the differential diagnosis.
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Affiliation(s)
- Nam V Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Ocular Imaging Research and Reading Center (OIRRC), Sunnyvale, California, USA
| | - Samendra Karkhur
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Murat Yuksel
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, TURKEY
| | - Muhammed Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center (OIRRC), Sunnyvale, California, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Murat Hasanreisoglu
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, TURKEY
- School of Medicine, Koç University, Istanbul, Turkey
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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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Kalogeropoulos D, Sakkas H, Mohammed B, Vartholomatos G, Malamos K, Sreekantam S, Kanavaros P, Kalogeropoulos C. Ocular toxoplasmosis: a review of the current diagnostic and therapeutic approaches. Int Ophthalmol 2022; 42:295-321. [PMID: 34370174 PMCID: PMC8351587 DOI: 10.1007/s10792-021-01994-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease. METHODS A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items. RESULTS Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used. CONCLUSION Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece.
| | - Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | | | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
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12
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Khochtali S, Krifa H, Zina S, Khairallah M, Jelliti B, Abroug N, Khairallah M. Multimodal Imaging of Acute Foveolitis following COVID-19 Vaccination. Ocul Immunol Inflamm 2021; 30:1214-1217. [PMID: 34797736 DOI: 10.1080/09273948.2021.1993270] [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: 10/19/2022]
Abstract
PURPOSE To report a case of unilateral acute foveolitis following COVID-19 vaccination. METHODS A case report. RESULTS A 24-year-old woman developed a sudden blurring of vision in the left eye (LE) 5 days after receiving the first dose of COVID-19 vaccine. Examination of the LE showed a visual acuity at 20/40, 2+ cells in the vitreous, and a small yellow-orange foveal subretinal lesion. Late-phase fluorescein angiography showed a mild diffuse retinal vascular leakage and a faint foveal hyperfluorescence. ICG angiography showed in the late-phase hypofluorescence of the centrofoveal lesion. OCT B-scan demonstrated a conical hyperreflective subfoveal lesion on the retinal pigment epithelium associated with disruption of the outer retinal layers. En-face OCT revealed granular hyperreflective specks mainly in the inner nuclear layer. Work-up results were unremarkable. The patient received oral prednisolone with subsequent full functional and anatomic recovery. CONCLUSION Foveolitis may rarely occur as a complication of COVID-19 vaccination.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hamza Krifa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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13
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Walker CJ, Flanagan KE, Pathoulas JT, Pupo Wiss I, Senna MM. Hair Growth in a Patient with Alopecia Areata on Tocilizumab. Skin Appendage Disord 2021; 7:408-412. [PMID: 34604334 DOI: 10.1159/000516300] [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] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/27/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Tocilizumab (TCZ), a recombinant humanized antihuman monoclonal antibody targeting interleukin-6 (IL-6) signaling, is often utilized in the management of autoimmune disease. Few reports have demonstrated hair growth changes in patients on TCZ. Case Presentation Herein, we review the literature and report a 21-year-old woman with progressive alopecia areata (AA) presenting with AA improvement while on TCZ for concomitant posterior uveitis. Discussion Our case demonstrates the potential ability of TCZ to disrupt IL-6 signaling involved in AA, leading to hair loss and regrowth.
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Affiliation(s)
- Chloe J Walker
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kelly E Flanagan
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James T Pathoulas
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isabel Pupo Wiss
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maryanne M Senna
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts, USA
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14
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Rueda-Rueda T, Sánchez-Vicente JL, Espiñeira-Periñán MA, Muñoz-Morales A, Rodríguez-Fernández C, López-Herrero F. Two case reports of acute zonal occult outer retinopathy (AZOOR): Importance of multimodal diagnosis. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:500-504. [PMID: 34479708 DOI: 10.1016/j.oftale.2020.07.010] [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] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
A presentation is made of two cases of acute zonal occult outer retinopathy (AZOOR); one a young man of 19 years, and the other a 42-year-old woman. The young man complained of unilateral scotoma and photopsia. The woman presented with bilateral visual loss and photopsia. Multimodal imaging, including fundus photography, fluorescein angiography, fundus autofluorescence, spectral-domain optical coherence tomography, and visual field testing, supported the diagnosis of AZOOR. The differential diagnosis is complicated, since it has clinical features in common with other retinopathies. This means that it is essential to use modern imaging tests, especially those where the characteristic trizonal pattern is shown, such as in autofluorescence and OCT.
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Affiliation(s)
- T Rueda-Rueda
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M A Espiñeira-Periñán
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - A Muñoz-Morales
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C Rodríguez-Fernández
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - F López-Herrero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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15
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Abstract
Diseases of the retina are common and numerous, with causes ranging over inherited, inflammatory, vascular, infectious, neoplastic, traumatic, toxic, and idiopathic etiologies. A key issue in the diagnosis of retinal disease is the duration of symptoms, which can be acute, chronic, or acute presentations of chronic disease. Clinical examination with direct ophthalmoscopy or, even better, biomicroscopy with a slit lamp and condensing lens, is a key component of diagnosis, which can be enhanced through investigational methods such as fluorescein angiography, optical coherence tomography, or electroretinography. Consideration of the history, visual acuity and visual field, and fundoscopic findings is usually sufficient to determine whether patients need referral on an emergency, urgent, or routine basis. Emphasis is given to vascular disease, age-related macular degeneration, diabetic retinopathy, genetic eye disease, and retinal detachment.
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Affiliation(s)
- Kevin Gregory-Evans
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
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16
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Amer R, Cohen O. Anti-tumor necrosis factor-alpha therapy for refractory uveitic optic disk neovascularization in active non-infectious posterior and panuveitis. Int Ophthalmol 2021; 41:3523-3531. [PMID: 34165681 DOI: 10.1007/s10792-021-01919-6] [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: 02/18/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Neovascularization of the optic disk (NVD) is mainly a complication of ischemic retinal disorders and of uveitis with vascular occlusion. Rarely, NVD may develop in patients with uveitis in the absence of retinal ischemia. This report aims to present our long-term experience of treating refractory uveitic NVD (uNVD) with adalimumab in three patients with active non-infectious posterior or panuveitis. METHODS Observational case series was collected from institutional tertiary referral center. Patients with chronic refractory uNVD who completed 24 months of follow-up were included. RESULTS uNVD was diagnosed on first presentation in all patients (3 eyes). Mean age at presentation was 29 years (median 20, range 18-49). Mean duration of complaints before presentation was 18.7 weeks (median 24, range 4-28). Uveitis was idiopathic in two patients and secondary to Behçet disease in one. All eyes had concomitant cystoid macular edema. Additional posterior segment signs included optic disk hemorrhage, preretinal hemorrhage and vitreous hemorrhage. All eyes showed retinal vascular leakage and macular leakage with no evidence of capillary non-perfusion. All patients were treated with systemic steroids and steroid-sparing agent. Because of NVD refractoriness, anti-TNF-α therapy was introduced at a mean of 24.7 weeks after first presentation (median 20, range 14-40). Complete regression of NVD was observed at a mean of 34.7 weeks (median 32, range 8-64) following adalimumab institution. Mean follow-up time after starting anti-TNF-α agents was 31.3 months. CONCLUSIONS Our results suggest that targeting TNF-α achieves long-term control of uveitic NVD refractory to conventional treatments.
