1
|
Response to Acthar Gel in sarcoidosis uveitis: A prospective open label study. Respir Med 2023; 219:107422. [PMID: 37827293 DOI: 10.1016/j.rmed.2023.107422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To investigate the response to Acthar Gel® in patients with moderate to severe sarcoidosis uveitis. METHODS This is a prospective open-label study that enrolled patients with moderate to severe sarcoidosis uveitis to receive 80 units daily of Acthar Gel for ten days followed by maintenance treatment with 80 units twice weekly. The primary outcome was the proportion of patients meeting at least one of the following variables 1) improved visual acuity, 2) resolution of intraocular inflammation, 3) ability to taper ocular or oral steroids by at least 50% or 4) reduction of cystoid macular edema, with no worsening of any single measure and no need for additional sarcoidosis therapies at 24 weeks. RESULTS A total of nine patients were enrolled in the study. Four patients completed the full 24-week course of Acthar Gel, and three of these met the primary endpoint. Among the five patients who did not complete the 24-week course of treatment, four discontinued the treatment due to worsening ocular inflammation. One patient discontinued treatment due to severe adverse effects. The most common adverse effects were fluid retention (77%), insomnia (44%), hypertension (44%) and hyperglycemia (44%). CONCLUSIONS We observed a clinical response to Acthar Gel in some patients with moderate to severe sarcoidosis uveitis, but a substantial proportion either failed to respond or did not tolerate the therapy. These observations may serve as preliminary data for controlled trials of Acthar Gel, but they do not support its role prior to failure of other agents.
Collapse
|
2
|
Relentless placoid chorioretinitis: A review of four cases in pediatric and young adult patients with a discussion of therapeutic strategies. Front Pediatr 2023; 11:885230. [PMID: 37051435 PMCID: PMC10083237 DOI: 10.3389/fped.2023.885230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
Introduction Relentless placoid chorioretinitis (RPC) is a rare, bilateral disease of the retinal pigment epithelium. The clinical course is prolonged and relapsing. No standard treatment has been established to date. The purpose of this case series is to report four cases of RPC in pediatric and young adult patients in which varying treatments were used, comparing them to previously published cases. Methods A literature review was conducted to investigate currently published presentations and treatment options for RPC. A multicenter retrospective chart review was also performed on four consecutive patients. These patients were diagnosed with RPC because of new chorioretinitis lesions continuing to appear without or despite therapy for 5-36 months (2 patients), with a clinical course prolonged and relapsing, or because of the atypical location of the multiple lesions (>50) extending from the posterior pole to the equator and mid-peripheral retina (all four patients), which were not consistent with other entities like acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. Results All four cases of RPC received oral or IV steroids acutely, and three of these patients were transitioned to a steroid-sparing agent and biologic therapy: anti-TNF alpha or anti-IL-6. Quiescence of the chorioretinitis lesions was obtained after 7 months, 1 month, and 36 months; however, the latter had issues with treatment adherence. Mycophenolate mofetil was insufficient to control the disease in one patient, but tocilizumab and infliximab thereafter were effective after cessation of adalimumab due to side effects. Adalimumab when started the first month after the presentation was effective in controlling the disease in one patient. After the failure of interferon-alpha-2a, one patient displayed long-term control with infliximab. One patient did not require a steroid-sparing agent after oral prednisone taper as there was no evidence of progression or recurrence. Conclusion This case series adds to the current knowledge regarding potential treatments for RPC, specifically the use of anti-TNF-alpha treatment and anti-IL-6 tocilizumab. In this case study, relapses of RPC were found among patients on mycophenolate mofetil and interferon-alpha-2a, and one case did not relapse on oral steroids without a steroid-sparing agent. Our findings suggest that adalimumab, infliximab, and tocilizumab may be useful medications to obtain quiescence of RPC.
