1
|
Jalil SA, Jaouni T, Amer R. Vasoproliferative Tumor Secondary to Sarcoidosis-Associated Intermediate Uveitis. Turk J Ophthalmol 2024; 54:108-111. [PMID: 38645965 PMCID: PMC11034545 DOI: 10.4274/tjo.galenos.2024.36926] [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: 08/22/2023] [Accepted: 01/31/2024] [Indexed: 04/23/2024] Open
Abstract
We report the visual and clinical outcomes of a middle-aged woman who presented with exudative retinal detachment (ERD) secondary to a vasoproliferative tumor (VPT) in an eye with sarcoidosis-associated intermediate uveitis. A 55-year-old woman previously diagnosed with sarcoidosis presented with decreased vision in the left eye (LE). Visual acuity in the LE was counting fingers. She had active vitritis, and a peripheral retinal vascular mass was noted in the superotemporal periphery. The mass was associated with ERD involving the posterior pole. The patient was managed with systemic and intravitreal steroids, and cyclosporine was subsequently added as a steroid-sparing agent. Because of recurrence of ERD, the patient underwent pars plana vitrectomy, and cryotherapy and laser photocoagulation were applied to the VPT. Two months postoperatively, visual acuity in the LE improved to 6/10. There was marked regression of the VPT and total resolution of the ERD. In conclusion, we report a favorable visual and clinical outcome in a patient with VPT-associated ERD who responded to a combination of medical therapy and surgical intervention. VPT may lead to different remote complications, so timely diagnosis of these tumors and proper management of their complications is warranted.
Collapse
Affiliation(s)
- Sara Abdel Jalil
- Hadassah Medical Center, Department of Ophthalmology, Jerusalem, Israel
| | - Tareq Jaouni
- Hadassah Medical Center, Department of Ophthalmology, Jerusalem, Israel
| | - Radgonde Amer
- Hadassah Medical Center, Department of Ophthalmology, Jerusalem, Israel
| |
Collapse
|
2
|
Ahmed AS, Dutta Majumder P, Elizabeth A, Rao V, Ganesh S, Biswas J. Retinal Vasoproliferative Tumours in Uveitis. Ocul Immunol Inflamm 2024:1-5. [PMID: 38421940 DOI: 10.1080/09273948.2024.2317418] [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: 11/09/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To describe a cohort of patients with retinal vasoproliferative tumours (RVPT) seen in the uveitis clinic of a single tertiary eye care institute in India. METHODS Retrospective Chart Review. RESULTS In our study of 17 patients with 18 eyes affected by RVPTs, 94.1% showed unilateral involvement, one patient had bilateral RVPTs, and another had two RVPTs in the same eye. The mean age was 36.3 ± 15.1 years (range: 12-63 years), with a male majority (76.4%). The most common location was inferotemporal quadrant (44.4%). The most common associated uveitic condition was intermediate uveitis (50%). Patients were treated with oral corticosteroid (in 94.1%) and immunosuppressive (35.2%) in addition to transconjunctival cryotherapy (in 52.9%) or laser photocoagulation (in 41.1%). Regression of the RVPT was achieved in all cases except one. Visual acuity at time of detection of RVPT ranged from 6/6 to HM. No significant change was noted in the mean best corrected visual acuity pre and post treatment in the study group. CONCLUSION RVPTs, rare peripheral retinal lesions often associated with intermediate uveitis, require early diagnosis with targeted therapy to prevent vision loss and achieve favorable long-term outcomes with rare recurrences.
Collapse
Affiliation(s)
- Arshee S Ahmed
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Amala Elizabeth
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vinita Rao
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sudha Ganesh
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
3
|
Gnanaraj R, Shah AA, Palestine AG, Reddy AK. Uveitis in the Setting of Co-Existing Systemic Sarcoidosis and Multiple Sclerosis. Ocul Immunol Inflamm 2024; 32:181-183. [PMID: 37467487 DOI: 10.1080/09273948.2023.2236211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/10/2023] [Revised: 05/26/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
We report a case of intermediate uveitis in the setting of both systemic sarcoidosis and multiple sclerosis. A 68-year-old female was diagnosed with bilateral granulomatous intermediate uveitis and cystoid macular edema. Initial systemic work-up was unrevealing. The uveitis was treated successfully with local corticosteroid injections. Eighteen months after presentation, the patient developed new systemic symptoms. Additional testing revealed systemic lymphadenopathy, with biopsy showing non-caseating granulomas, leading to a diagnosis of sarcoidosis. However, MRI of the brain and spinal cord along with cerebrospinal fluid analysis was consistent with MS. The management of the uveitis and systemic inflammation was co-managed by ophthalmology, neurology, and rheumatology, and eventually controlled with leflunomide and rituximab. Patients can rarely have co-existing systemic sarcoidosis and multiple sclerosis. Although challenging to diagnose, radiographic findings and cerebrospinal fluid analysis can be helpful to differentiate multiple sclerosis and neurosarcoidosis. Management of these patients requires coordination between multiple specialties.
Collapse
Affiliation(s)
- Ramya Gnanaraj
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anna A Shah
- Department of Neurology & Rocky Mountain MS Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amit K Reddy
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
4
|
Grewal DS, Agarwal M, Munk MR. Wide Field Optical Coherence Tomography and Optical Coherence Tomography Angiography in Uveitis. Ocul Immunol Inflamm 2024; 32:105-115. [PMID: 36534760 DOI: 10.1080/09273948.2022.2150223] [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: 01/20/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We review the current literature on the use of wide-field optical coherence tomography (OCT) and wide-field optical coherence tomography angiography (OCTA) in different uveitic phenotypes as well as various sequelae of uveitis and discuss the limitations of this evolving technology. MAIN BODY Current consensus guidelines on nomenclature in wide-field OCT and OCTA are described. The specific utility of wide-field OCT and OCTA in assessment of the retina and choroid using different en-face and cross-sectional slabs in various inflammatory diseases is reviewed. Furthermore, we discuss widefield OCT and OCTA in assessment of retinal ischemia and its limitations in assessing retinal vascular leakage. CONCLUSION Wide-field OCT and OCTA deliver more sensitive measures of inflammation. With continued advancement in both hardware technology and software processing, these modalities will allow for more accurate assessment of uveitis, better understanding of disease mechanisms, and precise monitoring of treatment response.
Collapse
Affiliation(s)
- Dilraj S Grewal
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Reading Center, Durham, North Carolina, USA
| | - Mamta Agarwal
- Uveitis & Cornea Consultant, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Sanghi P, Luis J, Ajamil S, Yeung IY, Hindle E, Sandhu S, Hassan S, Turner B, Rees A, Westcott M. Predictive Factors for Magnetic Resonance Imaging Changes Suggestive of Demyelination in Adult Patients with Uveitis Scanned Prior to Commencing Adalimumab Therapy. Ocul Immunol Inflamm 2023; 31:1804-1812. [PMID: 36099542 DOI: 10.1080/09273948.2022.2118134] [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: 07/13/2021] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the predictive clinical factors for abnormal magnetic resonance imaging (MRI) scans suggestive of demyelination by analysis of MRI's performed for adult non-infectious uveitic patients prior to commencing adalimumab therapy. METHODS Retrospective case review of 240 patients was conducted in a single tertiary institution between November 2017 and March 2020. Aetiology of underlying disease, clinical characteristics, and MRI outcomes were analysed. RESULTS The presence of bilateral idiopathic intermediate uveitis (IIU) (p = .0048) and neurological symptoms (p = .028) were highly predictive of an abnormal MRI strongly suggestive of demyelination (MRSSD); 5 out of 64 scans (7.8%) with these clinical characteristics had MRSSD. CONCLUSIONS Tumor necrosis factor antagonist-induced demyelination is a concern in adalimumab use. We propose an MRI screening protocol to identify those at high risk of demyelination; positive results can be maximised by screening all patients with IIU and those with neurological symptoms.