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Affiliation(s)
- Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel. .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Oren Cohen
- Department of Ophthalmology, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel
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17
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Berkowitz ST, Brock AL, Reichstein DA. Chorioretinal Biopsy-Proven Ocular Sarcoidosis in a Patient with a History of B-Cell Lymphoma. Case Rep Ophthalmol 2021; 12:438-445. [PMID: 34054498 PMCID: PMC8136327 DOI: 10.1159/000512694] [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: 10/06/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022] Open
Abstract
The purpose of this report is to describe biopsy-proven ocular sarcoidosis (OS) in a 67-year-old patient with a history of sarcoidosis and diffuse large B-cell lymphoma (DLBCL). Nonspecific posterior chorioretinal lesions in a patient with prior malignancy necessitated chorioretinal biopsy to rule out metastatic lymphoma. The association between sarcoidosis and malignancy remains unclear and can complicate management of similar patients with nonspecific posterior segment findings. Chorioretinal biopsy may, therefore, be required to rule out malignancy in patients with a leading history.
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Affiliation(s)
- Sean T Berkowitz
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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18
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Providência J, Fonseca C, Henriques F, Proença R. Serpiginous choroiditis presenting after SARS-CoV-2 infection: A new immunological trigger? Eur J Ophthalmol 2020; 32:NP97-NP101. [PMID: 33267645 DOI: 10.1177/1120672120977817] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/15/2022]
Abstract
INTRODUCTION To report the first case of a serpiginous choroiditis presenting after SARS-CoV-2 infection in a previously healthy young woman. CASE DESCRIPTION A 41-year-old woman reported blurry vision OS 1 month after a mild SARS-CoV-2 infection. Left eye fundus examination revealed multiple peripapillary atrophic lesions, adjacent to a larger diffuse, ill-defined, yellow-whitish deep amoeboid-like patch, involving the peripapillary region and extending temporally to the fovea. Multimodal imaging including fluorescein angiography, indocyanine-green angiography, fundus autofluorescence and optical coherence tomography was consistent with serpiginous choroiditis. A complete systemic work-up was performed to exclude potential infectious or inflammatory etiologies. The active choroidal lesions responded to high dose corticosteroids, with functional improvement. Immunomodulatory therapy with methotrexate was initiated for long-term management. CONCLUSION Serpiginous choroiditis is a rare but important sight-threatening condition that has been previously associated to viral infections, which seem to have a role in the induction and/or perpetuation of choroidal inflammation. SARS-CoV-2 infection appears to have played a role as a possible trigger for intraocular inflammation in this case. Therefore, COVID-19 patients reporting visual symptoms should be carefully evaluated in order to obtain adequate ophthalmological management to avoid irreversible visual damage.
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Affiliation(s)
- Joana Providência
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Fonseca
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Filipe Henriques
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Proença
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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19
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Marrero FM, De Jesus E, Alvarez S, Mendez Bermudez IJ, Vila M, Santos C, Oliver AL. Characteristics, Upon Presentation, of a Cohort of Hispanic Patients with Birdshot Retinochoroidopathy. P R Health Sci J 2020; 39:249-253. [PMID: 33031692] [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: 06/11/2023]
Abstract
OBJECTIVE To describe the characteristics, upon presentation, of a cohort of Hispanic patients with birdshot retinochoroidopathy. METHODS A retrospective chart review of Hispanic patients with birdshot retinochoroidopathy of was performed. The demographic and clinical characteristics were analyzed. RESULTS Nine patients who met the research criteria for a diagnosis of birdshot retinochoroidopathy were identified and included in the analysis, all of whom were HLA-A29 positive. The median age of the cohort upon presentation was 52 years; 89% of the patients were female, and all were Hispanics. Ninety-four percent of the eyes had an initial visual acuity of 20/50 or better, while 72% had measured 20/25 or better. Sixty-one percent of the eyes had retinal vasculitis, which was bilateral in 83% of the cases. Thirty-three percent of the patients had, upon presentation, evidence of cystoid macular edema, which was always bilateral. All the eyes had the typical birdshot lesions, at presentation. CONCLUSION Birdshot retinochoroidopathy can be found in Hispanic patients. Our study suggests that the characteristics upon presentation in Hispanics may be similar to those of Caucasian cohorts.
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Affiliation(s)
- Frances M Marrero
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Edgar De Jesus
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Samuel Alvarez
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Israel J Mendez Bermudez
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico; School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Mariam Vila
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Carmen Santos
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Armando L Oliver
- Department of Ophthalmology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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20
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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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Tang PH, Karkhur S, Nguyen QD. Obtaining undiluted vitreous sample using small gauge pars plana vitrectomy and air infusion. Am J Ophthalmol Case Rep 2020; 19:100768. [PMID: 32637728 PMCID: PMC7327279 DOI: 10.1016/j.ajoc.2020.100768] [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: 12/31/2018] [Revised: 04/15/2020] [Accepted: 06/01/2020] [Indexed: 11/07/2022] Open
Abstract
Vitreous biopsy is essential for establishing a definitive diagnosis and guiding potential therapy in patients with refractory vitritis and posterior uveitis, among other indications. Especially in cases where one must rule out intraocular lymphoma, obtaining a significant amount of undiluted vitreous increases diagnostic yield. We demonstrate our technique for obtaining a significant amount of undiluted vitreous using pars plana vitrectomy with air infusion.
