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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.
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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
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2
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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.
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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
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3
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Abstract
PURPOSE To provide an overview of pediatric pars planitis. METHODS Narrative literature review. RESULTS Pars planitis refers to the idiopathic subset of intermediate uveitis in which there is vitritis along with snowball or snowbank formation occurring in the absence of an associated infection or systemic disease. It is thought to be a T-cell mediated disease with a genetic predisposition. Pars planitis accounts for 5-26.7% of pediatric uveitis cases. Presentation is commonly bilateral but asymmetric, often with insidious onset of floaters and blurred vision. Although pars planitis is known to be a benign form of uveitis in most cases, severe complications secondary to chronic inflammation may arise, with cystoid macular edema being the most common cause of visual morbidity. Mild vitritis in the absence of symptoms, vision loss, or macular edema may be observed. Patients with severe vitritis and/or associated vision-threatening complications require prompt aggressive treatment. A stepladder approach including corticosteroids, immunosuppressive agents, anti‑tumor necrosis factor‑alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. CONCLUSION Timely diagnosis and adequate treatment of pediatric pars planitis and associated complications are crucial in order to improve visual outcomes.
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Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Pinar Ozdal
- Service of Uveitis and Retinal Diseases, Ankara Ulucanlar Eye Research Hospital, Ankara, Turkiye
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wijdène Nabi
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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4
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Heinz C, Baquet-Walscheid K. [Intermediate and Posterior Uveitis - Classification, diagnostics, complications, and therapeutic algorithms]. Klin Monbl Augenheilkd 2023; 240:1433-1447. [PMID: 37977203 DOI: 10.1055/a-2193-2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Intermediate and posterior uveitis describes a broad variety of different types of intraocular inflammation. Before starting treatment of intermediate or posterior uveitis, a differentiation between infectious or non-infectious uveitis must always be made. Pathognomonic symptoms do not exist, visual loss and vitreous floaters are the most common symptoms. The indication for therapy is influenced by the anatomical localization, the degree of inflammation, an association, complications and the activity of the inflammation. In addition to clinical ophthalmological standard examination, angiography and OCT are the most important investigations to classify and assess the course of inflammation. Macular edema is the most common complication of intermediate or posterior uveitis and should be treated at first onset, recurrence, or worsening. Oral, intravenous, or intravitreal corticosteroids are usually the primary therapy for intermediate or posterior uveitis. Systemic immunosuppression is indicated after steroid failure in non-infectious uveitis.
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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.
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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
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6
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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.
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Affiliation(s)
- Abhilasha Baharani
- Consultant Uvea Specialist, Neoretina Eyecare Institute, Hyderabad, India
| | - Raja Rami Reddy P
- Consultant Retina Specialist, Neoretina Eyecare Institute, Hyderabad, India
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7
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Al-Ani HH, Sims JL, Niederer RL. Long term complications and vision loss in HLA-B27 uveitis. Eye (Lond) 2023; 37:1673-1677. [PMID: 36038721 PMCID: PMC10219953 DOI: 10.1038/s41433-022-02216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/27/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the long term complications and vision loss in HLA-B27 uveitis. METHODS Retrospective review of subjects with HLA-B27 uveitis in a public tertiary centre between January 2008 and 2020. RESULTS 562 HLA-B27-positive subjects (834 eyes) had mean follow-up of 9.8 years (8173.2 eye-years). Median visual acuity at ten years was 0.1 logMAR (IQR 0.0-0.1). Complications occurred in 404 eyes (48.4%): posterior synechiae (39.7%), cataract (22.1%), elevated intraocular pressure (15.5%), cystoid macular oedema (6.0%). Permanent moderate vision loss ( ≤ 0.4 logMAR) due to uveitis occurred in 14 eyes (1.7%) and severe vision loss (≤ 1.0 logMAR) in 7 eyes (0.8%). Complications were more common with older age (OR 1.017 p = 0.016), chronic inflammation (OR 5.272 p < 0.001) and intermediate uveitis (OR 5.982 p < 0.001). CONCLUSIONS Complications are frequent in HLA-B27 uveitis, especially in older subjects, chronic inflammation and intermediate uveitis. Despite this, the majority of subjects maintain good visual prognosis.
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Affiliation(s)
- Haya H Al-Ani
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand.
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
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Iannetti L, Scarinci F, Alisi L, Armentano M, Sampalmieri L, La Cava M, Gharbiya M. Correlation between Morphological Characteristics of Macular Edema and Visual Acuity in Young Patients with Idiopathic Intermediate Uveitis. Medicina (B Aires) 2023; 59:medicina59030529. [PMID: 36984530 PMCID: PMC10054752 DOI: 10.3390/medicina59030529] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/12/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Background and Objectives: Macular edema (ME) is a common complication of intermediate uveitis (IU). It is often responsible for a decrease in visual acuity (VA). Three distinct patterns of macular edema have been described in intermediate uveitis, namely, cystoid macular edema (CME), diffuse macular edema (DME), and serous retinal detachment (SRD). The current study aims to describe the characteristics of macular edema in young patients with idiopathic intermediate uveitis and to correlate its features with VA using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A total of 27 eyes from 18 patients with idiopathic IU complicated by ME were included in this retrospective study. All patients underwent SD-OCT; data were gathered at the onset of ME. Best-corrected VA (BCVA) was correlated with the morphological features of ME. Results: BCVA was negatively correlated with Ellipsoid Zone (EZ) disruption (p = 0.00021), cystoid pattern (p = 0.00021), central subfield thickness (CST) (p < 0.001), and serous retinal detachment (0.037). Conclusions: In ME secondary to idiopathic IU, VA negatively correlates with Ellipsoid Zone disruption and increases in CST. Moreover, vision is influenced by the presence of cysts in the inner nuclear and outer nuclear layers and by the neuroepithelium detachment.
