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Rullo J, Mehraban Far P, Farmer JF, Clements-Baker M, Ten Hove M. A curious case of arteritis: infectious, inflammatory, or both. Can J Ophthalmol 2019; 54:e288-e292. [PMID: 31836116 DOI: 10.1016/j.jcjo.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/18/2022]
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2
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Koike KJ, Blice JP, Kylstra JA, Ralston JS, Self SE, Ruth NM, Del Priore LV. FROSTED BRANCH ANGIITIS IN METHIMAZOLE-INDUCED ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-POSITIVE VASCULITIS. Retin Cases Brief Rep 2018; 12:136-139. [PMID: 27749745 DOI: 10.1097/icb.0000000000000447] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To describe an unusual case of frosted branch angiitis that developed in a patient with acute onset systemic vasculitis possibly triggered by the antithyroid medication methimazole. METHODS We conducted a thorough review of the medical records of a 16-year-old female patient who presented with frosted branch angiitis. During the initial hospital admission, the patient underwent an extensive systemic workup to determine the etiology of her disease and ophthalmologic testing including fundus photographs and fluorescein angiography. RESULTS Our patient presented with a unilateral acute onset loss of vision, whose fundus examination revealed the pathognomonic features of frosted branch angiitis. Extensive systemic workup revealed an antineutrophilic cytoplasmic antibody-positive vasculitis, possibly triggered by methimazole. CONCLUSION This case is the first reported frosted branch angiitis associated with a drug-induced antineutrophilic cytoplasmic antibody-positive vasculitis triggered by methimazole.
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Affiliation(s)
| | | | | | | | | | - Natasha M Ruth
- Pediatric Rheumatology, Medical University of South Carolina, Charleston, South Carolina
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3
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Abstract
PURPOSE To identify significant fluorescein angiographic (FA) characteristics associated with visual acuity (VA) in Behçet retinal vasculitis. MATERIALS AND METHODS Retrospective review of 86 eyes of 48 patients (age: 35.6±10.2 years) with Behçet retinal vasculitis were performed. VA and FA findings as well as correlation between them were assessed. RESULTS The mean initial VA of eyes with posterior pole-involved vasculitis (63 eyes; 73.3%) was significantly worse than that of those with peripheral vasculitis (23 eye; 26.7%) (logarithm of the minimum angle of resolution VA: 0.554±0.572 vs. 0.078±0.148; p<0.0001). Subgroup analysis revealed a more severe and diffuse pattern of vascular leakage in posterior pole-involved vasculitis compared to peripheral vasculitis (p<0.0001). Retinal vascular leakage (β=0.345; p<0.0001), optic disc hyperfluorescence (β=0.147; p=0.032), and macular leakage (β=0.107; p=0.047) were significantly associated with worse initial VA. During the follow up (mean: 33.3±17.9 months), the change of leakage showed no significant correlation with change of VA in posterior pole-involved vasculitis (τ=0.199, p=0.092). CONCLUSION Posterior pole involvement, the degree of retinal vascular leakage, optic disc hyperfluorescence, and macular leakage are significantly associated with VA in Behçet retinal vasculitis.
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Affiliation(s)
- Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Kwon
- Institute of Vision Research, Department of Ophthalmology, Severance Eye and ENT Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Choi
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Eye and ENT Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chul Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Eye and ENT Hospital, Yonsei University College of Medicine, Seoul, Korea.