Collapse
Affiliation(s)
- Priyanka Sanghi
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Joshua Luis
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Sofia Ajamil
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ian Yl Yeung
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Edward Hindle
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Selina Sandhu
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Said Hassan
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ben Turner
- Department of Ophthalmology, Barts Health NHS Trust, London, UK
| | - Angela Rees
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mark Westcott
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, Barts Health NHS Trust, London, UK
| |
Collapse
|
6
|
Rojas-Carabali W, Boada-Robayo L, Chacón-Zambrano D, Criollo Porras E, Kerguelén Dumar V, de-la-Torre A. Multiple Sclerosis in a Patient with Intermediate Uveitis and Juvenile Idiopathic Arthritis Treated with Adalimumab: A Case Report. Ocul Immunol Inflamm 2023; 31:1873-1876. [PMID: 36150118 DOI: 10.1080/09273948.2022.2113800] [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: 12/21/2021] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To report a case of multiple sclerosis (MS) development in a patient with Juvenile Idiopathic Arthritis (JIA) and bilateral intermediate uveitis (IU) treated with Adalimumab. CASE REPORT A 21-year-old Colombian woman diagnosed with JIA and bilateral refractory IU treated with methotrexate and Adalimumab with difficult control of the disease and multiple ocular complications. Eight years after starting Adalimumab, the patient presented paresthesia in the left upper limb. Radiologic findings in the brain and cervical spine MRI confirmed the diagnosis of MS. CONCLUSIONS We reported the first case of MS development in a patient with JIA treated with Adalimumab and the third in a patient with noninfectious uveitis treated with anti-TNFα. It remains uncertain whether MS is secondary to anti-TNFα therapy or is linked to a polyautoimmunity phenomenon.
Collapse
Affiliation(s)
- William Rojas-Carabali
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Laura Boada-Robayo
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Daniela Chacón-Zambrano
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | - Valentina Kerguelén Dumar
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
7
|
Lobo-Chan AM, Joltikov K, Haseeb A, Mehta SD. A Systematic Review of Clinical Trials in Uveitis: Lessons Learned. Ophthalmic Epidemiol 2023; 30:445-452. [PMID: 36204817 PMCID: PMC10326894 DOI: 10.1080/09286586.2022.2131837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/22/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE Clinical trials in uveitis have led to the expansion of therapeutic options for the management of non-infectious uveitis. The purpose of this systematic review is to investigate why some clinical trials have yielded successful results and regulatory approval of new therapies, and some have not. METHODS A systematic literature search of the Pubmed/MEDLINE database and clinicaltrials.gov was performed from 2006 to 2021, according to the PRISMA guidelines. Phase III clinical trials of systemic and local therapies in adults with non-infectious intermediate, posterior, and panuveitis were included. RESULTS A total of 79 clinical trials were collected from ClinicalTrials.gov and PubMed/MEDLINE database search. Based on the inclusion and exclusion criteria, 14 clinical trials were included. CONCLUSION This review summarizes the study design, outcome measures, and results of recent phase III trials in non-infectious uveitis, in the interest of understanding limitations and rethinking new methods of defining endpoints in clinical trial design.
Collapse
Affiliation(s)
- Ann-Marie Lobo-Chan
- Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Katherine Joltikov
- Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Abid Haseeb
- Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Supriya D. Mehta
- Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| |
Collapse
|
8
|
Baharani A, Reddy P RR, Patil PM. The Efficacy and Safety of Intravitreal Dexamethasone Implant as Anti-inflammatory Monotherapy in the Management of Tuberculosis-associated Intermediate Uveitis. Ocul Immunol Inflamm 2023; 31:1594-1602. [PMID: 34637663 DOI: 10.1080/09273948.2021.1986544] [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: 04/08/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
AIM To study the long-term efficacy and safety of Ozurdex as anti-inflammatory monotherapy in the management of tuberculosis-associated intermediate uveitis (TBIU). METHODS Retrospective analysis of eyes with TBIU that received Ozurdex as anti-inflammatory monotherapy with a follow-up of at least 1 year. RESULTS 13 eyes (2 pseudophakic) of 11 patients were included. Mean BCVA improved from 0.65 to 0.11 at 3 months (p = .0005) and remained 0.11 at 1 year. Mean central foveal thickness improved from 452.87µ to 187.25µ at 3 months (p = .0009) and 184.62µ at 1 year in 8 eyes with CME. Mean vitreous haze improved from 2.38 to 0.11 at 3 months with no recurrences at 1 year. Mean IOP increased from 13.15mmHg to 15.53mmHg (p = .013) at 2 months and reduced to 12.46mmHg by 1 year. None required antiglaucoma medication. One eye underwent cataract surgery. The mean follow-up was 18.4 months. CONCLUSION Ozurdex is safe and efficacious in TBIU as anti-inflammatory monotherapy in conjunction with antitubercular therapy.
Collapse
Affiliation(s)
- Abhilasha Baharani
- Consultant Uvea Specialist, Neoretina Eyecare Institute, Hyderabad, India
| | - Raja Rami Reddy P
- Consultant Retina Specialist, Neoretina Eyecare Institute, Hyderabad, India
| | | |
Collapse
|
9
|
Badawi AH, Magliyah MS, Schatz P, Al-Shehri A, Alabdullah AA. Intermediate Uveitis in Retinitis Pigmentosa Associated with a Novel Homozygous Splice Site Mutation in PRPF8. Middle East Afr J Ophthalmol 2022; 29:59-62. [PMID: 36685344 PMCID: PMC9846957 DOI: 10.4103/meajo.meajo_98_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 01/24/2023] Open
Abstract
The manifestation of intermediate uveitis (IU) in patients with retinitis pigmentosa (RP) is uncommon and poses diagnostic and management challenges. In this case, we describe the clinical features and management outcomes in an RP patient with a novel homozygous splice site mutation in PRPF8. A 21-year-old male presented with unilateral decrease of vision in the right eye for 1 week. Retinal dystrophy features were present in the left eye. After 2 weeks of topical steroid therapy, near-total resolution of IU was achieved and vision improved to 20/30. Signs of (RP) were present bilaterally, with the right eye more affected than the left. Genetic testing indicated a novel homozygous c. 3061-6_3061-3del mutation in the PRPF8 gene. IU in young patients with RP can be effectively treated with a short course of topical steroids, sparing the need for systemic immunosuppressives. After the improvement in IU, the right eye showed more advanced RP changes.