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Affiliation(s)
- Ludovico Iannetti
- Ophthalmology Unit, Head and Neck Department, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-3388635417
| | | | - Ludovico Alisi
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Marta Armentano
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Maurizio La Cava
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Magda Gharbiya
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
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Siverio-Llosa C, Silva-Ocas I, Gálvez-Olórtegui T, Arana-Kaik G. Clinical course of HTLV-1 infection associated intermediate uveitis. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:386-390. [PMID: 35624063 DOI: 10.1016/j.oftale.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/07/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the clinical features at presentation, delivered treatment and follow-up of a case series of human T-cell lymphotropic virus type 1 (HTLV-1) associated intermediate uveitis. PATIENTS AND METHODS Retrospective, descriptive and longitudinal study of patients with HTLV-1 associated intermediate uveitis treated at a reference ophthalmology facility in Lima, Peru, during the years 2012 to 2018. RESULTS A total of 18 patients (28 eyes) were included, the average age at presentation was 57.3 years, 66.6% were women, and the average follow-up time was 1,280 days. The most frequent symptoms were blurred or diminished vision (78.6%) and floaters (57.1%). Best corrected visual acuity was 20/40 or better in 53.6%. The mean initial intraocular pressure was 14.95 mmHg. Keratic precipitates were observed in 50% of eyes, 17.9% were of the stellate type. The most frequent treatment was periocular corticosteroid injections (53.6%). Complications such as epimacular membrane (50%), cataract (21.4%) and glaucoma (7.1%) occurred. At the end of follow-up, only 2 eyes lost one line of vision; the final best corrected visual acuity was 20/40 or better in 85.7%, and 20/70 or better in 96.4%. Patients with both eyes affected increased from 33% at presentation to 55.5%. The course of the disease was chronic in 60.7%. CONCLUSION HTLV-1 associated intermediate uveitis mainly occurred in patients in the second half of life, developing a chronic course and with good visual prognosis.
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Affiliation(s)
- C Siverio-Llosa
- Departamento de Úvea, Oftálmica Clínica de la Visión, Lima, Peru.
| | - I Silva-Ocas
- Unidad de Investigación Clínica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
| | - T Gálvez-Olórtegui
- Departamento de Oftalmología, Hospital Nacional Guillermo Almenara Yrigoyen, Lima, Peru; Unidad de Oftalmología Basada en Evidencias (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
| | - G Arana-Kaik
- Departamento de Retina, Oftálmica Clínica de la Visión, Lima, Peru
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Abraham A, Nicholson L, Dick A, Rice C, Atan D. Intermediate uveitis associated with MS: Diagnosis, clinical features, pathogenic mechanisms, and recommendations for management. Neurol Neuroimmunol Neuroinflamm 2021; 8:e909. [PMID: 33127747 PMCID: PMC7641065 DOI: 10.1212/nxi.0000000000000909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/10/2020] [Indexed: 01/02/2023]
Abstract
Uveitis is a major cause of visual impairment and blindness among working-age adults, accounting for 10% of legal blindness in the United States. Among people with MS, the prevalence of uveitis is 10 times higher than among the general population, and because MS and uveitis share similar genetic risk factors and immunologic effector pathways, it is not clear whether uveitis is one of the manifestations of MS or a coincident disorder. This uncertainty raises several diagnostic and management issues for clinicians who look after these patients, particularly with regard to recognizing visual symptoms resulting from demyelination, intraocular inflammation, or the visual complications of disease modifying drugs for MS, e.g., fingolimod. Likewise, management decisions regarding patients with uveitis are influenced by the risk of precipitating or exacerbating episodes of demyelination, e.g., following anti-tumor necrosis factor biologic therapy, and other neurologic complications of immunosuppressive treatments for uveitis. In this review, we explore the similarities in the pathophysiology, clinical features, and treatment of patients with uveitis and MS. Based on the latest evidence, we make a set of recommendations to help guide neurologists and ophthalmologists to best manage patients affected by both conditions.
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Affiliation(s)
- Alan Abraham
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom.
| | - Lindsay Nicholson
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Andrew Dick
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Claire Rice
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Denize Atan
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
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11
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Placinta IA, Udaondo P. Multimodal imaging in intermediate tuberculous uveitis. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:e37-e38. [PMID: 32007343 DOI: 10.1016/j.oftal.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/08/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Affiliation(s)
- I A Placinta
- Departamento de Salud Valencia La Fe, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | - P Udaondo
- Departamento de Salud Valencia La Fe, Hospital Universitari i Politècnic La Fe, Valencia, España
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12
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Eiger-Moscovich M, Tomkins-Netzer O, Amer R, Habot-Wilner Z, Kasb A, Friling R, Kramer M. Visual and Clinical Outcome of Macular Edema Complicating Pediatric Noninfectious Uveitis. Am J Ophthalmol 2019; 202:72-78. [PMID: 30772346 DOI: 10.1016/j.ajo.2019.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the clinical course and visual outcome of macular edema (ME) in pediatric patients with chronic noninfectious uveitis. DESIGN Retrospective case series. METHODS The databases of the uveitis clinics of 4 tertiary medical centers in Israel and the UK were searched for all children treated for uveitic ME in the years 2005-2015. Data were collected from the medical records as follows: demographics, diagnosis, visual acuity, clinical and imaging findings, and treatment given specifically for ME. Findings at baseline and at 3, 6, 12, and 24 months were evaluated. RESULTS The cohort included 25 children (33 eyes) of mean age 8.5 ± 3.4 years. The most common diagnosis was intermediate uveitis, in 14 children (7 idiopathic, 7 pars planitis). Uveitis was active at ME diagnosis in 28 eyes (84.8%). Median duration of follow-up was 48 months. Median time to resolution of ME was 6 months, with complete resolution in 25 eyes (75.8%) by 24 months. Baseline visual acuity was ≥20/40 in 8 eyes (24.2%), increased to 57.6% at 3 months (P < .0001), and remained stable thereafter. Treatment regimens included corticosteroids (systemically and/or locally), immunosuppression, and biologic therapies. No correlation was found between outcome and either structural characteristics of ME or specific treatment strategy. CONCLUSIONS The prognosis of pediatric uveitic ME is favorable despite its chronic course. Larger randomized controlled trials are needed to define differences among treatment regimens.
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Affiliation(s)
- Maya Eiger-Moscovich
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, University College London, London, United Kingdom; Department of Ophthalmology, Bnei Zion Medical Center, Israel Institute of Technology-Technion, Haifa, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah University Hospital, Hadassah Medical School, Jerusalem, Israel
| | - Zohar Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ahmed Kasb
- Moorfields Eye Hospital, University College London, London, United Kingdom
| | - Ronit Friling
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Zarei M, Abdollahi A, Darabeigi S, Ebrahimiadib N, Roohipoor R, Ghassemi H, Moghaddam RS, Fard MA. An investigation on optic nerve head involvement in Fuchs uveitis syndrome using optical coherence tomography and fluorescein angiography. Graefes Arch Clin Exp Ophthalmol 2018; 256:2421-2427. [PMID: 30178139 DOI: 10.1007/s00417-018-4125-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mohammad Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 13352, Iran
| | - Ali Abdollahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 13352, Iran
| | - Sahel Darabeigi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 13352, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 13352, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 13352, Iran
| | - Hamed Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 13352, Iran
| | | | - Masoud Aghsaei Fard
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 13352, Iran.