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4
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Chawla R, Bypareddy R, Venkatesh P, Tomar AS. Idiopathic Frosted Branch Angiitis in a 2-Year-Old Boy. J Pediatr Ophthalmol Strabismus 2015. [PMID: 26214723 DOI: 10.3928/01913913-20150623-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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5
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Rajab HA, Baker NL, Hunt KJ, Klein R, Cleary PA, Lachin J, Virella G, Lopes-Virella MF. The predictive role of markers of Inflammation and endothelial dysfunction on the course of diabetic retinopathy in type 1 diabetes. J Diabetes Complications 2015; 29:108-14. [PMID: 25441222 PMCID: PMC4426877 DOI: 10.1016/j.jdiacomp.2014.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/22/2014] [Accepted: 08/12/2014] [Indexed: 01/29/2023]
Abstract
AIMS This study was undertaken to determine whether levels of inflammation and endothelial dysfunction biomarkers in serum samples collected at baseline in the Diabetes Control and Complications Trial (DCCT) cohort could predict the development of retinopathy. METHODS Levels of clotting/fibrinolysis, inflammation and endothelial dysfunction biomarkers were measured in 1391 subjects with type 1 diabetes to determine whether their levels predicted increased risk to develop or accelerate progression of retinopathy during 16years of follow-up. RESULTS Using regression models adjusted for DCCT treatment group, duration of diabetes, baseline retinopathy scores, HbA1c and albumin excretion rate, the baseline levels of sE-selectin and PAI-1 (active) were significantly associated with increased risk of a 3-step progression in retinopathy score in the primary prevention cohort (PPC). After adjusting for additional covariates (e.g., ACE/ARB and statin therapy), this association persisted. Levels of active and total PAI-1 in the same group were also significantly associated, after similar adjustments, with the time to progress to severe non-proliferative retinopathy during the follow-up period (54 and 29%, respectively of increased risk). No associations were observed in the secondary intervention cohort for any of the outcomes. CONCLUSIONS High levels of sE-selectin and PAI-1 are associated with the development of retinopathy in patients with uncomplicated type 1 diabetes.
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Affiliation(s)
- Hussein A Rajab
- Department of Medicine, Division of Endocrinology, Diabetes and Medical Genetics, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly J Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Richard Klein
- Department of Medicine, Division of Endocrinology, Diabetes and Medical Genetics, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Patricia A Cleary
- The Biostatistics Center, George Washington University, Washington DC, Washington DC, USA
| | - John Lachin
- The Biostatistics Center, George Washington University, Washington DC, Washington DC, USA
| | - Gabriel Virella
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Maria F Lopes-Virella
- Department of Medicine, Division of Endocrinology, Diabetes and Medical Genetics, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
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6
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Cahoon JM, Olson PR, Nielson S, Miya TR, Bankhead P, McGeown JG, Curtis TM, Ambati BK. Acridine orange leukocyte fluorography in mice. Exp Eye Res 2013; 120:15-9. [PMID: 24333760 DOI: 10.1016/j.exer.2013.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 05/29/2013] [Revised: 11/25/2013] [Accepted: 12/04/2013] [Indexed: 12/20/2022]
Abstract
Simultaneous non-invasive visualization of blood vessels and nerves in patients can be obtained in the eye. The retinal vasculature is a target of many retinopathies. Inflammation, readily manifest by leukocyte adhesion to the endothelial lining, is a key pathophysiological mechanism of many retinopathies, making it a valuable and ubiquitous target for disease research. Leukocyte fluorography has been extensively used in the past twenty years; however, fluorescent markers, visualization techniques, and recording methods have differed between studies. The lack of detailed protocol papers regarding leukocyte fluorography, coupled with lack of uniformity between studies, has led to a paucity of standards for leukocyte transit (velocity, adherence, extravasation) in the retina. Here, we give a detailed description of a convenient method using acridine orange (AO) and a commercially available scanning laser ophthalmoscope (SLO, HRA-OCT Spectralis) to view leukocyte behavior in the mouse retina. Normal mice are compared to mice with acute and chronic inflammation. This method can be readily adopted in many research labs.
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Affiliation(s)
- Judd M Cahoon
- Department of Ophthalmology and Visual Science, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84109, United States.