Collapse
Affiliation(s)
- Abdulrahman H. Badawi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Address for correspondence: Dr. Abdulrahman H. Badawi, Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al-Oruba Street, P.O. Box: 7191, Riyadh 11462, Saudi Arabia. E-mail:
| | - Moustafa S. Magliyah
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Department of Ophthalmology, Prince Mohammed Medical City, Riyadh, Saudi Arabia
| | - Patrik Schatz
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Department of Ophthalmology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden, Saudi Arabia
| | | | | |
Collapse
|
10
|
Ramdoss J, Jain A, Thejesvi GN, Biswas J. Prevalence, clinical profile, investigations, and visual outcome of sarcoid intermediate uveitis in a tertiary eye care center in South India. Indian J Ophthalmol 2022; 70:2454-2457. [PMID: 35791132 PMCID: PMC9426047 DOI: 10.4103/ijo.ijo_3099_21] [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] [Indexed: 11/17/2022] Open
Abstract
Purpose: To report the prevalence, clinical profile, investigations, and visual outcomes of sarcoid intermediate uveitis in a tertiary eye care center in South India. Methods: Retrospective, observational case series. Records of 29 patients with sarcoid intermediate uveitis were retrieved. Complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done. Results were analyzed using SPSS software. Results: Mean age group was 42.14 ± 11.31 years. The bilateral presentation was more common and females were more affected than males. Anterior chamber cells and flares in 22.4% of cases (N = 11 eyes), posterior synechiae in 20.4% (N = 10 eyes), and both small and mutton fat keratic precipitates in 14.2% of cases (N = 7 eyes) were noted; only one eye had Busacca nodules similar to other granulomatous uveitis. Cystoid macular edemas were present in three eyes. Treatment with oral steroids and systemic immunosuppression resulted in good visual recovery. The mean presenting visual acuity in right and left eye were 0.2 and 0.3, respectively. The mean final visual acuity in right and left eye was 0.1 and 0.3, respectively. Conclusion: Sarcoid intermediate uveitis is quite common in a tuberculosis endemic country like India. A complete review of systems with appropriate investigations is essential to prevent visual complications.
Collapse
Affiliation(s)
- Jeyasooriya Ramdoss
- Junior Research Fellow, Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Anupreeti Jain
- Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - G N Thejesvi
- Medical Retina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
11
|
Teo AYT, Betzler BK, Hua KLQ, Chen EJ, Gupta V, Agrawal R. Intermediate Uveitis: A Review. Ocul Immunol Inflamm 2022:1-20. [PMID: 35759636 DOI: 10.1080/09273948.2022.2070503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU). METHODS Narrative literature review. RESULTS IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice. CONCLUSIONS IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.
Collapse
Affiliation(s)
| | | | - Keith Low Qie Hua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Singapore Eye Research Institute, Singapore.,Duke NUS Medical School, Singapore
| |
Collapse
|
12
|
Pandurangan S, Samanta R, Kumawat D, Sood G, Devi TS, Agrawal A. Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India. Indian J Ophthalmol 2022; 70:1642-1647. [PMID: 35502042 PMCID: PMC9333025 DOI: 10.4103/ijo.ijo_2159_21] [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] [Indexed: 12/02/2022] Open
Abstract
Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.
Collapse
Affiliation(s)
- Sneha Pandurangan
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ramanuj Samanta
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Devesh Kumawat
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Gitanjli Sood
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Thounaojam S Devi
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ajai Agrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| |
Collapse
|
13
|
Alizadeh Ghavidel L, Mousavi F, Hashemi HS, Bagheri M. Optical coherence tomography angiography in intermediate uveitis-related cystoid macular edema. Med Hypothesis Discov Innov Ophthalmol 2022; 11:19-26. [PMID: 37641694 PMCID: PMC10445323 DOI: 10.51329/mehdiophthal1441] [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: 02/11/2022] [Accepted: 03/22/2022] [Indexed: 08/31/2023]
Abstract
Background Cystoid macular edema (CME) is the leading cause of permanent visual impairment in patients with uveitis, particularly in patients with intermediate uveitis (IU). This study was aimed at comparing the changes in the macular microvasculature in patients with IU with uveitic non-responsive CME and without macular edema. Methods In this case-control study, 55 eyes of patients with IU were assessed for macular microvascular structures, including vascular density, foveal avascular zone (FAZ) measurement, and vascular morphological changes, using spectral-domain optical coherence tomography angiography (OCT-A) with the AngioVue OCT-A system. We divided patients into the following two groups: the case group, including 30 eyes with IU-related non-responsive CME, and the control group, including 25 eyes with IU without macular edema. Results Participants in the case and control groups had comparable age (P = 0.753) and sex (P = 0.124) distributions. Superficial capillary plexus vessel density in the case group was significantly decreased in the whole image (P = 0.027) and the parafoveal area (P = 0.001) compared to the control group. However, there were no statistically significant differences between the two groups in terms of foveal superficial vessel density, deep capillary plexus vessel density, FAZ area, FAZ perimeter, FAZ acircularity index, or foveal vessel density in a 300-µm-wide annulus around the FAZ (all P > 0.05). Vascular morphological changes, such as the capillary tuft, telangiectatic vessels, or micro-aneurism, were not different in the overview images of the OCT-A printout between the two groups. Conclusions The mean superficial capillary plexus vessel density was lower in eyes with IU-related nonresponsive CME than in those without macular edema. We observed more cystoid spaces in SCP than in DCP. Microcystic changes in the inner retina and ischemia may be the underlying cause in eyes with nonresponsive CME. Future prospective longitudinal studies with healthy, matched controls are warranted to confirm our findings.
Collapse
Affiliation(s)
| | - Farideh Mousavi
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hesam Sadat Hashemi
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Bagheri
- Department of Ophthalmology, Imam Khomeini Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
14
|
Abstract
The term "vitritis" refers to the presence of a cellular infiltration of the vitreous body, usually in the context of an intraocular inflammation, but not exclusively. Intermediate uveitis is the most prominent cause of vitritis, including infectious and auto-immune/auto-inflammatory etiologies. Corticosteroids and immunosuppressive therapies should not be started before ruling out the infectious causes of vitritis, especially in immunosuppressed individuals. Other situations can mimic intermediate uveitis such as amyloidosis and ocular tumors. Primary intraocular lymphoma should always be suspected in case of vitreous infiltrations in individuals aged over 50 years.
Collapse
Affiliation(s)
- Sarah Touhami
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Mathilde Leclercq
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Dinu Stanescu-Segall
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.,Centre Nord Exploration Ophtalmologique, Lille, France
| | - Valérie Touitou
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| |
Collapse
|
15
|
Șuță MC, Karancsi OL, Mușat O, Balica N, Yasar I, Roșca C, Stanca S, Dărăbuş DM. Triamcinolone acetonide induces sterile endophthalmitis in patients with intermediate uveitis: A case report series. Exp Ther Med 2020; 20:2524-2528. [PMID: 32765744 PMCID: PMC7401768 DOI: 10.3892/etm.2020.8883] [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: 04/21/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Due to their anti-inflammatory, antiangiogenic and antiedematous properties, corticosteroids have been commonly used in the treatment of retinal diseases. Intravitreal administration of steroids offers the maximal drug efficacy and the lowest risk of systemic side effects. The authors report three cases of presumed sterile endophthalmitis induced by triamcinolone acetonide (TA) in three eyes with intermediate non-infectious uveitis. Each patient received a single intravitreal injection of TA of 4 mg. Because of the intense vitreous inflammatory reaction, retina examination and the optical coherence tomography could not be performed, although vitreous opacities were observed on the ocular ultrasound. The dense vitreous opacity is a defining factor, the anterior segment inflammation is mild to moderate and a hypopyon is present, which may be a sterile inflammatory reaction or the triamcinolone material itself. In cases of sterile endophthalmitis, the visual acuity increases progressively as the intraocular inflammation diminishes. Local treatment with topical antibiotics, prednisolone acetate and cycloplegic eyedrops is recommended to control the inflammatory reaction.