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Park JM, Lee H, Song S, Seong EY, Kwak IS, Park SW, Kim YK, Shin N, Sol MY. Primary Glomerulonephritis with Unique C4d Deposition and Concurrent Non-infectious Intermediate Uveitis: a Case Report and Literature Review. J Korean Med Sci 2018; 33:e136. [PMID: 29713256 PMCID: PMC5920125 DOI: 10.3346/jkms.2018.33.e136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/10/2017] [Indexed: 12/14/2022] Open
Abstract
C4 glomerulopathy is a recently introduced entity that presents with bright C4d staining and minimal or absent immunoglobulin and C3 staining. We report a case of a 62-year-old man with C4 glomerulonephritis (GN) and uveitis. He presented to the nephrology department with proteinuria and hematuria. The patient also had intermediate uveitis along with proteinuria and hematuria. A kidney biopsy that was performed in light of continuing proteinuria and hematuria showed a focal proliferative, focal sclerotic glomerulopathy pattern on light microscopy, absent staining for immunoglobulin or C3 by immunofluorescence microscopy, with bright staining for C4d on immunohistochemistry, and electron-dense deposits on electron microscopy. Consequently, C4 GN was suggested as the pathologic diagnosis. Although laser microdissection and mass spectrometry for glomerular deposit and pathologic evaluation of the retinal tissue were not performed, this is the first report of C4 GN in Korea and the first case of coexisting C4 GN and uveitis in the English literature.
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Affiliation(s)
- Jong Man Park
- Department of Internal Medicine, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Harin Lee
- Department of Internal Medicine, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sangheon Song
- Department of Internal Medicine, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Eun Young Seong
- Department of Internal Medicine, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sung Who Park
- Department of Ophthalmology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young-Keum Kim
- Department of Pathology, BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Nari Shin
- Department of Pathology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mee Young Sol
- Department of Pathology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Palimeris G, Marcomichelakis N, Konstantinidou V, Trakaniari AN. Intermediate Uveitis: What is the Natural Course of the Disease and Its Relationship with Other Systemic Diseases? Eur J Ophthalmol 2018; 4:223-7. [PMID: 7711475 DOI: 10.1177/112067219400400406] [Citation(s) in RCA: 11] [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: 11/15/2022]
Abstract
This study examined the natural course of intermediate uveitis, to find a possible correlation with systemic diseases and to identify the ocular complications. Patients were classified according to follow-up time in three groups: A (1-5 years) 12 pts, B (6-10 years) 10 pts, C (11-15 years or more) 6 pts for a total of 28 patients (52 eyes). We studied the recurrences, the complications of the disease and the overall prognosis. Eight patients were found to be suffering from systemic diseases: sarcoidosis 2, Adamantiades-Behcet 2, multiple sclerosis 3 and Lyme disease 1. Cataract was found in 21 eyes (40.5%) and macular changes in 20 eyes (38.4%) but chronic cystoid macular edema persisted in only six cases (12.5%). Group C presented more complications than group B. Group A had the fewest. The frequency of recurrences was 1-5 for group A. 1-3 for group B and 1-2 for group C. Four patients received no therapy, 15 received steroids and nine received cyclosporine and steroids. In this series intermediate uveitis was bilateral in 85.8% of patients and related with systemic diseases in 28.5%. Recurrences appeared mainly during the first five years. The longer the presence of the disease the more frequent were complications and the final visual acuity depended mostly on the severity of the initial attack and the number of exacerbations.
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Affiliation(s)
- G Palimeris
- Athens University Eye Clinic, General Hospital of Athens, Greece
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16
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Nakano H, Sakajiri K, Nitta E, Nagata A, Takahashi T. [A case of multiple sclerosis with bilateral intermediate uveitis]. Rinsho Shinkeigaku 2015; 55:716-721. [PMID: 26289756 DOI: 10.5692/clinicalneurol.cn-000582] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We describe a case of 20-year-old woman with visual impairment in her left eye. Her left visual acuity was 0.07 and an ophthalmoscopic examination demonstrated bilateral intermediate uveitis (IU). A neurological examination on admission revealed lower nasal quadrantanopsia in her left eye and an exaggerated right patellar tendon reflex. A T2-weighted MRI showed multiple high-intensity lesions in the bilateral periventricular region, corpus callosum, medulla. A short T1 inversion recovery MRI also showed a swollen left retrobulbar optic nerve and posterior thoracic cord lesion at Th 9 level. The latter longitudinal length was approximately 20 mm. Laboratory investigation demonstrated no abnormalities including an anti-aquaporin-4 antibody. A cerebrospinal fluid examination revealed an increased IgG-index (1.21) with oligoclonal IgG babds. Initially, a diagnosis of retrobulbar optic neuritis with IU was made. She received subtenon corticosteroid injection with intravenous methylprednisolone pulse and oral prednisolone therapy. An immediate improvement of her visual symptoms and MRI abnormalities was observed. Approximately 1 year later, a new high-intensity lesion in the right internal capsule was present on a follow-up T2-weighted brain MRI, established a diagnosis of multiple sclerosis (MS) based on the McDonald criteria in 2010. Previous reports in Japan demonstrated few cases of uveitis in patients with MS and this is the first report of MS with IU in Japan.
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Affiliation(s)
- Hiroto Nakano
- Department of Neurology, National Hospital Organization Kanazawa Medical Center
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Affiliation(s)
- M A Wagemans
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
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Affiliation(s)
- R M Franklin
- Bob Hope Eye Research Center, St. Joseph Hospital, Houston, Tex
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Affiliation(s)
- C S Foster
- Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Affiliation(s)
- E M Graham
- Medical Eye Unit, St. Thomas' Hospital, London, UK
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Kraus-Mackiw E, Alexandridis E. Intermediate uveitis and multiple sclerosis: considerations and necessary consequences for treatment. Dev Ophthalmol 2015; 23:111-4. [PMID: 1730341 DOI: 10.1159/000429637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Affiliation(s)
- C Eckardt
- Department of Ophthalmology, Christian Albrechts University, Kiel, FRG
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Abstract
PURPOSE To report dislocation of dexamethasone implant (Ozurdex®) into the anterior chamber and to discuss intervention options. DESIGN Interventional case report. METHODS An 89-year-old woman presented after Ozurdex® implant injection for chronic cystoid macular edema secondary to idiopathic intermediate uveitis. The dexamethasone implant dislocated into the anterior chamber. Pharmacologic dilation was administered and the patient was placed in a reclined supine position. RESULTS Successful repositioning of the implant into the vitreous cavity. CONCLUSIONS Although it is a rare complication, anterior dislocation of a dexamethasone implant may have serious consequences. Early recognition and appropriate management is advisable.