| | - Paul R Olson
- Department of Ophthalmology and Visual Science, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84109, United States
| | - Spencer Nielson
- Department of Ophthalmology and Visual Science, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84109, United States
| | - Tadashi R Miya
- Department of Ophthalmology and Visual Science, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84109, United States
| | - Peter Bankhead
- Centre for Vision and Vascular Science, Queen's University of Belfast, Institute of Clinical Sciences, Block A, Royal Victoria Hospital Belfast, Ireland
| | - J Graham McGeown
- Centre for Vision and Vascular Science, Queen's University of Belfast, Institute of Clinical Sciences, Block A, Royal Victoria Hospital Belfast, Ireland
| | - Timothy M Curtis
- Centre for Vision and Vascular Science, Queen's University of Belfast, Institute of Clinical Sciences, Block A, Royal Victoria Hospital Belfast, Ireland
| | - Balamurali K Ambati
- Department of Ophthalmology and Visual Science, John A Moran Eye Center, University of Utah, Salt Lake City, UT 84109, United States
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Ochi R, Harino S, Yamaoka S, Eda S, Tominaga A. [Case of retinal ischemia and retinal arteritis secondary to intravitreal nuclear drop]. Nippon Ganka Gakkai Zasshi 2011; 115:1101-1104. [PMID: 22312815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND A rare case of retinal arteritis and retinal ischemia as an incomplete branch retinal artery occlusion is reported following dropped lens fragments into the vitreous body. CASE A 69 year-old-woman had a cataract OD with corrected visual acuity of 0.4. When she underwent phacoemulsification on March 11, the posterior capsule was damaged and nucleus fragments dropped into a vitreous body. A few days later, the vitreous opacity increased. The corrected visual acuity OD dropped to 0.06 due to anterior chamber inflammation and the intraocular pressure increased to 26 mmHg. During a pars plana vitrectomy on May 7, some retinal whitening were observed and incomplete branch retinal artery occlusion was confirmed by fluorescence fundus angiography. The corrected visual acuity finally improved to 0.3, but the right visual field defect remained. CONCLUSION Incomplete branch retinal artery occlusion caused by phacoanaphylactic endophthalmitis secondary to lens fragments in the vitreous cavity seems to be a rare condition related to retinal whitening. The timing of pars plana vitrectomy should be considered before retinal arterial sheathing or retinal whitening can be noted.
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Affiliation(s)
- Ryosuke Ochi
- Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan.
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El-Remessy AB, Rajesh M, Mukhopadhyay P, Horváth B, Patel V, Al-Gayyar MMH, Pillai BA, Pacher P. Cannabinoid 1 receptor activation contributes to vascular inflammation and cell death in a mouse model of diabetic retinopathy and a human retinal cell line. Diabetologia 2011; 54:1567-78. [PMID: 21373835 PMCID: PMC3375271 DOI: 10.1007/s00125-011-2061-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 12/30/2010] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Recent studies have demonstrated that cannabinoid-1 (CB(1)) receptor blockade ameliorated inflammation, endothelial and/or cardiac dysfunction, and cell death in models of nephropathy, atherosclerosis and cardiomyopathy. However the role of CB(1) receptor signalling in diabetic retinopathy remains unexplored. Using genetic deletion or pharmacological inhibition of the CB(1) receptor with SR141716 (rimonabant) in a rodent model of diabetic retinopathy or in human primary retinal endothelial cells (HREC) exposed to high glucose, we explored the role of CB(1) receptors in the pathogenesis of diabetic retinopathy. METHODS Diabetes was induced using streptozotocin in C57BL/6J Cb(1) (also known as Cnr1)(+/+) and Cb(1)(-/-) mice aged 8 to 12 weeks. Samples from mice retina or HREC were used to determine: (1) apoptosis; (2) activity of nuclear factor kappa B, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), poly (ADP-ribose) polymerase and caspase-3; (3) content of 3-nitrotyrosine and reactive oxygen species; and (4) activation of p38/Jun N-terminal kinase/mitogen-activated protein kinase (MAPK). RESULTS Deletion of CB(1) receptor or treatment of diabetic mice with CB(1) receptor antagonist SR141716 prevented retinal cell death. Treatment of diabetic mice or HREC cells exposed to high glucose with SR141716 attenuated the oxidative and nitrative stress, and reduced levels of nuclear factor κB, ICAM-1 and VCAM-1. In addition, SR141716 attenuated the diabetes- or high glucose-induced pro-apoptotic activation of MAPK and retinal vascular cell death. CONCLUSIONS/INTERPRETATION Activation of CB(1) receptors may play an important role in the pathogenesis of diabetic retinopathy by facilitating MAPK activation, oxidative stress and inflammatory signalling. Conversely, CB(1) receptor inhibition may be beneficial in the treatment of this devastating complication of diabetes.