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Affiliation(s)
- Peter H Tang
- Vitreoretinal Surgery, P.A, Minneapolis, MN, USA
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Quan Dong Nguyen
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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22
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Sánchez-Vicente JL, Moruno-Rodríguez A, de Las Morenas-Iglesias J, Rueda-Rueda T, Lechón-Caballero B, López-Herrero F. Multifocal presentation in 2 cases of unilateral acute idiopathic maculopathy. ACTA ACUST UNITED AC 2020; 96:275-279. [PMID: 32593601 DOI: 10.1016/j.oftal.2020.05.023] [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: 03/19/2020] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 11/15/2022]
Abstract
Two cases of multifocal unilateral acute idiopathic maculopathy are presented, one in a 24 year-old man, and another in a 37 year-old woman. Both of them presented with acute vision loss and clinical findings compatible with unilateral acute idiopathic maculopathy. As a relatively uncommon finding, they had multifocal lesions around a larger central lesion. They experienced a spontaneous improvement of their vision. Atypical presentations of unilateral acute idiopathic maculopathy like multifocal lesions are possible. Ophthalmologists should be aware of this rare form of presentation.
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Affiliation(s)
- J L Sánchez-Vicente
- Sección de Retina Quirúrgica, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Moruno-Rodríguez
- Sección de Uveítis, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J de Las Morenas-Iglesias
- Sección General, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - T Rueda-Rueda
- Sección de Uveítis, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - B Lechón-Caballero
- Sección General, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F López-Herrero
- Sección de Retina Médica, Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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23
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Macedo S, Pohlmann D, Lenglinger M, Pleyer U, Joussen AM, Winterhalter S. Optical coherence tomography angiography (OCTA) findings in Serpiginous Choroiditis. BMC Ophthalmol 2020; 20:258. [PMID: 32605555 PMCID: PMC7325353 DOI: 10.1186/s12886-020-01527-5] [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: 01/08/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background To describe changes in the retina/choroid in patients with Serpiginous Choroiditis (SC) by Optical Coherence Tomography Angiography (OCTA) in a multimodal imaging approach. Methods Prospective, monocentric study of 24 eyes of 12 consenting patients diagnosed with SC, who underwent OCTA, which was analyzed and compared to other methods such as enhanced depth imaging-OCT, fluorescein angiography, indocyanine green angiography, and fundus autofluorescence. Results The study group consisted of 9 patients with peripapillary SC, 1 macular SC, and 2 atypical cases. All eyes presented an inactive SC confirmed by standard imaging. OCTA demonstrated the lesions tridimensionally in great detail. There was no difference in the angioarchitecture among the 3 forms of SC. A loss of the choriocapillaris/retinal pigment epithelium left a “window-defect”, where the vessels of larger caliber of the choroid became recognizable and their appearance inverted (“white-on-black”). A relationship between the presence of segmentation errors (SE) in the slabs and low visual acuity was established with a one-way ANOVA. Conclusions OCTA was able to non-invasively assess vascular lesions of the choroid/retina in patients with SC with a high degree of correlation to other diagnostic modalities. Consequent long-term assessments could lead to a better understanding of disease progression.
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Affiliation(s)
- Sergio Macedo
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Dominika Pohlmann
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias Lenglinger
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Tabatabaei SA, Cheraqpour K, Pour EK, Bohrani Sefidan B. Long-term prophylaxis in an immunocompetent patient with Cytomegalovirus retinitis: a case report and review of literature. J Ophthalmic Inflamm Infect 2020; 10:16. [PMID: 32588149 PMCID: PMC7316935 DOI: 10.1186/s12348-020-00207-1] [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: 01/13/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cytomegalovirus retinitis is an infectious sight-threatening condition that usually occurs in immunosuppressed individuals, but rare cases of Cytomegalovirus retinitis have been reported in immunocompetent patients. Findings A 68-year-old woman without any history of systemic diseases referred to the emergency ward of Farabi eye hospital with a two-week history of decreased vision in her left eye. Fundoscopy of the left eye revealed mild venous tortuosity, hemorrhagic retinitis within the macula, and papillitis. The right eye had a history of Cytomegalovirus retinitis 2 years ago that complicated with rhegmatogenous retinal detachment. Immunologic evaluations were normal without any sign of immunosuppressive conditions. She was treated with intravenous ganciclovir for 2 weeks, intravitreal ganciclovir (twice weekly) for 1 week, and also daily oral valganciclovir as maintenance therapy for 6 months resulted in resolving of retinitis patches and improving her best-visual acuity from hand motions to 20/100. Forty-five days after stopping maintenance therapy recurrence occurred. So we started the treatment again to stabilize the patient. She is currently maintained on valganciclovir 900 mg daily without recurrence for 9 months. Conclusions Cytomegalovirus retinitis can recur in the same or contralateral eye of immunocompetent patients, especially without prophylactic medication.
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Affiliation(s)
- Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Bohrani Sefidan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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25
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Wang D, Nair A, Goldberg N, Friedman A, Jabs D, Brodie SE. Oscillatory potentials in patients with birdshot chorioretinopathy. Doc Ophthalmol 2020; 141:293-305. [PMID: 32542469 DOI: 10.1007/s10633-020-09776-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The electroretinogram (ERG) has proven to be useful in the evaluation and monitoring of patients with posterior uveitis. ERG oscillatory potentials (OPs) are sometimes reduced in many uveitic eyes with otherwise grossly normal ERG responses. This study compares ERG parameters, including OPs, between patients with birdshot chorioretinopathy, other posterior uveitis, and controls. METHODS This was a retrospective case-control study. Sixty-four patients seen at a clinical practice had a total of 93 visits during which ERG was performed on both eyes. ERG data from 93 age-matched controls were also collected. Root-mean-squared (RMS) energy of the OPs was calculated using Fourier analysis for 88 patients and 88 age-matched controls for whom complete data were available. Photopic flicker amplitudes, photopic flicker latencies, scotopic b-wave amplitudes, and OP RMS values were compared between patients and controls. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves. RESULTS The mean ages of patients and controls were 55.9 ± 10.8 (SD) years and 55.1 ± 11.5, respectively. 83% of the patients had a diagnosis of BCR. The mean OP RMS value was significantly different in patients (15.6 µV ± 9.7 µV) versus control eyes (33.0 µV ± 12.7 µV), p < 0.001. Area under the ROC curves (AUROC) was 0.75 for photopic flicker amplitudes, 0.77 for photopic flicker latencies, 0.72 for scotopic b-wave amplitudes, and 0.88 for OP RMS. AUROC was significantly different between OP RMS and photopic flicker amplitudes (p < 0.001), between OP RMS and flicker latencies (p = 0.0032), and between OP RMS and scotopic b-wave amplitudes (p < 0.0001). CONCLUSION Analysis of OPs shows greater sensitivity and specificity in the diagnosis and evaluation of patients with birdshot chorioretinopathy than photopic and scotopic ERG amplitudes and photopic flicker latencies.