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Sczesny-Kaiser M, Veit M, Heinz C, Heiligenhaus A, Tegenthoff M, Schwenkreis P. [Manifestation of multiple sclerosis under treatment with infliximab for intermediate uveitis]. Nervenarzt 2011; 82:509-510. [PMID: 21153465 DOI: 10.1007/s00115-010-3191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- M Sczesny-Kaiser
- Neurologische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum GmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum.
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Malone PE, Herndon LW, Muir KW, Jaffe GJ. Combined fluocinolone acetonide intravitreal insertion and glaucoma drainage device placement for chronic uveitis and glaucoma. Am J Ophthalmol 2010; 149:800-6.e1. [PMID: 20189158 DOI: 10.1016/j.ajo.2009.12.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether a fluocinolone acetonide sustained-release intravitreal drug delivery system can be implanted safely at the same time that a glaucoma drainage device is placed for eyes with uveitis and elevated intraocular pressure (IOP) receiving maximum tolerated IOP-lowering therapy. DESIGN Retrospective, observational case series. METHODS Subjects had chronic noninfectious intermediate or posterior uveitis and elevated IOP while receiving maximum tolerated medical therapy. Fluocinolone acetonide implantation and glaucoma tube shunt placement were performed in a single surgical session. The main outcome measures were inflammatory recurrences, visual acuity (VA), use of adjunctive anti-inflammatory therapy, IOP, and adverse events. RESULTS Seven eyes of 5 patients were studied. The average number of recurrences 12 months before implantation was 3 episodes per eye; of the 3 eyes followed up for more than 30 months, none had an inflammatory recurrence within 30 months after implantation. The mean Snellen visual acuity 12 months after the combined surgery was 20/114, compared with 20/400 at baseline. Adjunctive steroid use decreased. Average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg 12 months after the combined surgery (P = .019). CONCLUSIONS The favorable results observed in all eyes suggest that fluocinolone acetonide implantation can be safely combined with glaucoma tube shunt placement in a single surgical session in eyes with uveitis and elevated IOP receiving maximum tolerated IOP-lowering therapy. Uveitis recurrences decreased, visual acuity improved, and IOP decreased. There were no adverse events during insertion of the fluocinolone acetonide implant and placement of the glaucoma tube shunt.
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Affiliation(s)
- Paula E Malone
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
PURPOSE To report the favorable response of bilateral recalcitrant uveitic cystoid macular edema (CME) to treatment with a somatostatin analog. METHODS Medical ophthalmic history and the results of ophthalmic examinations were recorded. Fluorescein angiography (FA) studies were reviewed. RESULTS A 52-year-old white female with intermediate uveitis developed bilateral recalcitrant CME. Treatment with subcutaneous injections of the somatostatin analog octreotide resulted in partial resolution of the CME and improvement of visual acuity. CONCLUSIONS Somatostatin may play a role in the treatment of CME secondary to uveitis.
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Affiliation(s)
- Thekla Papadaki
- Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Abstract
Intermediate uveitis is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases: multiple sclerosis, idiopathic optic neuritis, autoimmune corneal endotheliopathy, sarcoidosis, thyroid diseases and inflammatory bowel diseases. Symptoms are blurry vision, floaters and distortion of central vision. The syndrome is bilateral in 80% of the patients and chronic with periods of exacerbation and remission. Clinical presentation includes: mild to moderate anterior chamber inflammation, thin keratic precipitates in the inferior portion of the cornea, autoimmune endotheliopathy, vitreitis, vasculitis in the peripheral retina, intravitreal "snowballs," retinal "snowbanking," optic neuritis and cystoid macular edema. Cataract and glaucoma are frequent complications. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulation of the peripheral retina are options in patients with snowbanking when there is an insufficient response to periocular or systemic corticosteroids. Imunosuppression may also be used when other therapies fail, and Cyclosporin A is the first drug of choice. Pars plana vitrectomy is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous hemorrhage, tractional retinal detachment and epiretinal membranes. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications. Patients can often maintain a vision of 20/50 or better.
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Affiliation(s)
- Adriana A Bonfioli
- Eye & Ear Institute of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Shen X, Xu GZ. [Vitrectomy in vitreo-retinal complications associated with intermediate uveitis]. Zhonghua Yan Ke Za Zhi 2008; 44:25-29. [PMID: 18510238] [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: 05/26/2023]
Abstract
OBJECTIVE To investigate the effects of vitrectomy in vitreo-retinal complications associated with intermediate uveitis. METHODS Retrospective case series of sixteen eyes of 16 patients in vitreo-retinal disease associated with intermediate uveitis in a 3-year period from Mar 2002 to Jun 2005 were included in the study. They were treated with vitrectomy and the mean follow-up was (14.25 +/- 7.90) months (range: 5-32 months). Visual acuity in final follow-up, post-operative complications and the recurrence of intermediate uveitis were retrospectively reviewed. RESULTS Four patients were associated with tuberculosis, rheumatoid arthritis, multiple sclerosis or Behcet disease, respectively. The remaining 12 cases had idiopathic diseases. Pre-operatively, all patients were treated with steroids for a long time and the mean treatment time was (9.94 +/- 2.67) months (range: 6-16 months). Pre-operative vitreo-retinal complications included severe vitreous organization (5 eyes), tractional retinal detachment (6 eyes), rhegmatogenous retinal detachment (1 eye), vitreous hemorrhages (2 eyes), epimacular membrane (2 eyes) accompanied with vitreous tissue, and peripheral retinal neovascularization (16 eyes). In the post-operative period, tractional retinal detachment in one eye and complicated cataract in 3 eyes were observed. Post-operatively, only 4 cases need long-term immunosuppression therapy (more than 6 months). Fourteen of 16 eyes achieved a final visual acuity equal to or better than baseline (X2 = 4.923, P < 0.05). Recurrent intermediate uveitis was not found in these patients. CONCLUSIONS The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the intermediate uveitis which was severe or uncontrolled by immunosuppressive drugs and accompanied with vitreo-retinal complications. The beneficial effects include improving visual acuity, reducing need for long-term immunosuppression treatment.