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MESH Headings
- Animals
- Apoptosis/drug effects
- Apoptosis/physiology
- Caspase 3/metabolism
- Cell Line
- Diabetes Mellitus, Experimental/chemically induced
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/physiopathology
- Diabetic Retinopathy/etiology
- Diabetic Retinopathy/metabolism
- Diabetic Retinopathy/physiopathology
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Endothelium, Vascular/physiopathology
- Glucose/pharmacology
- Humans
- Intercellular Adhesion Molecule-1/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- NF-kappa B/metabolism
- Oxidative Stress/drug effects
- Reactive Oxygen Species/metabolism
- Receptor, Cannabinoid, CB1/deficiency
- Receptor, Cannabinoid, CB1/genetics
- Receptor, Cannabinoid, CB1/physiology
- Retina/metabolism
- Retina/pathology
- Retina/physiopathology
- Retinal Vasculitis/metabolism
- Retinal Vasculitis/physiopathology
- Signal Transduction/physiology
- Streptozocin/adverse effects
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Affiliation(s)
- A. B. El-Remessy
- Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, USA. Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - M. Rajesh
- Section on Oxidative Stress Tissue Injury, Laboratory of Physiological Studies, National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism, 5625 Fishers Lane, MSC-9413, Bethesda, MD 20892-9413, USA
| | - P. Mukhopadhyay
- Section on Oxidative Stress Tissue Injury, Laboratory of Physiological Studies, National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism, 5625 Fishers Lane, MSC-9413, Bethesda, MD 20892-9413, USA
| | - B. Horváth
- Section on Oxidative Stress Tissue Injury, Laboratory of Physiological Studies, National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism, 5625 Fishers Lane, MSC-9413, Bethesda, MD 20892-9413, USA. Institute of Human Physiology and Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - V. Patel
- Section on Oxidative Stress Tissue Injury, Laboratory of Physiological Studies, National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism, 5625 Fishers Lane, MSC-9413, Bethesda, MD 20892-9413, USA
| | - M. M. H. Al-Gayyar
- Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, USA. Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - B. A. Pillai
- Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, USA. Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - P. Pacher
- Section on Oxidative Stress Tissue Injury, Laboratory of Physiological Studies, National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism, 5625 Fishers Lane, MSC-9413, Bethesda, MD 20892-9413, USA
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Akesbi J, Brousseaud FX, Adam R, Rodallec T, Nordmann JP. Intravitreal bevacizumab (Avastin) in idiopathic retinitis, vasculitis, aneurysms and neuroretinitis. Acta Ophthalmol 2010; 88:e40-1. [PMID: 19508455 DOI: 10.1111/j.1755-3768.2009.01540.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Habibullah M, Uddin MS, Islam S. Association of tuberculosis with vasculitis retinae. Mymensingh Med J 2008; 17:129-133. [PMID: 18626445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Retinal vasculitis is one of the common causes of blindness among the young adult in this subcontinent. Causes of retinal vasculitis are variable and it is one of the common ocular manifestations of tuberculosis. This case control study was carried out on 45 patients with retinal vasculitis of different age groups. All the patients were purposively selected from the department of ophthalmology, Bangabandhu Sheikh Mujib Medical University and National Institute of Ophthalmology Dhaka. This study reveals that vasculitis retinae is a disease of younger age group (68.9%). Mean+/-SD age of cases were 31.84+/-10.82 years. It occurs more in male (75.6%) and male female ratio is 3.09:1, single or both eye may involve. Retinal vasculitis occurs more in middle socio-economic status persons (62.2%). It present with floaters (58.9%), hazy media (60%), vitreous haemorrhage (57.8%) and retinal haemorrhage (42.2%). All 45 subjects both cases and control groups were tested with Mantoux test. 18(40%) subjects of cases and 13(28.9%) subjects of control group were found positive Mantoux test. It was observed that the association of tuberculosis with vasculitis retinae is not statistically significant. As tuberculosis is common in this country, further specific and extensive study over a longer period of time is necessary for understanding the role of tuberculosis in retinal vasculitis patients.