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26
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Williams AM, Nguyen VQ, Botsford BW, Eller AW. Bilateral acute retinal necrosis caused by two separate viral etiologies. Am J Ophthalmol Case Rep 2020; 18:100636. [PMID: 32154437 PMCID: PMC7057152 DOI: 10.1016/j.ajoc.2020.100636] [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: 02/13/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe an unusual case of bilateral acute retinal necrosis (ARN) that was caused by varicella zoster virus in one eye and Epstein-Barr virus in the fellow eye. Observations A 67-year-old immunocompromised man presented with ARN in the left eye following a dermatomal vesicular rash, with an aqueous sample positive for varicella zoster virus. Four months later, the patient presented with panuveitis and serous retinal detachment in the right eye, with vitreous sample positive for Epstein-Barr virus and negative for varicella zoster, herpes simplex, and cytomegalovirus. Conclusions and importance We report a rare case of bilateral ARN with independent infection of each eye by different viruses; varicella zoster in the left eye and, four months later, Epstein-Barr virus in the right eye. Immunocompromised patients are vulnerable to ARN from any of its inciting viral causes, and intraocular fluid should be obtained for diagnostic confirmation from the second eye in cases of bilateral ARN.
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Affiliation(s)
- Andrew M Williams
- Retina Service, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, USA
| | - Vincent Q Nguyen
- Retina Service, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, USA
| | - Benjamin W Botsford
- Retina Service, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, USA
| | - Andrew W Eller
- Retina Service, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, USA
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27
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Venkat AG, Sharma S. Automated measurement of leakage on wide-field angiography in the assessment of retinal vasculitis. J Ophthalmic Inflamm Infect 2020; 10:4. [PMID: 32009203 PMCID: PMC6995796 DOI: 10.1186/s12348-019-0193-8] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Automated analysis of leakage on fluorescein angiography is a measurable and clinically applicable endpoint that can be used to follow patients with posterior uveitis. A number of studies have analyzed the use of automated analysis of leakage on fluorescein angiography and are reviewed in this article.
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Affiliation(s)
- Arthi G Venkat
- Cleveland Clinic, Cole Eye Institute, 9500 Euclid Avenue, Desk i32, Cleveland, OH, 44195, USA
| | - Sumit Sharma
- Cleveland Clinic, Cole Eye Institute, 9500 Euclid Avenue, Desk i32, Cleveland, OH, 44195, USA.
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28
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Pichi F, Neri P. Multimodal imaging patterns of posterior syphilitic uveitis: a review of the literature, laboratory evaluation and treatment. Int Ophthalmol 2020; 40:1319-1329. [PMID: 31927680 DOI: 10.1007/s10792-020-01285-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/29/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To review the multimodal imaging patterns of posterior syphilitic uveitis. METHODS A systematic review. RESULTS The percentage of syphilis has started to increase again: The World Health Organization has reported 12 million new cases of syphilis each year. In addition, syphilis was responsible for 0.3% of deaths globally in 2002. Eye manifestations happen prevalently in secondary and tertiary stages of syphilis, even though ocular involvement can occur in all stages. Syphilis has the nickname: "the great imitator" since it has no unique clinical presentation, even though posterior uveitis is considered the most common form. Syphilis is known as "the great imitator," making its diagnosis in the presence of posterior uveitis particularly challenging as it presents similarly to other ocular conditions such as acute retinal necrosis. However, with the advent of multimodal imaging some particular patterns of pre-retinal, retinal, retinochoroidal and optic nerve involvement from syphilis can be identified to guide the diagnosis and the laboratory workup. CONCLUSION This review highlights the various patterns of pre-retinal precipitates, multifocal retinitis, retinochoroiditis (confluent and placoid) and optic neuritis caused by syphilis, the appropriate laboratory work to be obtained and the treatment to be initiated.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA.
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
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29
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Mora-Cantallops A, Pérez MD, Revenga M, González-López JJ. Ellipsoid layer restoration after Ozurdex ® treatment in a patient with acute posterior multifocal placoid pigment epitheliopathy. Eur J Ophthalmol 2019; 31:NP49-NP53. [PMID: 31642338 DOI: 10.1177/1120672119883598] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An atypical case of acute posterior multifocal placoid pigment epitheliopathy with a clear reappearance of the ellipsoid layer of the retina after Ozurdex® intravitreal implantation is presented. A 51-year-old woman reported a 3-week history of left eye photopsia. On slit-lamp examination, yellowish placoid lesions were found on her left eye fundus. Ancillary tests were performed. The patient was diagnosed as a left eye acute posterior multifocal placoid pigment epitheliopathy, and observational approach was decided. Later, the condition started to progress in an ampiginous manner and a decrease of visual acuity caused by an increase in number and size of the lesions was observed. As the disease was progressing with the conservative, observational approach, and the macula was menaced, an intravitreal dexamethasone implant was injected in the left eye with a consequent improvement of the visual acuity and lesion stabilization. The ellipsoid layer, unidentifiable inside the placoid lesions in previous optical coherence tomography tests, reappeared after the treatment. Intravitreal dexamethasone implants can be used to stabilize acute posterior multifocal placoid pigment epitheliopathy lesions and help resolve the condition. Spectral domain optical coherence tomography can also be useful for monitoring these lesions, as the ellipsoid layer may reappear upon resolution.
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Affiliation(s)
- Arnau Mora-Cantallops
- Department of Ophthalmology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - M Dolores Pérez
- Department of Ophthalmology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Marcelino Revenga
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad de Alcalá, Madrid, Spain
| | - Julio Jose González-López
- Department of Ophthalmology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Department of Surgery, School of Medicine, Universidad de Alcalá, Madrid, Spain
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30
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Schlaen A, Aquino MP, Ormaechea MS, Couto C, Saravia M. Spectral optical coherence tomography findings in an adult patient with syphilitic bilateral posterior uveitis and unilateral punctate inner retinitis. Am J Ophthalmol Case Rep 2019; 15:100489. [PMID: 31211286 PMCID: PMC6562369 DOI: 10.1016/j.ajoc.2019.100489] [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: 07/29/2018] [Revised: 03/07/2019] [Accepted: 06/03/2019] [Indexed: 11/03/2022] Open
Abstract
Purpose To describe the spectral domain optical coherence tomography (SD-OCT) features of a punctate inner retinitis, a rare ocular manifestation of syphilis, in an HIV positive adult patient. Observations In the right eye, SD-OCT images during the active period showed hyperreflectivity of the full thickness of the inner retina, precluding the individualization of the layers. In addition, multifocal areas with higher hyperreflectivity were identified within the affected retina. Once the lesion became inactive, SD-OCT images revealed inner retina layers atrophy, disruption of the ellipsoid layer, and multifocal damage to the retinal pigment epithelium layer. Conclusion and importance Punctate inner retinitis affects the full thickness retina, leading to severe retinal damage, along with multifocal damage of the retinal pigment epithelium. The multifocal white retinal lesions observed within the affected retinal area correlated with the presence of intense hyperreflective dots within the retina showed by SD-OCT. These lesions are deeper than was described in other reports.