Collapse
Affiliation(s)
- Marius Cristian Șuță
- Department of Ophthalmology, ‘Victor Babeş’ University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Olimpiu Ladislau Karancsi
- Department of Oral Implantology and Prosthetic Restorations on Implants, ‘Victor Babeş’ University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Ovidiu Mușat
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Nicolae Balica
- Department of ENT, ‘Victor Babeş’ University of Medicine and Pharmacy, Timişoara County Emergency Clinical Hospital, 300041 Timişoara, Romania
| | - Iasmina Yasar
- Department of Ophthalmology, Timişoara County Emergency Clinical Hospital, 300041 Timişoara, Romania
| | - Cosmin Roșca
- Department of Ophthalmology, Oculens Clinic, 400501 Cluj-Napoca, Romania
| | - Simona Stanca
- Department of Pediatrics, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Diana-Maria Dărăbuş
- Department of Ophthalmology, ‘Victor Babeş’ University of Medicine and Pharmacy, 300041 Timişoara, Romania
| |
Collapse
|
16
|
Abstract
We report a patient with unilateral syphilitic intermediate uveitis without dermatological, neurological, or any systemic involvement. He presented to our clinic with complaints of eye floaters and worsening visual acuity in the left eye. He had intermediate uveitis and cystoid macular edema in that eye and both venereal disease research laboratory and microhemagglutination assay for Treponema pallidum serological tests were confirmatory for syphilis. Ocular manifestations of syphilis have variable presentations, and it should be considered when diagnosing unexplained ocular inflammatory diseases, even if the patient’s recent history and systemic evaluation are not compatible.
Collapse
Affiliation(s)
- Sevcan Yıldız Balcı
- University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Ece Turan Vural
- University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Şehnaz Özçalışkan
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| |
Collapse
|
17
|
Affiliation(s)
- Kalaivani Jayakumar
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
18
|
Abd El Latif E, Abdelhalim AS, Montasser AS, Said MH, Shikhoun Ahmed M, Abdel Kader Fouly Galal M, Ibrahim W, Samy Abd Elaziz M, Fathi Abuelkheir A, Elbarbary H, Elsayed AMA, Lotfy A, Elmorsy OA, Gab-Alla AA, Hatata RM, Abousamra AAH, Farouk MM, Elbakary MA, Awara AM, Amer I, Elzawahry WMAE, Kandil HW, Barrada OA, Bakr Elessawy K, Zayed MA, El Hennawi H, Tawfik MA. Pattern of Intermediate Uveitis in an Egyptian Cohort. Ocul Immunol Inflamm 2019; 28:524-531. [PMID: 31642742 DOI: 10.1080/09273948.2019.1668429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the clinical experience with intermediate uveitis at six Egyptian tertiary eye centers.Methods: A multicenter retrospective chart review of all patients with intermediate uveitis seen at six ocular inflammation referral clinics in Egypt between January 2010 and January 2017.Results: The study included a total of 781 patients with intermediate uveitis. The study cohort comprised of 282 male and 499 female patients. In over half of our cohort (58.77%), no specific cause could be confirmed. The remaining patients had sarcoidosis (16.26%), tuberculosis (14.85%), multiple sclerosis (9.09%), and TINU (1.02%). By the end of our study, 62% of the affected eyes had a BCVA better than 20/40Conclusion: More than 40% of our patients with intermediate uveitis had sarcoidosis, tuberculosis, multiple sclerosis, or TINU as the underlying etiology. Owing to their potential morbidity, these diseases need to be considered in Egyptian patients presenting with intermediate uveitis.
Collapse
Affiliation(s)
- Eiman Abd El Latif
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Mohamed Hassan Said
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Walid Ibrahim
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Amr Fathi Abuelkheir
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hossameldeen Elbarbary
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Ayman Lotfy
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Osama A Elmorsy
- Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amr A Gab-Alla
- Department of Ophthalmology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ragai Magdy Hatata
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | | | - Molham A Elbakary
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Mahmoud Awara
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ibrahim Amer
- Department of Ophthalmology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | | | - Hazem W Kandil
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar A Barrada
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Kareem Bakr Elessawy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Zayed
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hazem El Hennawi
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Tawfik
- Department of Ophthalmology, Memorial Institute for Ophthalmic Research, Cairo, Egypt
| |
Collapse
|
19
|
McCartney M, McCluskey P, Zagora S. Intravitreal dexamethasone implants for non-infectious uveitis. Clin Exp Ophthalmol 2019; 47:1156-1163. [PMID: 31412151 DOI: 10.1111/ceo.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Inflammatory-mediated cystoid macular oedema (CMO) is the most common inflammatory-mediated threat to vision in non-infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained-release dexamethasone (DEX) implant devices provide localized therapy. BACKGROUND The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort. DESIGN A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital. PARTICIPANTS Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies. METHODS Cases from March 2012 and March 2018 were retrospectively selected with follow-up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow-up was 32 weeks. MAIN OUTCOME MEASURES The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure and medication regimens. RESULTS Ninety-five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P < .01). Sixty-one percent demonstrated improved BCVA at week 8 (P < .05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low. CONCLUSIONS AND RELEVANCE In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort.
Collapse
Affiliation(s)
- Matthew McCartney
- Department of General Surgery, St Vincent's Hospital, Sydney, Victoria, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sophia Zagora
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Tian M, Tappeiner C, Zinkernagel MS, Wolf S, Munk MR. Swept-source optical coherence tomography angiography reveals vascular changes in intermediate uveitis. Acta Ophthalmol 2019; 97:e785-e791. [PMID: 30729711 DOI: 10.1111/aos.14024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 06/26/2018] [Accepted: 12/29/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate retinal and choroidal vascular changes in patients with intermediate uveitis with/without concomitant retinal vasculitis using wide field swept-source optical coherence tomography angiography (OCTA). METHODS In this study consecutive patients with intermediate uveitis ± vasculitis and healthy age-matched controls were evaluated using central 3 × 3 mm OCTA scans and montage scans. Differences among the groups as well as the association between central changes assessed by 3 × 3 scans and wide field OCTA were evaluated. RESULTS 93 eyes of 58 patients with intermediate uveitis and 33 healthy age-matched controls were included. The presence of a cystoid macular oedema (CME) was associated with capillary non-and reduced perfusion of the superficial capillary plexus (SCP) (p = 0.03 and 0.02, respectively), and deep capillary plexus (DCP) (p = 0.02 and p ≤ 0.0001, respectively) of the 3 × 3 mm scans. The raw length, circularity and size of foveal avascular area (FAZ) significantly differed among the three groups. (p = 0.01, p = 0.045 and p = 0.004, respectively). Multivariable regression analysis revealed that the presence of epiretinal membranes (ERM) and CME rather than the disease entity contributed to the changes of FAZ size (R2 = 0.15, p = 0.0003) The mean vessel density (VD) of the SCP significantly differed among the three groups (intermediate uveitis with concomitant vasculitis: 16.8 ± 3.8 mm-1 vs intermediate uveitis only: 15.6 ± 4.4 mm-1 versus control: 18 ± 3.5 mm-1 , p = 0.046). Multivariable regression analysis showed that the presence of CME rather than the disease entity impacted vessel density of SCP (R2 = 0.1, p = 0.016). There was no association between peripheral non- or reduced perfusion of the wide field OCTA slabs of the SCP and DCP and the VD of the 3 × 3 slabs. CONCLUSION Although patients with intermediate uveitis and vasculitis present with reduced central vessel density compared to healthy age-matched controls, these changes are presumably contributed to the presence of CME.