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Affiliation(s)
- M Habibullah
- Department of Ophthalmology, Mymensingh Medical College Hospital, Bangladesh
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11
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Ishaq M, Feroze AH, Shahid M, Baig MA, Ameen SS, Feroze SH, Chishti RA. Intravitreal steroids may facilitate treatment of Eales' disease (idiopathic retinal vasculitis): an interventional case series. Eye (Lond) 2006; 21:1403-5. [PMID: 16980931 DOI: 10.1038/sj.eye.6702551] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Eales' disease is an idiopathic peripheral perivasculitis leading to proliferative vascular retinopathy, recurrent vitreous haemorrhages, and tractional retinal detachment. It is an elusive cause of blindness in young, otherwise healthy individuals. We studied the effects of intravitreal triamcinolone acetonide (IVTA) in patients of Eales' disease, which may eventually reduce the side effects and cost of management, with results equivalent to or better than oral steroids. METHODS Ethics approval and prior patient consent were obtained. Fluorescein fundus angiograms (FFAs) of 12 eyes of 12 Eales' disease patients were taken before enrolment. These patients received 0.1 ml of 40 mg/ml (4 mg) intravitreal triamcinolone through pars plana under topical anaesthesia. Regular weekly follow-ups were initiated to ascertain Snellen visual acuity, intraocular pressure (IOP) with Goldman tonometer, and triple mirror examination. Fluorescein fundus angiography was again performed in the 8th week to monitor response to treatment. Decrease in areas of late perivascular dye extravasation on fluorescein angiography was used as marker for improvement. RESULTS Ten out of a total of 12 (83.33%) eyes treated with IVTA showed significant reduction of late leakage from retinal vessels on fluorescein fundus angiography. Two out of 12 eyes (16.67%) did not show considerable decrease in late perivascular fluorescein dye leakage after 8 weeks of intravitreal triamcinolone injection. Two patients (16.67%) had a significant rise in IOP after IVTA. CONCLUSION Intravitreal steroids may be advocated for management of idiopathic retinal vasculitis without complications of systemic steroids, and minimize need for more invasive procedures.
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Affiliation(s)
- M Ishaq
- Department of Ophthalmology, Army Medical College, Rawalpindi, Pakistan
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12
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple organ systems. When eyes are involved, the principle manifestations are hemorrhage, retinal cotton wool spots, microangiopathy and vaso-occlusion. Research in the past two decades has significantly contributed to our understanding about this disease in general and its therapeutic management, although knowledge about the mechanism of ocular involvement and pathogenesis in SLE is limited. This is an important issue, because the ocular symptoms in this disease could be potentially sight threatening in acute cases. Here, we present an overview of the clinical and histopathologic features of retinal and choroidal vascular changes, as seen in patients with SLE. We discuss the role of immune complex deposition in vascular pathogenesis in the eye. Reports indicated an involvement of antiphospholipid antibodies (APAs) in the retinal and choroidal vasculopathy in SLE, although their precise role in this process is uncertain. It is important to look for mechanisms of immune complex-mediated vasculopathy and role of inflammatory mediators in this process in SLE. For this, established animal models can be utilized in research to learn about the precise role of various autoantibodies and complements involved in disease pathogenesis. A clear knowledge about the immunopathogenesis is warranted, and the rationale for the future therapy should be based on reducing vascular inflammation as well as ameliorating autoimmunity in this disease.
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Affiliation(s)
- Tapas C Nag
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi.
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Hammond MD, Ward TP, Katz B, Subramanian PS. Elevated intracranial pressure associated with idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome. J Neuroophthalmol 2004; 24:221-4. [PMID: 15348989 DOI: 10.1097/00041327-200409000-00008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome typically occurs in young patients and may produce multiple retinal macroaneurysms, neuroretinitis, and peripheral capillary nonperfusion. Optic disc edema has been described, but elevated intracranial pressure has not been previously documented. We report a case of a 12-year-old girl who presented with bilateral disc swelling and peripapillary hemorrhage. Brain magnetic resonance imaging (MRI) was normal, but lumbar puncture yielded an opening pressure of 360 mm H2O with normal constituents. Fluorescein angiography delineated saccular aneurysms of the retinal arteriolar vasculature, and IRVAN syndrome was diagnosed. MR venography disclosed poor filling of both transverse venous sinuses. Acetazolamide treatment of 14 months did not alter the fundus findings. IRVAN syndrome may present initially with optic nerve swelling and elevated intracranial pressure with subsequent development of the characteristic retinal vascular abnormalities.