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Affiliation(s)
- Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Argentina.,Department of Ophthalmology, University of Buenos Aires, Argentina
| | | | - María Soledad Ormaechea
- Department of Ophthalmology, Hospital Universitario Austral, Argentina.,Department of Ophthalmology, University of Buenos Aires, Argentina
| | - Cristóbal Couto
- Department of Ophthalmology, University of Buenos Aires, Argentina
| | - Mario Saravia
- Department of Ophthalmology, Hospital Universitario Austral, Argentina
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Reich M, Cakir B, Cvetkoski S, Lang SJ, Stahl A, Ness T, Agostini H, Lange C. Acute unilateral maculopathy associated with adult onset of hand, foot and mouth disease: a case report. BMC Ophthalmol 2019; 19:104. [PMID: 31064339 PMCID: PMC6505311 DOI: 10.1186/s12886-019-1111-4] [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: 02/11/2019] [Accepted: 04/22/2019] [Indexed: 01/29/2023] Open
Abstract
Background To report the case of a 31-year-old patient with Hand, Foot and Mouth Disease (HFMD) and concurrent acute monocular maculopathy, and to describe multimodal imaging findings never before described including optical coherence tomography angiography (OCT-A). Case presentation Nine days after the onset of clinically highly probable but not laboratory-verified HFMD, a 31-year old male noticed a central scotoma, distorted lines and loss of visual acuity (Snellen visual acuity 20/400) in his right eye. Funduscopy revealed focal alterations in the retinal pigmented epithelium (RPE) and yellow retinal dots corresponding to focal dots of decreased fundus autofluorescence (FAF) surrounded by increased FAF. Spectral domain optical coherence tomography (SD-OCT) demonstrated irregularities in the ellipsoide zone, hyperreflective dots above the RPE and RPE thickening. Fundus fluorescein angiography (FAG) revealed central hypofluorescence in the macular area in the early phase, as well as increasing focal hyperfluorescence in the late phase corresponding with RPE defects observed in FAF. Indocyanine green angiography (ICGA) showed central hypofluorescence in the early and late phase, corresponding with areas of reduced flow in the choroidea and choriocapillaris as apparent in OCT-A. Visual acuity improved within 3 months without any systemic or local therapy. At his three-month follow-up, SD-OCT revealed subtle subretinal fluid that resolved spontaneously over time. No signs of choroidal neovascularization were observed. Twelve months following the onset of symptoms Snellen visual acuity was 400/400. Multimodal imaging revealed subtly changed, decreased FAF while the choroidal architecture recovered completely as demonstrated by OCT-A. Conclusions HFMD-associated maculopahty is an uncommon but important differential diagnosis of chorioretinitis with macular involvement. The prognosis can be good and the initially observed morphological pathologies such as impaired perfusion of the choroidal vessels can recover spontaneously over a period lasting 12 months. OCT-A can be employed as a non-invasive tool to detect the reduced perfusion of the choroidal vessels and for monitoring the disease course.
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Affiliation(s)
- Michael Reich
- Eye Center, Faculty of Medicine, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - Bertan Cakir
- Eye Center, Faculty of Medicine, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | | | - Stefan J Lang
- Eye Center, Faculty of Medicine, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - Andreas Stahl
- Eye Center, Faculty of Medicine, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.,Department of Ophthalmology, University Medical Center Greifswald, Greifswald, Germany
| | - Thomas Ness
- Eye Center, Faculty of Medicine, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - Hansjürgen Agostini
- Eye Center, Faculty of Medicine, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - Clemens Lange
- Eye Center, Faculty of Medicine, Albert-Ludwigs University Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
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Noda K, Oishi A, Uji A, Tanaka S, Tsujikawa A. Limited efficacy of adalimumab in the acute phase of serpiginous choroiditis refractory to corticosteroid and cyclosporine, a case report. BMC Ophthalmol 2019; 19:95. [PMID: 31014297 PMCID: PMC6480770 DOI: 10.1186/s12886-019-1104-3] [Citation(s) in RCA: 3] [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: 01/04/2019] [Accepted: 04/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal treatment of serpiginous choroiditis is not established. While recent reports indicate the efficacy of adalimumab, there is limited evidence. We present a case of serpiginous choroiditis refractory to steroids, immunosuppressants, and adalimumab. CASE PRESENTATION An 18-year-old woman presented with severe vision loss in both eyes. A fundus examination revealed a foveal grayish-white lesion, and optical coherence tomography revealed outer retinal damage. She was diagnosed with serpiginous choroiditis and treated with steroid pulse therapy, but the disease progressed continuously. The addition of sub-Tenon's injection of triamcinolone and oral cyclosporine did not change the disease course. We also administered subcutaneous injections of adalimumab, but even with the intensive treatment, the retinal lesions and subsequent atrophy progressed. Her right and left visual acuity declined from 20/22 to 20/66 and 20/200, respectively, during the 9 months of follow-up. CONCLUSION Here, we report a case of serpiginous choroiditis refractory to corticosteroids, immunosuppressants, and adalimumab. Further studies are needed to establish the optimal treatment for such cases.