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Affiliation(s)
- Xi Shen
- Department of Ophthalmology, Ruijin Hospital of Jiaotong University, Shanghai 200025, China
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Schadlu R, Apte RS. Spontaneous resolution of an inflammation-associated epiretinal membrane with previously documented posterior vitreous detachment. Br J Ophthalmol 2007; 91:1252-3. [PMID: 17709592 PMCID: PMC1954932 DOI: 10.1136/bjo.2006.113597] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dada T, Dhawan M, Garg S, Nair S, Mandal S. Safety and efficacy of intraoperative intravitreal injection of triamcinolone acetonide injection after phacoemulsification in cases of uveitic cataract. J Cataract Refract Surg 2007; 33:1613-8. [PMID: 17720079 DOI: 10.1016/j.jcrs.2007.04.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Accepted: 04/22/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of a single intraoperative intravitreal injection of triamcinolone acetonide after phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis. SETTING Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS This prospective randomized controlled study included 40 eyes (40 patients) with chronic idiopathic anterior uveitis or intermediate uveitis that had phacoemulsification with intraocular lens implantation. Twenty eyes received an intravitreal injection of triamcinolone acetonide (4 mg/0.1 mL) intraoperatively (triamcinolone acetonide group), and 20 received oral steroids (steroid group) postoperatively. Outcome measures were Early Treatment Diabetic Retinopathy Study best corrected visual acuity (BCVA), anterior chamber reaction, intraocular pressure (IOP) by applanation tonometry, and central macular thickness by optical coherence tomography. RESULTS The mean BCVA (decimal) improved from a baseline of 0.13 +/- 0.14 to 0.64 +/- 0.32 in the triamcinolone acetonide group and from 0.05 +/- 0.06 to 0.61 +/- 0.36 in the steroid group (P = .74). There were no statistically significant differences between the 2 groups in postoperative anterior chamber reaction, IOP, or central macular thickness. Four patients in the triamcinolone acetonide group and 5 in the steroid group had recurrence of uveitis; 5 patients in the triamcinolone acetonide group had ocular hypertension. One patient in the triamcinolone acetonide group and 3 in the steroid group had cystoid macular edema postoperatively. CONCLUSION A single intraoperative intravitreal injection of triamcinolone acetonide seemed to be a safe and efficacious route of steroid delivery during phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis and is recommended as a substitute for postoperative oral steroid administration.
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Affiliation(s)
- Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kamboj B, Chawla S, Khemchandani M. Latanoprost versus timolol gel-forming solution once daily in primary open-angle glaucoma or ocular hypertension. Can J Ophthalmol 2007; 42:153-4. [PMID: 17361270 DOI: 10.3129/can j ophthalmol.06-118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Deuter CME, Koetter I, Guenaydin I, Stuebiger N, Zierhut M. INTERFERON ALFA-2A: A NEW TREATMENT OPTION FOR LONG LASTING REFRACTORY CYSTOID MACULAR EDEMA IN UVEITIS? Retina 2006; 26:786-91. [PMID: 16963852 DOI: 10.1097/01.iae.0000244265.75771.71] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [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: 12/14/2022]
Abstract
PURPOSE To perform a prospective pilot study to evaluate interferon alfa-2a (IFN alfa-2a) for the treatment of refractory cystoid macular edema (CME) in endogenous uveitis. METHODS IFN alfa-2a was administered at an initial dose of 3 or 6 million IU (depending on body weight) per day subcutaneously. Afterwards IFN alfa-2a was tapered slowly over 6 months and finally discontinued. If CME relapsed IFN alfa-2a was reinstituted and tapered slowly again to evaluate the lowest maintenance dose to keep remission. RESULTS A total of 15 eyes of 8 patients with refractory CME due to intermediate or posterior uveitis were included. Ineffective pretreatment consisted of systemic steroids and acetazolamide (all patients) and at least one additional immunosuppressant (6 patients). Six of 8 patients (11 eyes) responded well to IFN alfa-2a and CME resolved completely during 6 months treatment. One patient was lost to follow-up after IFN alfa-2a was stopped. In 1 patient (1 eye) even 19 months after cessation of IFN alfa-2a no recurrence of CME occurred. In 4 patients (8 eyes) IFN alfa-2a had to be reinstituted because CME relapsed. All 4 patients responded again. During a mean follow-up period of 16.4 months since restart of therapy we succeeded in all 4 patients to taper IFN alfa-2a to maintenance doses between 1.5 million IU every second and every sixth day without a recurrence of CME in any of the 8 eyes. CONCLUSION IFN alfa-2a can be a treatment option for patients with otherwise treatment resistant uveitic CME.
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Venkatesh P, Abhas Z, Garg S, Vohra R. Prospective optical coherence tomographic evaluation of the efficacy of oral and posterior subtenon corticosteroids in patients with intermediate uveitis. Graefes Arch Clin Exp Ophthalmol 2006; 245:59-67. [PMID: 16896918 DOI: 10.1007/s00417-006-0378-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Revised: 04/20/2006] [Accepted: 05/16/2006] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To prospectively evaluate the efficacy of oral corticosteroids and posterior subtenon injection in the treatment of macular edema in patients with intermediate uveitis using optical coherence tomography (OCT). METHODS Twenty-two patients with intermediate uveitis were treated with posterior subtenon injection when the disease was unilateral (group A, n=11) or with oral steroids when the disease was bilateral (group B, n=11). Changes in macular thickness from baseline was determined using OCT in both groups at day 0, day 3, day 14, 6 weeks and 12 weeks. RESULTS Statistically significant improvement in Snellen visual acuity in group A was seen at 6 weeks and in group B at 2 weeks. In patients receiving oral corticosteroids, foveal thickness decreased by 63% by day 3. In those treated with posterior subtenon injection, even at day 14 only a 55% reduction of foveal thickness was evident. Spearman's correlation coefficient for visual acuity and foveal thickness was found to be significant. CONCLUSION OCT confirms a significantly more rapid decrease in macular edema in patients treated with oral corticosteroids. A short course of oral steroids may be useful in enabling earlier visual recovery in patients treated with posterior subtenon injection for unilateral uveitic macular edema.