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Affiliation(s)
- Matthew D Hammond
- Ophthalmology Service, Walter Reed Army Medical Center, 5900 Georgia Avenue NW, Washington, DC 20307, USA
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14
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Jain RS. Eales' disease with neurological manifestations. J Assoc Physicians India 2004; 52:342; author reply 342. [PMID: 15636351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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15
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Ermakova NA, Alekberova ZS, Prokaeva TB, Poljanskaja IB. Frequency of HLA in patients with Behçet's disease and association with occlusive retinal vasculitis. Adv Exp Med Biol 2003; 528:231-3. [PMID: 12918697 DOI: 10.1007/0-306-48382-3_46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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16
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Affiliation(s)
- David A DiLoreto
- Retinal Vascular Center, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Rajesh M, Sulochana KN, Punitham R, Biswas J, Lakshmi S, Ramakrishnan S. Involvement of oxidative and nitrosative stress in promoting retinal vasculitis in patients with Eales' disease. Clin Biochem 2003; 36:377-85. [PMID: 12849870 DOI: 10.1016/s0009-9120(03)00058-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Eales' disease (ED) is an idiopathic retinal vasculitis condition, which affects retina of young adult males. The histopathological hallmark in ED is the adhesion of leukocytes to the endothelium and the infiltration of these cells into the retinal parenchyma. Phagocyte generated free radicals have been implicated in mediating tissue damage associated with various inflammatory vasculopathies. In the present study, we have investigated the possible role of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in causing retinal tissue damage in ED. DESIGN AND METHODS 35 patients with ED and 20 healthy control subjects were included in the study. Monocytes (MC) were separated from peripheral blood of the respective study participants. Inducible nitric oxide synthase (iNOS) protein expression was assessed using Western blot and 3 nitrotyrosine (3NTYR) by reversed phase high performance liquid chromatography (RP HPLC). Thiobarbituric acid reactive substances (TBARS) were determined by measuring malondialdehyde (MDA) formed. Superoxide dismutase (SOD) activity was assayed based on the ability of SOD to inhibit auto-oxidation of epinephrine. Iron, copper and zinc content were determined using Atomic Absorption Spectrophotometer. Immunolocalization of iNOS and 3NTYR was performed on the surgically excised epiretinal membranes (ERM) from patients with ED. RESULTS There was a significant increase in the expression of iNOS, as well as 3NTYR accumulation, diminished SOD activity, elevated lipid peroxides, iron, copper and decreased zinc content in the MC of patients with ED when compared with healthy control subjects. The elevated levels of ROS and RNS products correlated with diminished antioxidant status in patients with ED. Strong immunoreactivity for iNOS and 3NTYR was observed in inflammatory cells and endothelial cells in ERM obtained from patients with ED. CONCLUSIONS Our findings from this study clearly reveal the involvement of RNS and ROS in the development of retinal vasculitis in ED. Based on our present study and earlier studies we confirm the role of free radicals in mediating retinal tissue damage in ED. Hence we believe selective inhibition of iNOS or supplementation with antioxidants vitamin E and C might be beneficial in controlling retinal vasculitis in patients with ED.
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Affiliation(s)
- Mohanraj Rajesh
- Biochemistry Research Department, Vision Research Foundation, Sankara Nethralaya, 600006 Chennai, India
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Yeshurun I, Recillas-Gispert C, Navarro-Lopez P, Arellanes-Garcia L, Cervantes-Coste G. Extensive dynamics in location, shape, and size of aneurysms in a patient with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Idiopathic retinal vasculitis, aneurysms, and neuroretinitis. Am J Ophthalmol 2003; 135:118-20. [PMID: 12504719 DOI: 10.1016/s0002-9394(02)01823-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe an unusual case of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome with rapid dynamics in the number and appearance of the aneurysms. DESIGN Observational case report. METHODS Clinical and angiographic data of the patient were reviewed. RESULTS In the course of only 6 months, preexisting retinal aneurysms resolved while new ones appeared. Changes were observed in the shape and size of preexisting lesions. The resolution of lesions in eyes previously untreated by laser is reported for the first time. CONCLUSIONS Vascular lesions in IRVAN syndrome may show an unusually rapid turnover. The resolution of aneurysms is a part of the natural course of the disease and may occur without previous retinal laser photocoagulation.
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Affiliation(s)
- Itamar Yeshurun
- Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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