Collapse
Affiliation(s)
- Meng Tian
- Department of Ophthalmology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Martin S. Zinkernagel
- Department of Ophthalmology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital Bern University Hospital University of Bern Bern Switzerland
- Bern Photographic Reading Center Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Marion R. Munk
- Department of Ophthalmology, Inselspital Bern University Hospital University of Bern Bern Switzerland
- Bern Photographic Reading Center Inselspital Bern University Hospital University of Bern Bern Switzerland
| |
Collapse
|
21
|
Tian M, Tappeiner C, Zinkernagel MS, Huf W, Wolf S, Munk MR. Evaluation of vascular changes in intermediate uveitis and retinal vasculitis using swept-source wide-field optical coherence tomography angiography. Br J Ophthalmol 2018; 103:1289-1295. [PMID: 30538102 PMCID: PMC6709771 DOI: 10.1136/bjophthalmol-2018-313078] [Citation(s) in RCA: 26] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 01/16/2023]
Abstract
Purpose To evaluate vascular changes in patients with intermediate uveitis with or without retinal vasculitis using swept-source wide-field optical coherence tomography angiography (OCTA). Methods This is a prospective cross-sectional study. Consecutive patients with intermediate uveitis were evaluated using wide-field OCTA. Wide-field OCTA and en-face OCT images were analysed for the presence of capillary non-perfusion and reduced perfusion, disruption of ellipsoid zone, and abnormalities on en-face wide-field retinal thickness maps, respectively, and compared with fluorescein angiography (FA) findings in a subcohort. Results 164 eyes of 88 patients with intermediate uveitis were included. Areas of capillary non-perfusion and reduced perfusion were more frequently observed in the choroidal OCTA slab (33.3% and 49.4%), choriocapillaris (CC; 31.4% and 48%) and deep capillary plexus (DCP; 9.6% and 34.6%) than in the superficial capillary plexus (SCP; 5% and 26.3%), respectively. Intermediate uveitis with vasculitis presented more frequently with non-perfusion and hypoperfusion in the DCP (p=0.003 and p=0.05, respectively) and SCP (p=0.007 and p=0.005, respectively) than intermediate uveitis without vasculitis. Peripheral capillary leakage on FA correlated with the presence of perivascular, macular and generalised thickening on en-face wide-field thickness maps (p=0.007). Ischaemia on FA was significantly associated with non-perfusion on wide-field OCTA in SCP and DCP (p=0.019 and p=0.027, respectively). Conclusion Changes in the choroid, CC and DCP are more frequently found than in the SCP on wide-field OCTA in intermediate uveitis. While wide-field OCTA is a reliable tool to detect capillary non-perfusion in intermediate uveitis, it was not helpful in determining disease activity. Trial registration number NCT02811536.
Collapse
Affiliation(s)
- Meng Tian
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
- Department of Laboratory Medicine, Hietzing Hospital, Vienna, Austria
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
22
|
Habot-Wilner Z, Tiosano L, Sanchez JM, Shulman S, Barequet D, Rahat O, Amarilyo G, Amer R. Demographic and Clinical Features of Pediatric Uveitis in Israel. Ocul Immunol Inflamm 2018; 28:43-53. [PMID: 30332547 DOI: 10.1080/09273948.2018.1535079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To report the epidemiology, etiology, ocular characteristics, treatment and visual outcome of pediatric uveitis in Israel.Methods: Retrospective study from two tertiary uveitis centers.Results: Included were 107 patients (182 eyes), 55% females. Mean age at diagnosis 8.8 years. Uveitis was predominantly anterior, idiopathic, bilateral, and chronic. Systemic associations were seen in 36% of patients of which the most common disease was juvenile idiopathic arthritis. Infectious uveitis accounted for 37% of posterior uveitis cases of which toxoplasmosis was the most common cause. Anterior segment complications were commonly observed at presentation (41%); the most predominant were posterior synechiae, cataract, and band keratopathy. The most common posterior segment complications were papillitis, epiretinal membrane, and macular atrophy/scar. Ninety-three percent of eyes had visual acuity >20/40 at last follow-up.Conclusion: The pattern of pediatric uveitis in Israel is similar to that in the western world. Visual outcome was good in most eyes.
Collapse
Affiliation(s)
- Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Tiosano
- Department of Ophthalmology, Hadassah Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Juan M Sanchez
- Department of Ophthalmology, Hadassah Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Shiri Shulman
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Barequet
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Rahat
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Amarilyo
- Schneider Children's Medical Center of Israel, Petach Tikvah, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Petah Tikva, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| |
Collapse
|
23
|
Abstract
Purpose: To describe two cases of anterior and intermediate uveitis following yellow fever vaccination with fractional dose. Methods: Case report. Results: Case 1: A 35 year-old healthy woman presented with unilateral anterior uveitis 10 days after the yellow fever vaccination. Testing excluded infectious and rheumatic diseases and the episode was fully recovered after a short course of topical treatment. Case 2: A 21 year-old previously healthy woman presented with blurred vision in the left eye (OS) 14 days after the yellow fever vaccination. The ophthalmic examination of the OS revealed intermediated uveitis. Testing excluded infectious and neurological diseases. After six weeks of treatment with oral prednisone, the ocular inflammation had resolved. Conclusion: Physicians should be aware of the possibility of eye inflammation following the yellow fever vaccination.
Collapse
Affiliation(s)
- Ana Luiza Biancardi
- a Ophthalmology Department , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | | |
Collapse
|
24
|
Abstract
Purpose: To describe clinical and imaging features of Fuchs' Uveitis (FU) and investigate the rate of misdiagnosis in Iranian patients. Methods: Records of 82 FU patients (89 eyes) were reviewed retrospectively. Results: Remarkable findings included iris heterochromia in 14 (17.1%) patients and Fuchs' keratic precipitates in 97.8%, vitritis in 89.7% and cataract in 69.7% eyes. FU discovered as an incidental finding in 7 patients (10.0%). Imaging revealed disc hyperfluorescence, mild vascular leakage and epiretinal membrane in 72.7%, 32.5% and 19.4% of eyes, respectively. The rate of misdiagnosis was 19.5% (16 patients) with intermediate uveitis being as the most common erroneous diagnosis (10 patients). Patients with the wrong diagnosis were significantly younger (p = 0.045) and more likely to have bilateral involvement (p = 0.004) or no anterior chamber cells (p = 0.039). Conclusions: Heterochromia is an infrequent clinical feature in Iranian FU patients, however, vitreous involvement is common. Intermediate uveitis is a usual misdiagnosis.
Collapse
Affiliation(s)
- Mohammad Zarei
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Sahel Darabeigi
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Mehrpour
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Ramak Roohipoor
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Hamed Ghassemi
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Nazanin Ebrahimiadib
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| |
Collapse
|
25
|
Babu K, Kumaradas M. In Response to Laovirojjanakul W., Acharya N. and Gonzales J. A.'s "Ultra-Widefield Fluorescein Angiography in Intermediate Uveitis". Ocul Immunol Inflamm 2017; 27:362-364. [PMID: 29283787 DOI: 10.1080/09273948.2017.1408844] [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] [Indexed: 10/18/2022]
Abstract
We read with great interest the article by Laovirojjanakul et al. on ultra-widefield fluorescein angiography in intermediate uveitis. We would like to share a similar case of chronic intermediate uveitis highlighting a fern-like pattern of diffuse vascular leakage on fluorescein angiography, with good visual acuity, absence of clinically active inflammation, and a similar fluorescein angiography picture over a follow-up of 4 years.