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Affiliation(s)
- Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Tranos P, Scott R, Zambarakji H, Zambarajki H, Ayliffe W, Pavesio C, Charteris DG. The effect of pars plana vitrectomy on cystoid macular oedema associated with chronic uveitis: a randomised, controlled pilot study. Br J Ophthalmol 2006; 90:1107-10. [PMID: 16723360 PMCID: PMC1857372 DOI: 10.1136/bjo.2006.092965] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [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: 02/06/2023]
Abstract
AIM To evaluate the efficacy of pars plana vitrectomy (PPV) in the management of chronic uveitic cystoid macular oedema (CMO). METHODS A prospective, interventional, randomised, controlled, pilot study. 23 eyes of 23 patients with CMO secondary to chronic intermediate or posterior uveitis unresponsive to medical treatment were randomised into a surgical (group S) or medical group (group M). 12 patients in group S underwent PPV as opposed to 11 patients in group M who received systemic corticosteroid and/or immunosuppressive treatment during the study period. The primary outcome measures of the study were change in visual acuity and angiographic appearance of CMO at 6 months. RESULTS Mean visual acuity in group S improved significantly from 1.0 (0.62) at baseline to 0.55 (0.29) at 6 months following vitrectomy (p = 0.011), with five (42%) eyes reaching vision of 20/40 or better. Conversely, mean visual acuity in group M improved only marginally by 0.03 (0.27) (p = 0.785). CMO after vitrectomy was angiographically improved in four (33%) eyes, remained unchanged in seven (58%) eyes, and deteriorated in one (8%) eye. In the medical group, fluorescein leakage decreased in one eye, did not alter in four eyes, and deteriorated in two eyes. CONCLUSION PPV for macular oedema secondary to chronic uveitis despite angiographic improvement in only one third of the patients, seems to have a significant beneficial effect on visual function. This study provides enough evidence to justify a large scale trial which would define the role of vitrectomy in uveitic macular oedema.
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Affiliation(s)
- P Tranos
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, London, EC1V 2PD, UK
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Abstract
PURPOSE We analyzed the epidemiologic data and vision-threatening complications in different forms of childhood uveitis. METHODS This retrospective study included 187 consecutive patients with onset of uveitis before the age of 16 years classified as anterior (AU), intermediate (IU), posterior (PU), and panuveitis (PanU). We analyzed the epidemiologic data as well as visual acuity, uveitic complications and the conservative and surgical therapy. RESULTS Associated disease was observed in 85 of 187 patients. The most common complications in AU patients were cataract, posterior synechiae, band keratopathy and CME. IU was accompanied by dense vitreous opacities, cataract and CME. Macular scars were the most frequent cause for visual loss in PU. PanU was complicated by dense vitreous opacities, cataract, retinal detachment, CME and phthisis bulbi. CONCLUSIONS Childhood uveitis is frequently associated with systemic immune-mediated diseases. The diverse uveitis types have different but typical complications.
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Affiliation(s)
- A Mingels
- Augenabteilung, St. Franziskus Hospital, Münster.
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Ermakova NA. [The nature of changes in the local and systemic fibrinolytic activity in patients with retinal angiitis of various genesis]. Vestn Oftalmol 2005; 121:9-12. [PMID: 16075620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The mechanism responsible for the development of occlusive processes on the fundus of the eye in different forms of retinal angiitis remains unknown. So the purpose of this study was to investigate the local and systemic fibrinolytic activity in 10 patients with optic disk vasculitis (ODV), 16 patients with peripheral uveitis (PU), 21 patients with isolated retinal angiitis (IRA), 17 patients with systemic lupus erythematosus (SLE) versus 8 healthy donors (a control group). Fibrinolytic activity was determined by the area of lysis, which appeared on the fibrin plate around the 2x2-mm filter paper previously placed in tear or blood. Fibrinolytic activity was ascertained to be decreased if the area of lysis was less than 30 mm2. There was a significant reduction in local fibrinolytic activity in the eyes with occlusive retinal vasculitis (RV) compared with the eyes with RV without occlusions by PU (60 and 9.1%, respectively; p = 0.0048), IRA (61.5 and 12.5%, respectively; p = 0.0056), and as compared to the eyes without vasculitis by ODV (70 and 0%, respectively, p = 0.0031). In SLE, the decrease in local fibrinolytic activity was detected significantly less frequently (33.3 and 16.6% with and without retinal vascular occlusion (RVO), respectively). Blood fibrinolytic activity was lowered only in patients with SLE (with 100 and 16.7% with and without RVO, respectively; p = 0.0151) and remained unchanged in those with ODV, PU, and IRA (more than 50 mm2). Thus, RVO is associated with impaired local reactions in patients with PU, ODV, and IRA and with impaired systemic reactions in those with SLE.
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Lim WK, Ursea R, Rao K, Buggage RR, Suhler EB, Dugan F, Chan CC, Straus SE, Nussenblatt RB. Bilateral uveitis in a patient with autoimmune lymphoproliferative syndrome. Am J Ophthalmol 2005; 139:562-3. [PMID: 15767081 DOI: 10.1016/j.ajo.2004.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2004] [Indexed: 11/26/2022]
Abstract
PURPOSE We report a case of autoimmune lymphoproliferative syndrome (ALPS) presenting with bilateral uveitis. DESIGN Observational case report. METHODS Review of case record, serum and aqueous IL-10 and IL-6 cytokine results, and immunosuppressive treatment of a patient with a mutation in the gene encoding Fas. RESULTS Control of the intermediate uveitis required sustained doses of topical and periocular corticosteroids as well as systemic cyclosporine. The serum IL-10 level was elevated, as commonly seen in ALPS, but the aqueous IL-10 was not. CONCLUSIONS Despite a Th2 immune predominance in ALPS, uveitis, a Th1-mediated disease, may still manifest in these patients. The pathogenesis of uveitis in ALPS may differ from that of the systemic disease overall. Long-term follow-up is required for patients with uveitis associated with ALPS.