Collapse
|
3
|
Ophthalmic Manifestations of Hodgkin Lymphoma: A Review. Ocul Oncol Pathol 2022; 7:381-389. [PMID: 35087814 DOI: 10.1159/000519032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells. In contrast to ophthalmic manifestations by non-HL that are well recognized, there is paucity of the literature as it relates to ophthalmic manifestation by HL. We performed a comprehensive review of published studies (case reports and small case series) to characterize the ophthalmic manifestations of HL. Summary Thirty patients were identified with ophthalmic manifestation of HL. Thirteen (43%) were male, and 14 (46%) were female (in 3 cases, sex was not specified). The median age at ophthalmic presentation was 27 years. Diagnosis of HL was made after ophthalmic manifestation in 10 (33%) cases, whereas 11 (36%) cases had a prior diagnosis of HL. Ophthalmic manifestations can be classified into 3 main groups; direct infiltration, inflammatory reaction, and paraneoplastic process. Seven cases had infiltration of the optic nerve. Uveal inflammatory reaction was reported in 21 cases. The presence of intraocular Reed-Sternberg cells had been confirmed in 1 case with granulomatous uveitis. Conjunctival and corneal reaction was seen in 3 cases. HL was in stage 2 or higher, with only 1 case with stage 1A (12 cases HL stage not specified). Seven cases (22%) died of HD, all were diagnosed with advanced lymphoma, and none was treated with chemotherapy. Key Message Ocular involvement in HL is extremely rare. A few cases of histopathologically confirmed optic nerve/tract infiltration are within the spectrum of CNS involvement by HL. Inflammatory uveitis is the most common ophthalmic association of HL. In the presence of prior known diagnosis of HL, restaging should be considered to exclude recurrence. Toxicity or adverse reaction to drugs used to treat HL may also contribute to ophthalmic involvement.
Collapse
|
4
|
The Collaborative Ocular Tuberculosis Study (COTS) Consensus (CON) Group Meeting Proceedings. Ocul Immunol Inflamm 2020; 28:85-95. [PMID: 32250731 DOI: 10.1080/09273948.2020.1716025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB.
Collapse
|
5
|
Standardization of Nomenclature for Ocular Tuberculosis – Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop. Ocul Immunol Inflamm 2019; 28:74-84. [DOI: 10.1080/09273948.2019.1653933] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
6
|
Local therapy for cancer therapy-associated uveitis: a case series and review of the literature. Br J Ophthalmol 2019; 104:703-711. [PMID: 31409649 DOI: 10.1136/bjophthalmol-2019-314403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/09/2019] [Accepted: 08/08/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS Immunotherapy and targeted therapy for metastatic cancer may cause immune-related adverse events (irAEs) such as uveitis. If irAEs are severe or require systemic steroids, cancer therapy is often held or discontinued. Local steroid therapy for cancer therapy-associated uveitis allows the continuation of cancer therapy. This series demonstrates successful management of cancer therapy-associated uveitis with local therapy based on uveitis subtype. METHODS This is an Institutional Review Board-approved retrospective case series of patients with uveitis secondary to immunotherapy or targeted therapy managed with local treatment, and focused literature review. RESULTS Five patients (median age: 54, range 31 to 75) were included. Time to uveitis onset following cancer therapy initiation was 3 to 12 months. All patients received checkpoint inhibitor therapy; one patient additionally received targeted therapy. Two patients presented with anterior uveitis, two with panuveitis and one with posterior uveitis. Four of five patients demonstrated evidence of posterior segment inflammation on multimodal imaging. Anterior uveitis was successfully treated with topical prednisolone acetate 1% (PA 1%) alone, and posterior segment involvement recalcitrant to topical PA 1% was treated successfully with topical difluprednate, intravitreal triamcinolone acetonide or a combination. Patients with isolated anterior uveitis did not require maintenance topical therapy; those with posterior and panuveitis required chronic low-dose topical therapy. CONCLUSION Based on our series as well as the existing literature demonstrating the use of local therapy for irAEs, we propose an approach to local therapy for cancer therapy-associated uveitis starting with topical steroids and initiating injectable steroids in cases of recalcitrant panuveitis or posterior uveitis. Subclinical inflammation on posterior segment imaging responds robustly to difluprednate or intravitreal steroid therapy, and patients with posterior segment involvement may require more aggressive management and long-term maintenance.