Collapse
Affiliation(s)
- Kalpana Babu
- a Department of Ocular Inflammation and Vitreoretinal Services, Vittala International Institute of Ophthalmology & Prabha Eye Clinic and Research Center , Bangalore, India
| | | |
Collapse
|
26
|
Deuter CME, Engelmann K, Heiligenhaus A, Lanzl I, Mackensen F, Ness T, Pleyer U, Stuebiger N, Wilhelm B, Luedtke H, Zierhut M, Doycheva D. Enteric-coated mycophenolate sodium in the treatment of non-infectious intermediate uveitis: results of a prospective, controlled, randomised, open-label, early terminated multicentre trial. Br J Ophthalmol 2017; 102:647-653. [PMID: 28903965 DOI: 10.1136/bjophthalmol-2017-310156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/05/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the efficacy, safety and tolerability of enteric-coated mycophenolate sodium (EC-MPS) in combination with low-dose corticosteroids compared with a monotherapy with low-dose corticosteroids in subjects with non-infectious intermediate uveitis (IU). METHODS Open-label, prospective, controlled, randomised multicentre trial. Patients were randomised in a 1:1 ratio to either the treatment group (prednisolone plus EC-MPS) or control group (prednisolone monotherapy). Patients in the control group who relapsed within 6 months changed to the crossover group (prednisolone plus EC-MPS). Maximum treatment duration was 15 months. The primary endpoint was the time to first relapse in the treatment group and control group. RESULTS Forty-one patients at eight sites were analysed. Twenty-two patients were allocated to the treatment group, with 19 patients in the control group. A first relapse occurred in 9 patients (40.9%) in the treatment group and 15 patients (78.9%) in the control group (p=0.03). The median time to the first relapse was >15 months for the treatment group and 2.8 months for the control group (p=0.07). The probability of relapse-free survival at month 15 was estimated to be 52.9% in the treatment group and 19.7% in the control group (p=0.01). 15 patients changed to the crossover group. Of these, only four patients developed a second relapse. No safety concerns arose during the trial. Only one patient had to discontinue EC-MPS due to increased liver enzymes. CONCLUSION EC-MPS can be considered an effective and well-tolerated immunosuppressive drug to prevent relapses in patients with chronic IU. TRIAL REGISTRATION NUMBER EUDRACT number: 2009-009998-10, Results.
Collapse
Affiliation(s)
| | | | - Arnd Heiligenhaus
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Ines Lanzl
- Department of Ophthalmology, Technical University of Munich, Munich, Germany
| | | | - Thomas Ness
- University Eye Center, University of Freiburg, Freiburg, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow-Klinikum, Charite University Medicine, Berlin, Germany
| | - Nicole Stuebiger
- Department of Ophthalmology, Campus Benjamin Franklin, Charite University Medicine, Berlin, Germany
| | - Barbara Wilhelm
- STZ eyetrial at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | | | - Manfred Zierhut
- Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Deshka Doycheva
- Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | | |
Collapse
|
27
|
Abstract
PURPOSE To study the patterns of intermediate uveitis in the pediatric age group in a referral eye care center in South India. METHODS This is a study of twenty consecutive patients under 16 years of age with intermediate uveitis, conducted at a tertiary referral center. Numerous variables were assessed, including age and gender distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features, their complications, therapeutic strategies with their outcomes, remission, final visual acuity (VA), and characteristics associated with poor visual outcome. RESULTS Bilateral involvement was observed in 80% of the patients. Remission was observed in five out of 7 patients (78%) with completed follow-up of 5 years. Final VA improved by at least two lines in 11 patients, remained stable in 6 patients, and worsened in 3 patients. The etiological diagnosis showed one patient with Bechet's disease, one with juvenile idiopathic arthritis, 1 with human leukocyte antigen B27 associated uveitis, 9 with laboratory proven tuberculosis, and 3 with sarcoidosis and 5 where it was idiopathic. The mean follow-up was 4.8 years (range 3-8 years). Cataract was the most frequent complication observed (40%). Glaucoma, choroidal neovascularization, and amblyopia accounted for worsening of vision in three patients. CONCLUSION Median time of development of complications is about 3 years based on our study. Intermediate uveitis of childhood might exhibit a self-limiting course after several years. Visual recovery is good in the majority, and visual loss is limited despite the high rate of ocular complications.
Collapse
Affiliation(s)
- Radha Annamalai
- Deparment of Uveitis and Ocular Inflammation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
28
|
Abstract
The aim of the study was to investigate the characteristics of ocular toxocariasis (OT) presenting with intermediate uveitis in the Korean population.We studied intermediate uveitis patients using ocular and systemic evaluations and a Toxocara IgG serology test.Of 50 intermediate uveitis patients, 19 were seropositive for Toxocara IgG. Of the 19 OT patients, 4 presented with recurrence within 6 months and were significantly younger than nonrecurrence patients (P = 0.009). Thirteen patients had a history of eating raw cow liver.There were 14 males and 5 females in the OT group, and 11 males and 20 females in the non-OT group (P = 0.009). There was bilateral involvement in 7 out of 19 patients in the OT group, and 20 out of 31 patients in non-OT group (P = 0.033).Intermediate uveitis patients in OT were predominately male and had more unilateral presentation than non-OT patients.
Collapse
|
29
|
Abstract
PURPOSE To describe a case of intermediate uveitis caused by chikungunya virus infection in the Western Hemisphere. METHODS Case report of a patient diagnosed with chikungunya infection presenting with blurry vision and floaters. RESULTS Exam revealed a unilateral intermediate uveitis, with an extensive work-up positive for chikungunya virus immunoglobulin M and G titers. The patient responded to oral corticosteroids with signs and symptoms resolving over the course of 3 months' treatment. CONCLUSIONS While anterior uveitis and retinitis are the most common ocular manifestations of chikungunya infection, we report here a case of chikungunya infection presenting as an intermediate uveitis, responding well to oral corticosteroids. This case demonstrates the varied presentation of chikungunya-related uveitis and highlights its consideration in the differential diagnoses of those who have had preceding systemic viral symptoms and uveitis.
Collapse
Affiliation(s)
- James Lin
- a Department of Ophthalmology , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Royce W S Chen
- a Department of Ophthalmology , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Albert Hazan
- a Department of Ophthalmology , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Michael Weiss
- a Department of Ophthalmology , Columbia University College of Physicians and Surgeons , New York , New York , USA
| |
Collapse
|
30
|
Abstract
PURPOSE To describe the treatment and outcomes of a cohort of pediatric intermediate uveitis (IU) patients, with a particular focus on the use of immunomodulatory therapy (IMT). METHODS The disease course, treatment, and outcomes of 39 pediatric IU patients treated in the Uveitis Clinic at the University of Utah from 1999 to 2012 were reviewed, retrospectively. RESULTS Mean age at presentation was 7.7 years (SD 3.1). In total, 95% had bilateral involvement. Out of 77 total eyes involved, the most frequent disease complications were ocular hypertension (0.71 events per person year, PPY), cataracts (events PPY = 0.39), and cystoid macular edema (events PPY = 0.33). A total of 20 patients received IMT; 19/20 were tapered off systemic corticosteroids without a uveitis recurrence; 75% of eyes had inactive disease at final follow-up (mean 37 months). CONCLUSIONS The use of IMT, including biologic therapies, may effectively manage disease inflammation and reduce steroid dosages in pediatric IU patients.