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Affiliation(s)
- Wee-Kiak Lim
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1857, USA
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Reinthal EK, Völker M, Freudenthaler N, Grüb M, Zierhut M, Schlote T. Die optische Koh�renztomographie (OCT) als Diagnose- und Verlaufsparameter bei uveitisbedingtem Makula�dem. Ophthalmologe 2004; 101:1181-8. [PMID: 15156343 DOI: 10.1007/s00347-004-0996-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 10/26/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a relatively new, noninvasive method and has been well established as an effective diagnostic procedure for the investigation of several macular diseases. Knowledge about the efficacy of OCT in the diagnosis and follow-up of macular edema in uveitis patients is still limited. PATIENTS AND METHODS In the first part of the study, OCT was performed in 22 eyes of 18 patients with anterior or intermediate uveitis who showed angiographic and fundoscopic evidence of macular edema. The OCT results were compared with the visual acuity and fundoscopic and angiographic appearance of macular edema. In the second part of the study, the same patients were followed over a period of approximately 5 months (+/-2 months) and OCT was repeated at different time points during treatment of uveitic macula edema. RESULTS OCT investigation also showed clear evidence of macular edema in all eyes and was not compromised by a low or medium degree of optical haze. Furthermore, OCT investigation revealed marked differences in the individual degree of macular edema (foveal heights 168-810 microm). Diffuse macular edema ( n = 4 ) and different types of cystoid macular edema (several distinguished cysts n = 6, partially or completely confluent cysts n = 11, one marked cyst n = 1) were observed. During the follow-up of the patients, OCT results, visual acuity, and fundoscopic appearance of the macula showed a comparable behavior. In some eyes, a stable visual acuity was accompanied by changes of foveal edema demonstrated by OCT. CONCLUSION Optical coherence tomography is a safe and highly effective method in the diagnosis of macular edema in uveitis associated with low or medium haze of the optical media. Furthermore, OCT investigation seems to be useful in the follow-up of uveitic macular edema under treatment.
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Kodjikian L, Seve P, Le Hoang P, Garweg JG. Atypical Vogt-Koyanagi-Harada disease or new uveomeningitic syndrome? Graefes Arch Clin Exp Ophthalmol 2004; 243:263-5. [PMID: 15378380 DOI: 10.1007/s00417-004-1002-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Revised: 07/01/2004] [Accepted: 07/09/2004] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To report on a patient affected by bilateral intermediate uveitis (IU) as the initial sign of an uveomeningitic syndrome. METHODS Thorough history, physical examination and ancillary laboratory and radiological testing were performed in this observational case study. RESULTS A 23-year-old Caucasian man developed bilateral IU, primarily diagnosed as "idiopathic" since a detailed etiologic work-up was not indicative of underlying disease. Seven months later, he presented with poliosis and vitiligo. Lumbar puncture revealed cerebrospinal fluid pleocytosis. Optical coherence tomography showed bilateral subclinical macular edema (ME). The visual acuity was still 20/20 in both eyes. Clinical, laboratory and radiological results did not fit into any known syndrome. CONCLUSIONS According to all the tests performed, the disease in our patient is a uveomeningitic disease with IU and ME which could be interpreted as an atypical form of Vogt-Koyanagi-Harada disease or a new uveomeningitic syndrome because there is no evidence for any other known disease.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, University Hospital, Bern, Switzerland.
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Román E, Zamora I, Vera F. [Mesangial glomerulonephritis and intermediate uveitis]. Nefrologia 2004; 24:489-92. [PMID: 15648908] [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: 05/01/2023] Open
Abstract
Uveitis in children are less frequent than in adults. Their prognosis is variable because it may be found as an isolated and idiophatic condition or in association with definite clinical entities. The associated noninfectious diseases with predominantly renal involvement are tubulointerstitial nephritis and uveitis syndrome (TINU syndrome), mesangial glomerulonephritis isolated or in association with Behçet's disease. A case of 14-years-old girl with intermediate uveitis (pars planitis) and mesangial glomerulonephritis is presented. The ocular symptoms was eye redness and ocular pain and she has snow-banks in pars plana. She showed microscopic hematuria and intermitent proteinuria that increased during the ocular clinical exacerbation. Renal biopsy revealed both mild mesangial matrix increase and mesangial celullarity with normal tubulointerstitial structure and mesangial deposition of IgA and IgG immunoglobulins. This case is de first pediatric patient report in the literature with intermediate uveitis and mesangial glomerulonephritis with immune deposition. Mesangial glomerulonephritis were observed in patients whit Behçet disease, known etiological cause of uveitis in adults and children. These findings may suggest that uveitis and glomerulonephritis have common immunological pathogenesis including circulatory immune complexes. In uveitis patients, screening for associated extra-ocular and renal manifestations is mandatory and should have careful long-term follow-up with regular systemic evaluation.
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Affiliation(s)
- E Román
- Servicio de Pediatría Hs Orihuela, Hospital Infantil La Fe.
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Abstract
We present a case of bilateral dislocation of in-the-bag intraocular lenses (IOLs) in a patient with intermediate uveitis. The IOLs dislocated into the vitreous cavity 24 and 41 months postoperatively. A complete pars plana vitrectomy with sutured posterior chamber IOL implantation was performed after each dislocation. The final visual acuity was 20/20(-) in each eye.
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Affiliation(s)
- Harilaos S Brilakis
- Georgetown University Hospital, Department of Ophthalmology, Washington, DC, USA.
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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.
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Affiliation(s)
- B van Kooij
- Department of Ophthalmology, FC Donders Institute, University Hospital Utrecht, The Netherlands.
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Abstract
OBJECTIVE To describe the effect of pars plana vitrectomy in patients with intermediate uveitis. METHODS Retrospective analysis of the clinical course and visual outcome following pars plana vitrectomy in patients with intermediate uveitis. RESULTS Thirty-two patients (43 eyes) were included in the study. Pars plana vitrectomy was combined with cataract surgery in 22 of 43 eyes. The intermediate uveitis was associated with sarcoidosis in 16 eyes and multiple sclerosis in five eyes, and was idiopathic in 22 eyes. The mean (+/-SD) follow-up was 45.6 (+/-38) months (range: 6-146 months). In 19 of 43 eyes (44.1%), there was improvement in the course of uveitis, allowing the discontinuation of immunosuppressive treatment in seven patients. Cystoid macular edema resolved in 12 of 37 eyes (32.4%). Forty of 43 eyes achieved a better or retained their initial visual acuity. The remaining three eyes deteriorated by two or more lines in the Snellen chart due to the progression of cataract, chronic cystoid macular edema, and glaucomatous optic atrophy, respectively. CONCLUSIONS The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the course of uveitis and the associated complications of cystoid macular edema, thereby reducing the need for long-term immunosuppression. Pars plana vitrectomy combined with simultaneous cataract surgery can improve the visual outcome in these patients.