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Affiliation(s)
- Kazunori Noda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Saori Tanaka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Khochtali S, Gargouri S, Zina S, Ksiaa I, Abroug N, Zaouali S, Jelliti B, Attia S, Khairallah M. Acute multifocal retinitis: a retrospective review of 35 cases. J Ophthalmic Inflamm Infect 2018; 8:18. [PMID: 30328571 PMCID: PMC6192942 DOI: 10.1186/s12348-018-0160-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/17/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022] Open
Abstract
Background Acute multifocal retinitis is a rare condition that has been considered to be often idiopathic. The purpose of this study was to analyze clinical features and causes of acute multifocal retinitis. Results This study is a retrospective review of the charts of 35 patients with acute multifocal retinitis. Patients with three or more retinal lesions in at least one eye, with at least one lesion of less than 500 μm in size were included. All patients had complete ophthalmological examination, fundus photography, and fluorescein angiography. Twelve patients (34.3%) had optical coherence tomography. An extensive work-up was performed including a detailed comprehensive medical history, examination by an internist and an infectious disease specialist, a chest X-ray, Mantoux test, and laboratory tests for syphilis, human immunodeficiency virus, Bartonella, and Rickettsia. Of the 35 patients, 25 (71.4%) had bilateral involvement and 10 (28.6%) had unilateral involvement (total number of eyes: 60). Mean best-corrected visual acuity (BCVA) was 20/25 (range, 20/1000–20/20). Retinal lesions ranged from 3 to more than 20 in number in at least 1 eye, and from 150 to 1500 μm in size. Associated findings included mild anterior chamber inflammation in 5 eyes (8.3%), mild vitritis in 46 eyes (76.7%), optic disc swelling in 9 eyes (15%), macular star in 4 eyes (6.7%), exudative retinal detachment in 6 eyes (10%), and branch retinal artery occlusion in 6 eyes (10%). Acute multifocal retinitis was found to be caused by Rickettsia conorii infection in 20 patients (57.1%), Rickettsia typhi infection in 4 patients (11.4%), cat-scratch disease in 8 patients (22.9%), and syphilis in 1 patient (2.9%). It was idiopathic in two patients (5.7%). Retinal lesions resolved without scarring in 3 to 12 weeks in all but three eyes (5%), in which residual retinal pigment epithelial changes were noted. Conclusion Rickettsial disease was the most common cause of acute multifocal retinitis. Other identified causes included cat-scratch disease and syphilis, and a very small subset of patients was diagnosed with idiopathic multifocal retinitis.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Salma Gargouri
- Department of Ophthalmology, Faculty of Medicine, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sonia Zaouali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
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Agarwal A, Invernizzi A, Singh RB, Foulsham W, Aggarwal K, Handa S, Agrawal R, Pavesio C, Gupta V. An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management. J Ophthalmic Inflamm Infect 2018; 8:13. [PMID: 30209691 PMCID: PMC6135736 DOI: 10.1186/s12348-018-0155-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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: 01/04/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
Inflammatory choroidal neovascular membranes are challenging to diagnose and manage. A number of uveitic entities may be complicated by the development of choroidal neovascularization leading to a decrease in central visual acuity. In conditions such as punctate inner choroidopathy, development of choroidal neovascularization is extremely common and must be suspected in all cases. On the other hand, in patients with conditions such as serpiginous choroiditis, and multifocal choroiditis, it may be difficult to differentiate between inflammatory choroiditis lesions and choroidal neovascularization. Multimodal imaging analysis, including the recently introduced technology of optical coherence tomography angiography, greatly aid in the diagnosis and management of inflammatory choroidal neovascularization. Management of these neovascular membranes consists of anti-vascular growth factor agents, with or without concomitant anti-inflammatory and/or corticosteroid therapy.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Rohan Bir Singh
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - William Foulsham
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Sabia Handa
- Advanced Eye Center, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK.,Singapore Eye Research Institute, Singapore, Singapore
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
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Xerri O, Salah S, Monnet D, Brézin AP. Untreated Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): a case series. BMC Ophthalmol 2018; 18:76. [PMID: 29554890 DOI: 10.1186/s12886-018-0744-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a rare inflammatory eye disease that affects the Retinal Pigment Epithelium and outer retina. The purpose of this study was to describe its presentations, as well as its prognosis in a series of untreated patients. Methods Records of patients seen in the department of Ophthalmology at Cochin University Hospital, Paris, between April 2002 and June 2015 were retrospectively studied. Patients were included if they presented with the typical findings of APMPPE characterized by whitish or yellowish bilateral placoid lesions, a typical pattern of early hypofluorescence and late hyperfluorescence on fluorescein angiography. Only untreated patients who had been followed for at least 1 month were included. Results Out of 22 patients’ records with a diagnosis of APMPPE, 10 patients (9 women, 1 man), with a mean age of 24.5 ± 4.2 years, fulfilled the study criteria with a diagnosis of typical untreated APMPPE. Prodromal symptoms were reported in 7/10 patients. Macular lesions were observed in 18/20 eyes. Sub-retinal fluid was seen at presentation in 3 eyes. Initial mean BCVA was 0.56 ± 0.81 LogMAR [− 0.10 to 2.30]. In 9 out of 10 cases, the time interval between manifestations in the first affected eye and the fellow eye was less than 3 days. After 1 month, BCVA had improved to 0.05 ± 0.089 LogMAR [0–0.3], with a decimal BCVA ≥0.8 in 17/20 eyes. Conclusions In these 10 cases of untreated APMPPE, a favorable outcome was observed.
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Hosseini SM, Moghaddas E, Sharifi K, Dadgar Moghaddam M, Shamsian SA. Assessment of ocular toxoplasmosis patients reported at a tertiary center in the northeast of Iran. Int Ophthalmol 2018; 38:2527-2533. [PMID: 29335806 DOI: 10.1007/s10792-017-0764-3] [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: 09/07/2016] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Ocular toxoplasmosis, which is caused by the single-cell parasite Toxoplasma gondii, is currently the most significant cause of posterior uveitis in the world. No previous studies have described the prevalence and clinical features of ocular toxoplasmosis in the northeast of Iran. The purpose of the current study was to address this gap. METHODS In this retrospective study, the medical records of 488 uveitis patients who presented to the Khatam-al-Anbia Eye Hospital of Mashhad University of Medical Sciences, a tertiary ophthalmology center in the northeast of Iran, between January 2013 and December 2015 were evaluated. The clinical features and risk factors of 99 (20%) consecutive patients with ocular toxoplasmosis were extracted. RESULTS Ninety-nine including 53 (53.5%) female and 46 (46.5%) male patients with ocular toxoplasmosis were included in the analysis. Reduced vision (77%) and floaters (15.2%) were the most common presenting symptoms. The age category that was most affected by ocular toxoplasmosis was 20-40 years (range: 11-65 years) with a mean age of 27.2. All patients had retinochoroiditis, but just two had anterior uveitis. All of the extracted patients, with the exception of three patients, had unilateral involvement. None of the patients had any other medical disorders with the exception of one woman, who had diabetes. Only four recurring ocular toxoplasmosis patients were referred to the education hospital during the study. Serology data were available for just 32 patients, of which 31 (96.8%) were IgG positive, and 1 (3.2%) was IgM positive. CONCLUSION Toxoplasma gondii was responsible for 20% of the patients of uveitis that presented to the largest ophthalmology center in the northeast of Iran. There is a high incidence of patients of ocular toxoplasmosis in the northeast of Iran, and it is a significant cause of uveitis and visual impairment in this area.