Collapse
Affiliation(s)
- Aimee O Hersh
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Spencer Cope
- b University of Texas San Antonio, Center for Health Sciences , San Antonio , Texas , USA
| | - John F Bohnsack
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Akbar Shakoor
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Albert T Vitale
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
| |
Collapse
|
31
|
Abstract
PURPOSE To determine the associations of systemic diseases with intermediate uveitis. METHODS The medical records of 50 consecutive cases with intermediate uveitis referred to The Eye Center in Riyadh, Saudi Arabia, were reviewed. Age- and sex-matched patients without uveitis served as controls. Patients had complete ophthalmic and medical examinations. RESULTS There were 27 male and 23 female patients. Mean age was 29 years with a range of 5-62 years. Overall, 21 cases (42%) had systemic disorders associated with intermediate uveitis and 29 cases (58%) had no associated systemic disease. A total of 11 patients (22%) had asthma, 4 (8%) had multiple sclerosis, 3 (6%) had presumed ocular tuberculosis, 1 (2%) had inflammatory bowel disease, 1 (2%) had non-Hodgkin lymphoma and 1 (2%) had sarcoidosis. Evidence of systemic disease was found in 50 (5%) of the 1,000 control subjects. Bronchial asthma was found in 37 patients (3.7 %), multiple sclerosis in 9 patients (0.9%), inflammatory bowel disease in 3 patients (0.3%), and tuberculosis in 1 patient (0.1%). None of the control patients had sarcoidosis or lymphoma. There were statistically significant associations between intermediate uveitis and bronchial asthma (p = 0.0001), multiple sclerosis (p = 0.003) and tuberculosis (p = 0.0005). CONCLUSION Bronchial asthma and multiple sclerosis were the most frequently encountered systemic diseases associated with intermediate uveitis in our patient population. Patients with intermediate uveitis should undergo careful history-taking and investigations to rule out associated systemic illness.
Collapse
Affiliation(s)
- Samir S Shoughy
- a The Eye Center and The Eye Foundation for Research in Ophthalmology , Riyadh , Saudi Arabia
| | - Igor Kozak
- b King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
| | - Khalid F Tabbara
- a The Eye Center and The Eye Foundation for Research in Ophthalmology , Riyadh , Saudi Arabia.,c Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia.,d The Wilmer Ophthalmological Institute of the Johns Hopkins University School of Medicine , Baltimore , MD , USA
| |
Collapse
|
32
|
Kinyas Ş, Esgin H. Peripheral Vasculitis, Intermediate Uveitis and Interferon Use in Multiple Sclerosis. Turk J Ophthalmol 2016; 46:41-43. [PMID: 27800257 PMCID: PMC5076309 DOI: 10.4274/tjo.35555] [Citation(s) in RCA: 3] [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: 05/03/2014] [Accepted: 08/07/2014] [Indexed: 12/01/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. A 40-year-old female patient with a 12-year history of MS was admitted to our clinic with blurred vision and floaters in her right eye for about 1 month. Here, we share the findings and the management of intermediate uveitis and retinal periphlebitis in an MS case being treated with interferon beta-1a for 7 years.
Collapse
Affiliation(s)
- Şeref Kinyas
- Trakya University Faculty of Medicine, Department of Ophthalmology, Edirne, Turkey
| | - Haluk Esgin
- Trakya University Faculty of Medicine, Department of Ophthalmology, Edirne, Turkey
| |
Collapse
|
33
|
Kardes E, Sezgin Akcay BI, Bozkurt K, Unlu C, Erdogan G, Akcali G. Clinical characteristics of intermediate uveitis in adult Turkish patients. Int J Ophthalmol 2015; 8:759-63. [PMID: 26309876 DOI: 10.3980/j.issn.2222-3959.2015.04.21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/06/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To describe the clinical characteristics of Turkish patients with intermediate uveitis (IU) and to investigate the effect of clinical findings and complications on final visual acuity (VA). METHODS We retrospectively analyzed the medical records of patients with IU who had at least 6mo of follow-up and were older than 16y. RESULTS A total of 78 eyes of 45 patients were included in the study and the mean follow-up period was 19.4mo. The mean age at the time of presentation was 42.9s. Systemic disease associations were found in 17.7% of cases; sarcoidosis (8.8%) and multiple sclerosis (6.6%) were the most common diseases. Recurrence rate (odds ratio=45.53; 95%CI: 2.181-950.58), vitritis equals to or more than 3+ cells (odds ratio=57.456; 95%CI: 4.154-794.79) and presenting with VA less than 20/40 (odds ratio=43.81; 95%CI: 2.184-878.71) were also found as high risk factors for poor final VA. At the last follow-up examination, 67.9% of eyes had VA of 20/40 or better. CONCLUSION IU is frequently seen at the beginning of the fourth decade of life. The disease is most commonly idiopathic in adult Turkish patients. Patients with severe vitritis at presentation and patients with frequent recurrences are at high risk for poor visual outcome.
Collapse
Affiliation(s)
- Esra Kardes
- Department of Ophthalmology, Umraniye Research and Training Hospital, Istanbul 34764, Turkey
| | | | - Kansu Bozkurt
- Department of Ophthalmology, Umraniye Research and Training Hospital, Istanbul 34764, Turkey
| | - Cihan Unlu
- Department of Ophthalmology, Umraniye Research and Training Hospital, Istanbul 34764, Turkey
| | - Gurkan Erdogan
- Department of Ophthalmology, Umraniye Research and Training Hospital, Istanbul 34764, Turkey
| | - Gulunay Akcali
- Department of Ophthalmology, Umraniye Research and Training Hospital, Istanbul 34764, Turkey
| |
Collapse
|
34
|
Shulman S, Jóhannesson G, Stefánsson E, Loewenstein A, Rosenblatt A, Habot-Wilner Z. Topical dexamethasone-cyclodextrin nanoparticle eye drops for non-infectious Uveitic macular oedema and vitritis - a pilot study. Acta Ophthalmol 2015; 93:411-415. [PMID: 25988730 DOI: 10.1111/aos.12744] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 01/08/2015] [Accepted: 04/05/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of 1.5% dexamethasone nanoparticle (DexNP) drops in eyes with non-infectious uveitic macular oedema and vitritis. METHODS In a prospective pilot study, DexNP drops were administered four times a day for 4 weeks followed by drops tapering over a period of another 4 weeks. Follow-up time was 12 weeks. RESULTS Five eyes with macular oedema and three eyes with vitritis were included in the study. Best corrected visual acuity (BCVA) significantly improved from a median of 0.2 logMAR to a median of 0.15 logMAR at 4 weeks' time (p < 0.05). Median BCVA was 0.175 logMAR and 0.2 logMAR, at week 8 and 12, respectively (p > 0.05). Macular oedema significantly improved at all time-points as compared to baseline (p < 0.05) and resolved in all eyes during follow-up. One eye had macular oedema relapse at week 12. Vitritis improved in all eyes and resolved completely in two eyes. One eye had intraocular pressure (IOP) elevation which was well controlled with topical antihypertensive treatment, and one eye had cataract progression. CONCLUSION This short pilot study demonstrates favourable effect of 1.5% DexNP eye drops on eyes with non-infectious uveitic macular oedema and vitritis. Further comparative long-term studies are warranted to assess this effect.