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Affiliation(s)
- P Stavrou
- Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Abstract
BACKGROUND Cystoid macular edema (CME) is a common complication in the course of intermediate uveitis. In spite of systemic therapy with steroids or carbonic anhydrase inhibitors, persistence of CME is observed. Pars plana vitrectomy (PPV) is known to influence the course of intermediate uveitis positively. The present study was performed to investigate the role of PPV in the therapy of CME in intermediate uveitis. MATERIALS AND METHODS Forty-two eyes of 32 patients were re-examined after PPV for CME. In all eyes fluorescein angiography was performed. Average age at the time of surgery was 31.9 years (range 6-64 years). All patients had received systemic corticosteroid and/or immunosuppressive treatment during the course of their disease. In some patients systemic therapy with carbonic anhydrase inhibitors was performed. The mean duration of postoperative follow-up was 20.2 months (range 6-102 months). RESULTS Preoperative visual acuity (VA) in all eyes was between 1/10 and 0.5. Total regression of CME after surgery was observed in 18 of 42 eyes (42.8%), partial improvement in 7 eyes (16.7%). In 13 of 42 eyes (30.9%) the CME remained unchanged. Twenty-one of 42 eyes (50.0%) experienced a postoperative improvement of VA of 2 lines or more. In 18 of 42 eyes (42.8%) there was no change; in 3 eyes (7.2%) VA was less. In the long-term follow-up the corresponding results were slightly worse (17/17/8 eyes) due to secondary complications. In the majority of patients systemic medical therapy could be reduced or discontinued. CONCLUSION Pars-plana vitrectomy led to regression of CME in 59% of cases and to subsequent improvement of VA in 50% of eyes with intermediate uveitis. PPV should be considered soon after medical therapy has been shown to be ineffective.
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Affiliation(s)
- B Wiechens
- Department of Ophthalmology, Universitäsklinikum Kiel, Germany.
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Abstract
PURPOSE To report the safety and efficacy of intravitreal triamcinolone in the treatment of inflammatory cystoid macular oedema (CMO) in six patients who were resistant to other forms of therapy. METHODS An open-label unmasked prospective nonrandomized pilot study of six patients with idiopathic uveitis and visually significant macular oedema, resistant to periocular and/or systemic corticosteroid treatment, was carried out. Baseline examination and investigations were performed, including fundus fluorescein angiography, and the patients were given a single intravitreal injection of triamcinolone (4 mg/0.1 mL). The primary outcome measure was angiographic resolution of CMO. Patients were reviewed at intervals of 2-4 weeks for 12 months. RESULTS A single intravitreal injection of triamcinolone induced clinical and angiographic resolution of inflammatory macular oedema in all patients for varying periods of time up to 6 months. Five patients experienced increased intraocular pressure to 30 mmHg or greater which required treatment. Two patients developed posterior subcapsular cataract. CONCLUSION One injection of intravitreal triamcinolone was an effective short-term treatment for resistant CMO in uveitis. As with steroids given by other routes, raised intraocular pressure and cataract may occur. As it was so effective in these eyes with resistant CMO, a larger study is warranted to evaluate this form of therapy.
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Affiliation(s)
- S Young
- Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, London, UK
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Abstract
PURPOSE To evaluate optical coherence tomography in allergy-prone uveitis patients. METHODS Thirty-four patients (43 eyes) with posterior uveitis (31 eyes) and intermediate uveitis (12 eyes) were evaluated by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Follow-up examinations used optical coherence tomography in allergy-prone patients. RESULTS Optical coherence tomography identified epiretinal membranes, which were removed surgically (three eyes); persistent cystoid macular edema, which resolved with cytotoxic treatment (12 eyes); and juxtafoveolar membranes, which were treated by diode laser (six eyes) and excision (two eyes). CONCLUSION Optical coherence tomography may provide useful information on complications developing in uveitis patients.
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Abstract
PURPOSE To determine the efficacy of medical treatment of cystoid macular edema (CME) in patients with uveitis. METHODS Retrospective study of 40 patients (57 eyes) with uveitis and CME. Inclusion criteria were presence of CME with minimal and no macular pathology, or vascular disease which could account for CME. Patients who had undergone intraocular surgery or had visual acuity (VA) of > or = 20/40 were excluded. The diagnosis of CME was based on clinical and/or angiographic findings. Three treatment groups were defined: (1) transseptal injection of steroids (n=13 eyes); (2) systemic non steroidal anti-inflammatory drugs (NSAIDs) (n=11 eyes); both 1 and 2 (n=33 eyes). RESULTS Overall, 79% of eyes improved 3 or more lines of Snellen VA after treatment: 51% improved 4 or more lines. The average number of lines improved was 3.8 for eyes treated with transseptal injections of steroids, 2.9 for eyes treated with NSAIDs, and 4 for eyes treated with both. For all 3 treatment groups between 60-70% of eyes improving 2 or more lines reached best VA only after a minimum of 6 months of follow up. CONCLUSIONS CME, a vision threatening complication of uveitis, respond fairly well to medical treatment; however, the best VA is achieved after several months. The improvement in VA did not differ markedly among the three treatment groups.
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MESH Headings
- Adolescent
- Adult
- Aged
- Anterior Chamber/pathology
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Carbonic Anhydrase Inhibitors/administration & dosage
- Carbonic Anhydrase Inhibitors/therapeutic use
- Child
- Drug Administration Routes
- Drug Therapy, Combination
- Female
- Fluorescein Angiography
- Fundus Oculi
- Glucocorticoids/administration & dosage
- Glucocorticoids/therapeutic use
- Humans
- Macula Lutea/pathology
- Macular Edema/complications
- Macular Edema/diagnosis
- Macular Edema/drug therapy
- Male
- Middle Aged
- Recurrence
- Retrospective Studies
- Uveitis, Anterior/complications
- Uveitis, Anterior/diagnosis
- Uveitis, Anterior/drug therapy
- Uveitis, Intermediate/complications
- Uveitis, Intermediate/diagnosis
- Uveitis, Intermediate/drug therapy
- Uveitis, Posterior/complications
- Uveitis, Posterior/diagnosis
- Uveitis, Posterior/drug therapy
- Visual Acuity
- Vitreous Body/pathology
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Affiliation(s)
- B Rojas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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McCluskey P, Forrester J, Lightman S. Uniocular macular oedema and reduced vision in a patient with uveitis. Clin Exp Ophthalmol 2000; 28:9-12. [PMID: 11345355 DOI: 10.1046/j.1442-9071.2000.00267.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P McCluskey
- Department of Ophthalmology, St Vincent's Hospital, Sydney, New South Wales, Australia
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50
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Sulkes DJ, Ip MS, Baumal CR, Wu HK, Puliafito CA. Spontaneous resolution of vitreomacular traction documented by optical coherence tomography. Arch Ophthalmol 2000; 118:286-7. [PMID: 10676801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- D J Sulkes
- New England Eye Center, Boston, MA 02111, USA
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