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Affiliation(s)
| | - Elham Moghaddas
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Karim Sharifi
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Dadgar Moghaddam
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Aliakbar Shamsian
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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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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Abstract
Vogt-Koyanagi-Harada (VKH) disease is defined as a severe bilateral, chronic granulomatous panuveitis associated with serous retinal detachments, disk edema, and vitritis, with central nervous system, auditory, and integumentary manifestations. It is an autoimmune inflammatory condition mediated by T cells that target melanocytes in individuals genetically susceptible to the disease. Vogt-Koyanagi-Harada disease presents clinically in 4 different phases: prodromal, acute inflammatory, chronic, and recurrent, with extraocular manifestations including headache, meningitis, hearing loss, poliosis, and vitiligo. Optical coherence tomography (OCT) allows earlier diagnosis of VKH disease by revealing heterogeneous exudative detachments of the retina in the acute stage and choroidal thickening, and by demonstrating choroidal thinning in the chronic stage. Treatment of this disease is initially with intravenous corticosteroids, with, if needed, a transition to immunosuppressant drugs for long-term control. Patients with VKH disease can have good final visual outcomes if treated promptly and aggressively.
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Affiliation(s)
- C Bonnet
- Université Paris Descartes, 75014 Paris, France; Centre Cochin ambulatoire d'ophtalmologie, groupe hospitalier Cochin-Hôtel-Dieu, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - J-B Daudin
- Centre Cochin ambulatoire d'ophtalmologie, groupe hospitalier Cochin-Hôtel-Dieu, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - D Monnet
- Université Paris Descartes, 75014 Paris, France; Centre Cochin ambulatoire d'ophtalmologie, groupe hospitalier Cochin-Hôtel-Dieu, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Brézin
- Université Paris Descartes, 75014 Paris, France; Centre Cochin ambulatoire d'ophtalmologie, groupe hospitalier Cochin-Hôtel-Dieu, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Chronopoulos A, Roquelaure D, Souteyrand G, Seebach JD, Schutz JS, Thumann G. Aqueous humor polymerase chain reaction in uveitis - utility and safety. BMC Ophthalmol 2016; 16:189. [PMID: 27793120 PMCID: PMC5084402 DOI: 10.1186/s12886-016-0369-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 07/30/2016] [Accepted: 10/20/2016] [Indexed: 11/23/2022] Open
Abstract
Background To study the value and safety of aqueous humor polymerase chain reaction (PCR) analysis for Herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus and Toxoplasma gondii in patients with uveitis. Methods Records of 45 consecutive patients with anterior and posterior uveitis who underwent AC paracentesis with PCR were reviewed. The main outcome measure was frequency of PCR positivity. Secondary outcomes were alteration of treatment, safety of paracentesis, and correlation of keratitic precipitates with PCR positivity, Results The overall PCR positivity was 48.9 % (22/45). Therapy was changed because of the PCR results in 14/45 patients (37.7 %). One patient experienced a paracentesis related complication (1/45, 2.2 %) without long-term sequelae. Conclusion Aqueous PCR altered the diagnosis and treatment in over a third of our patients and was relatively safe. Aqueous PCR should be considered for uveitis of atypical clinical appearance, recurrent severe uveitis of uncertain etiology, and therapy refractory cases.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland.
| | - Daniel Roquelaure
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Georges Souteyrand
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Jörg Dieter Seebach
- Division of Immunology and Allergy, University Hospitals and School of Medicine, Geneva, Switzerland
| | - James Scott Schutz
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Gabriele Thumann
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
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Shah JS, Shetty N, Shah SKD, Shah NKS. Tubercular Uveitis with Ocular Manifestation as the First Presentation of Tuberculosis: A Case Series. J Clin Diagn Res 2016; 10:NR01-3. [PMID: 27134908 DOI: 10.7860/jcdr/2016/16219.7375] [Citation(s) in RCA: 4] [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] [Received: 08/12/2015] [Accepted: 01/27/2016] [Indexed: 11/24/2022]
Abstract
Tuberculosis is very common disease in India. It is one of the most common causes of Granulomatous Uveitis in our Country even today. So the strongest suspicion in our mind when we are treating a case of Uveitis, should be TB. We reviewed all the cases of clinically suspected ocular tuberculosis attending the Ophthalmology OPD of Sri Siddhartha Medical College between December 2012 and December 2014 who were refractory to routine uveitis management and later on responded to anti-Tubercular treatment. History of TB contact, Ocular manifestation, Demographic Profile of the patients, Diagnostic test, Treatment regime were looked into. Here by we present a case series of 15 cases of refractory uveitis that later were detected to be of tuberculous origin. We studied the characteristic features, complications and correlation of mantoux test, ESR and Koch's contact with these cases.
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Affiliation(s)
- Jayashree S Shah
- Professor, Department of Ophthalmology, Sri Siddhartha Medical College and Hospital , Karnataka, India
| | - Niharika Shetty
- Associate Professor, Department of Ophthalmology, Sri Siddhartha Medical College and Hospital , Karnataka, India
| | - Sharath Kumar D Shah
- Professor and HOD, Department of Medicine, Sri Siddhartha Medical College , Karnataka, India
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Biggee K, Gale MJ, Smith TB, Suhler EB, Pennesi ME, Lin P. Parafoveal cone abnormalities and recovery on adaptive optics in posterior uveitis. Am J Ophthalmol Case Rep 2016; 1:16-22. [PMID: 29503883 DOI: 10.1016/j.ajoc.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/18/2016] [Accepted: 03/08/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To determine if adaptive optics (AO) flood illumination imaging can detect subclinical changes in 4 cases of posterior uveitis affecting the outer retina. Observations In all 4 cases, the affected eye showed altered areas in the photoreceptor mosaic on AO that corresponded to changes on other imaging modalities. Abnormalities not apparent on other imaging modalities were also noted. In one case of multifocal choroiditis with acute outer retinal atrophy, AO revealed decreased visualization of photoreceptors in the unaffected eye that was not noted on spectral domain-optical coherence tomography. In the patient with multiple evanescent white dot syndrome, focal photoreceptor abnormalities were more apparent on AO compared to other imaging modalities, and these areas normalized on AO during follow-up. Five weeks after initiation of high dose prednisone and azathioprine in a patient with serpiginous choroidopathy, AO images showed recovery in apparent parafoveal cone density. Conclusions and importance AO detects subclinical changes in the photoreceptor layer in posterior uveitis that can recover over time. AO may be useful in following outer retinal inflammatory conditions.