Collapse
Affiliation(s)
- Shiri Shulman
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gauti Jóhannesson
- Department of Clinical Science, Ophthalmology; Umeå University; Umeå Sweden
| | - Einar Stefánsson
- Department of Ophthalmology; National Hospital Reykjavik; University of Iceland; Reykjavik Iceland
| | - Anat Loewenstein
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Amir Rosenblatt
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Zohar Habot-Wilner
- Division of Ophthalmology; Tel Aviv Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
35
|
Kalogeropoulos C, Koumpoulis I, Mentis A, Pappa C, Zafeiropoulos P, Aspiotis M. Bartonella and intraocular inflammation: a series of cases and review of literature. Clin Ophthalmol 2011; 5:817-29. [PMID: 21750616 PMCID: PMC3130920 DOI: 10.2147/opth.s20157] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [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: 06/17/2011] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis. METHODS Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature. RESULTS Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12-62). Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%), vitritis in two eyes (14.2%), neuroretinitis in one eye (7.1%), focal retinochoroiditis in one eye (7.1%), branch retinal vein occlusion (BRVO) due to vasculitis in one eye (7.1%), disc edema with peripapillary serous retinal detachment in one eye (7.1%), and iridocyclitis in one eye (7.1%). Most of the patients (70%) did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis. CONCLUSION Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the spectrum of Bartonella intraocular inflammation is very large. In our study the most common clinical entity was intermediate uveitis.
Collapse
Affiliation(s)
| | - Ioannis Koumpoulis
- Department of Ophthalmology, Medical School, University of Ioannina, Greece
| | - Andreas Mentis
- Laboratory of Medical Microbiology, Hellenic Pasteur Institute, Athens, Greece
| | - Chrisavgi Pappa
- Department of Ophthalmology, Medical School, University of Ioannina, Greece
| | | | - Miltiadis Aspiotis
- Department of Ophthalmology, Medical School, University of Ioannina, Greece
| |
Collapse
|
36
|
Yaylali SA, Akcakaya AA, Işik N, Erbil HH, Olgun A, Aslan Z, Kansu T. Idiopathic Hypertrophic Cranial Pachymeningitis Associated With Intermediate Uveitis. Neuroophthalmology 2011; 35:88-91. [PMID: 30151029 DOI: 10.3109/01658107.2011.559683] [Citation(s) in RCA: 3] [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: 10/17/2010] [Revised: 01/04/2011] [Accepted: 01/04/2011] [Indexed: 11/13/2022] Open
Abstract
The authors report a case with idiopathic hypertrophic cranial pachymeningitis associated with intermediate uveitis. The patient complained of decreased vision in both eyes, especially the right. Ophthalmic examination revealed right optic disc pallor, bilateral vitritis, and cystoid macular edema. Magnetic resonance imaging revealed marked enhancement of a dural lesion. The macular edema responded well to medical treatment. Intermediate uveitis has not yet been reported in the context of idiopathic hypertrophic cranial pachymeningitis.
Collapse
Affiliation(s)
- Sevil Ari Yaylali
- Department of Ophthalmology, Istanbul Goztepe Educational Hospital, Istanbul, Turkey
| | | | - Nihal Işik
- Department of Neurology, Istanbul Goztepe Educational Hospital, Istanbul, Turkey
| | - Hasan Hasbi Erbil
- Department of Ophthalmology, Istanbul Goztepe Educational Hospital, Istanbul, Turkey
| | - Ali Olgun
- Department of Ophthalmology, Istanbul Goztepe Educational Hospital, Istanbul, Turkey
| | - Zeki Aslan
- Department of Ophthalmology, Istanbul Goztepe Educational Hospital, Istanbul, Turkey
| | - Tulay Kansu
- Department of Neurology, Hacettepe University Medical Faculty, Ankara, Turkey
| |
Collapse
|
37
|
Yeh S, Li Z, Forooghian F, Hwang FS, Cunningham MA, Pantanelli S, Lew JC, Wroblewski KK, Vitale S, Nussenblatt RB. CD4+Foxp3+ T-regulatory cells in noninfectious uveitis. Arch Ophthalmol 2009; 127:407-13. [PMID: 19365016 PMCID: PMC2928652 DOI: 10.1001/archophthalmol.2009.32] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate CD4(+)Foxp3(+) (forkhead box P3) T-regulatory cell populations in patients with uveitis and to determine if T-regulatory cell populations are associated with disease features. METHODS Patients with uveitis were evaluated for CD4(+)Foxp3(+) T-regulatory cells by flow cytometry. Systemic and ocular diagnoses, disease activity, and the presence of cystoid macular edema were reviewed. Percentages of CD4(+)Foxp3(+) lymphocytes were compared for patients with inactive vs active disease, systemic vs ocular diagnoses, and the presence or absence of cystoid macular edema. Real-time polymerase chain reaction testing was performed on 2 patients with extremely low CD4(+)Foxp3(+) cell populations to assess Foxp3 mRNA. RESULTS A total of 20 patients with intermediate uveitis, posterior uveitis, and panuveitis were evaluated. The mean age was 40.6 years and the mean visual acuity was 20/57. Percentages of CD4(+)Foxp3(+) cells were lower in patients with active compared with inactive uveitis (P< .05). No differences in T-regulatory cells were observed between the other subgroups. Two patients with recalcitrant uveitis who demonstrated less than 1% CD4(+)Foxp3(+) lymphocytes showed extremely low or absent Foxp3 mRNA. CONCLUSION T-regulatory cells are reduced in patients with active compared with inactive disease. Severe depletion of CD4(+)Foxp3(+) T cells and Foxp3 mRNA in 2 patients with severe uveitis suggests that loss of the T-regulatory cells of uveitis may be a salient feature in certain patients.
Collapse
Affiliation(s)
- Steven Yeh
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
AIMS To assess visual function, vision related quality of life (VR-QOL), and general health related quality of life (HR-QOL) in intermediate uveitis (IU). METHODS VR-QOL and HR-QOL were evaluated in 42 patients with IU using the VCM1 and SF-36 questionnaires, respectively. LogMAR visual acuity (VA), Pelli-Robson contrast sensitivity (CS), Farnsworth-Munsell 100 hue colour vision (CV), and Estermann visual field (VF) were recorded monocularly and binocularly. RESULTS Median (interquartile range) visual acuity (VA) and CS of 72 affected eyes were 0.1 (0.015-0.3) and 1.55 (1.35-1.65), respectively. 9.5% of patients had a VCM1 score of more than 2.0, indicating "more than a little" concern over vision. Worse eye VA (p=0.045) and CS (p=0.042) were predictive of a VCM1 score of more than 2.0 independently of age, sex, uveitis duration, laterality and activity, systemic uveitis therapy, and medical co-morbidity. The physical and mental component summary scores of the SF-36 were significantly worse in those who reported significant impairment of vision on the VCM1 than those who did not. CONCLUSIONS The majority of patients with IU maintain good visual function and quality of life. VR-QOL impairment in IU correlates with vision in the worse eye and is associated with impaired HR-QOL.
Collapse
Affiliation(s)
- C C Murphy
- Division of Ophthalmology, University of Bristol, Bristol BS1 2LX, UK
| | | | | | | |
Collapse
|
39
|
Abstract
AIM To report on eight patients with severe idiopathic intermediate uveitis (IU) and granuloma annulare (GA), a self limiting cutaneous condition of unknown aetiology. METHODS Retrospective case series. Clinical ophthalmic and dermatological data were studied and fluorescein angiography and skin biopsies were reviewed. RESULTS All patients with idiopathic IU had similar ocular features (eight with vitritis, seven with retinal vasculitis) and developed complications such as cystoid macular oedema (n=5), cataract (n=4), and glaucoma (n=3). Systemic diseases were not found, but a localised type of GA was observed in all. CONCLUSION Seven out of eight patients with IU and GA developed severe retinal vasculitis. Further studies are needed for a better understanding of this association, a common pathogenesis, and its eventual clinical consequences.
Collapse
Affiliation(s)
- B van Kooij
- Department of Ophthalmology, FC Donders Institute, University Hospital Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|