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Deschasse C, Bielefeld P, Muselier A, Bour JB, Besancenot JF, Garcher CC, Bron AM. [Eye and cat scratch disease: A case series]. J Fr Ophtalmol 2016; 39:164-70. [PMID: 26868534 DOI: 10.1016/j.jfo.2015.06.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cat scratch disease is a pleiomorphic condition, sometimes with isolated ophthalmic involvement. We report the clinical observations of seven cases with ophthalmologic manifestations of cat scratch disease. OBSERVATIONS There were seven patients, with a median age of 52 years, of whom five were women and three had unilateral involvement. Six exhibited Leber's stellate neuroretinitis, an incomplete syndrome in two cases, and one associated with chorioretinal foci. One patient had isolated retinal infiltrates. The diagnosis of cat scratch disease was confirmed by Bartonella henselae serology, positive in all cases. All patients received treatment with doxycycline. Ocular complications (with optic atrophy and macular retinal pigment epithelial changes) were noted in five cases. DISCUSSION Ocular bartonellosis is an atypical clinical form. It requires a directed ancillary work-up with serology or PCR, which has the peculiarity of being highly specific if not very sensitive. Treatment is above all preventive. Antibiotics may be initiated. CONCLUSION Cat scratch disease must be excluded in the work-up of posterior uveitis.
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Affiliation(s)
- C Deschasse
- Service d'ophtalmologie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Bielefeld
- Service de médecine interne, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - A Muselier
- Service d'ophtalmologie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - J B Bour
- Service de virologie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - J F Besancenot
- Service de médecine interne, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - C C Garcher
- Service d'ophtalmologie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France; INRA, UMR1324, centre des sciences du goût et de l'alimentation, 21000 Dijon, France; CNRS, UMR6265, centre des sciences du goût et de l'alimentation, 21000 Dijon, France; Centre des sciences du goût et de l'alimentation, université de Bourgogne, 21000 Dijon, France
| | - A M Bron
- Service d'ophtalmologie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France; INRA, UMR1324, centre des sciences du goût et de l'alimentation, 21000 Dijon, France; CNRS, UMR6265, centre des sciences du goût et de l'alimentation, 21000 Dijon, France; Centre des sciences du goût et de l'alimentation, université de Bourgogne, 21000 Dijon, France.
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Lembo A, Pichi F, Santangelo E, Carrai P, Hadjistilianou T, Serafino M, Nucci P. Two masquerade presentations of retinoblastoma. Int Ophthalmol 2015; 36:275-9. [PMID: 26449229 DOI: 10.1007/s10792-015-0134-y] [Citation(s) in RCA: 2] [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: 01/06/2015] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
Abstract
Masquerade syndromes are disorders occurring with intraocular inflammation misdiagnosed as uveitis. The underlying causes may be benign or malignant conditions, and one of the most important diagnoses to take into consideration in children is retinoblastoma. We present two cases with uncertain early misdiagnosis whose definite diagnosis eventually was retinoblastoma.
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Affiliation(s)
- Andrea Lembo
- San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, 20123, Milan, Italy.
| | - Francesco Pichi
- San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, 20123, Milan, Italy
| | - Elisabetta Santangelo
- San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, 20123, Milan, Italy
| | - Paola Carrai
- San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, 20123, Milan, Italy
| | - Theodora Hadjistilianou
- Department of Ophthalmology, Azienda Ospedaliera e Universitaria Santa Maria alle Scotte, Siena, Italy
| | - Massimiliano Serafino
- San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, 20123, Milan, Italy
| | - Paolo Nucci
- San Giuseppe Hospital, University Eye Clinic, Via San Vittore 12, 20123, Milan, Italy
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Abstract
PURPOSE To report a case of a patient with primary vitreoretinal lymphoma masquerading as retinitis. METHODS Retrospective review of the patient's clinical, histopathological and imaging records. RESULTS Cytopathology was negative for malignancy, and preliminary polymerase chain reaction results supported the diagnosis of varicella zoster virus retinitis. Therefore, the patient was treated with antiviral therapy. However, under this treatment, the retinitis progressed. As a result, primary vitreoretinal lymphoma was suspected, and empirical treatment with intravitreal methotrexate injections was started. Under this treatment, the ocular features improved. Five months after initial ocular presentation and ocular resolution, the patient presented with central nervous system lymphoma. CONCLUSION This case should raise the awareness of the variable clinical presentations, the challenging diagnosis and treatment of primary vitreoretinal lymphoma. All cases should be continuously systemically evaluated.
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Affiliation(s)
- Ofira Zloto
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir E Abd Elkader
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Didi Fabian
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vicktoria Vishnevskia-Dai
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Agrawal R, Bhan K, Balaggan K, Lee RW, Pavesio CE, Addison PK. Unilateral acute maculopathy associated with adult onset hand, foot and mouth disease: case report and review of literature. J Ophthalmic Inflamm Infect 2015; 5:2. [PMID: 25774239 PMCID: PMC4333364 DOI: 10.1186/s12348-015-0034-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 10/12/2014] [Accepted: 01/04/2015] [Indexed: 11/10/2022] Open
Abstract
Background Acute maculopathy is a rare condition of unknown aetiology and Coxsackie virus is known to be associated with this macular chorioretinitis. Findings We report a case of acute unilateral maculopathy in a 35-year-old woman with concurrent hand foot and mouth disease. Furthermore, we display multimodal imaging (colour fundus photographs, autofluorescence, spectral domain ocular coherence tomography, fluorescein angiography and indocyanine green angiography) charting the course of the disease. The source of the virus was thought to be the patient's child. Empirical treatment with oral corticosteroids was commenced and the inflammation resolved, leaving a residual macular scar. Conclusions We present this case combined with the review of literature of adult onset Coxsackie-virus-associated retinitis. This case reiterates the fact that Coxsackie virus is an uncommon but important consideration in the differential diagnosis of chorioretinitis and posterior uveitis with atypical retinopathy.
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Affiliation(s)
- Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, 162 City Road, London, EC1V 2PD UK ; Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK ; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Kanchan Bhan
- Moorfields Eye Hospital, NHS Foundation Trust, 162 City Road, London, EC1V 2PD UK
| | - Kam Balaggan
- Moorfields Eye Hospital, NHS Foundation Trust, 162 City Road, London, EC1V 2PD UK
| | - Richard Wj Lee
- Moorfields Eye Hospital, NHS Foundation Trust, 162 City Road, London, EC1V 2PD UK ; Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK ; University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW UK
| | - Carlos E Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, 162 City Road, London, EC1V 2PD UK ; Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK
| | - Peter Kf Addison
- Moorfields Eye Hospital, NHS Foundation Trust, 162 City Road, London, EC1V 2PD UK
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