Collapse
|
7
|
MUST Beg to Differ. Ophthalmic Surg Lasers Imaging Retina 2019; 50:266-268. [DOI: 10.3928/23258160-20190503-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 03/27/2019] [Indexed: 11/20/2022]
|
8
|
Forward Modeling of Coronal Mass Ejection Flux Ropes in the Inner Heliosphere with 3DCORE. SPACE WEATHER : THE INTERNATIONAL JOURNAL OF RESEARCH & APPLICATIONS 2018; 16:216-229. [PMID: 29780287 PMCID: PMC5947730 DOI: 10.1002/2017sw001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/20/2017] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
Forecasting the geomagnetic effects of solar storms, known as coronal mass ejections (CMEs), is currently severely limited by our inability to predict the magnetic field configuration in the CME magnetic core and by observational effects of a single spacecraft trajectory through its 3-D structure. CME magnetic flux ropes can lead to continuous forcing of the energy input to the Earth's magnetosphere by strong and steady southward-pointing magnetic fields. Here we demonstrate in a proof-of-concept way a new approach to predict the southward field B z in a CME flux rope. It combines a novel semiempirical model of CME flux rope magnetic fields (Three-Dimensional Coronal ROpe Ejection) with solar observations and in situ magnetic field data from along the Sun-Earth line. These are provided here by the MESSENGER spacecraft for a CME event on 9-13 July 2013. Three-Dimensional Coronal ROpe Ejection is the first such model that contains the interplanetary propagation and evolution of a 3-D flux rope magnetic field, the observation by a synthetic spacecraft, and the prediction of an index of geomagnetic activity. A counterclockwise rotation of the left-handed erupting CME flux rope in the corona of 30° and a deflection angle of 20° is evident from comparison of solar and coronal observations. The calculated Dst matches reasonably the observed Dst minimum and its time evolution, but the results are highly sensitive to the CME axis orientation. We discuss assumptions and limitations of the method prototype and its potential for real time space weather forecasting and heliospheric data interpretation.
Collapse
|
9
|
Acute Retinal Necrosis Secondary to Varicella Zoster Infection in a Immunocompromised Patient Post Lung Transplantation. Chest 2017. [DOI: 10.1016/j.chest.2017.08.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
10
|
Fear of the correct treatment dose. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.01536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Local steroidal treatments: what's new. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
12
|
Flashes, Floaters, and an Unfamiliar Fundus. JAMA Ophthalmol 2016; 134:595-596. [DOI: 10.1001/jamaophthalmol.2015.3655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
13
|
Controversies in intraocular lens implantation in pediatric uveitis. J Ophthalmic Inflamm Infect 2016; 6:12. [PMID: 27009616 PMCID: PMC4805676 DOI: 10.1186/s12348-016-0079-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/13/2016] [Indexed: 11/10/2022] Open
Abstract
Cataract is one of the most common and visually debilitating complications of pediatric uveitis. It develops as a consequence of chronic inflammation and steroid use and is seen most often in juvenile idiopathic arthritis (JIA)-associated uveitis. Cataract extraction with intraocular lens (IOL) insertion has been carried out with a measure of success in non-uveitic pediatric eyes, but in cases of uveitis, multiple factors affect the final outcome. Chronic inflammation and its sequelae such as band keratopathy, posterior synechiae, and cyclitic membranes make surgical intervention more challenging and outcome less certain. Postoperative complications like increased inflammation, glaucoma, posterior capsular opacification, retrolental membranes, and hypotony may compromise the visual outcome. Early refractive correction is imperative in pediatric eyes to prevent amblyopia. The use of contact lenses and intraocular lenses in pediatric uveitic eyes were fraught with complications in the past. Surgical interventions such as vitreo-lensectomy followed by contact lens fitting and small incision cataract surgery followed by different types of intraocular lenses have been utilized, and many reports have been published, albeit in small patient groups. This review analyzes and discusses the existing literature on intraocular lens implantation in cases of pediatric uveitic cataract surgery.
Collapse
|
14
|
|
15
|
Vision-Related Functioning Outcomes of Dexamethasone Intravitreal Implant in Noninfectious Intermediate or Posterior Uveitis. ACTA ACUST UNITED AC 2013; 54:4864-70. [DOI: 10.1167/iovs.12-10981] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Normative Comparison of Patient-Reported Outcomes in Patients With Noninfectious Uveitis. JAMA Ophthalmol 2013; 131:219-25. [DOI: 10.1001/2013.jamaophthalmol.102] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
17
|
Abstract
PURPOSE To quantify cells in the ocular anterior chamber (AC) by optical coherence tomography (OCT). METHODS A time-domain anterior segment OCT system was used to image latex microsphere suspensions in vitro and the AC of uveitis and normal subjects in vivo. The OCT scan pattern, consisting of 2- and 4-mm-diameter concentric circular scans, was divided into central, superior, and inferior regions. A computer algorithm was developed to automatically identify particles in OCT images. A uveitis specialist used slit-lamp biomicroscopy to grade the AC cells on a scale of 0 to 4+. RESULTS Latex microspheres and ac cells were visualized as reflective spots in oct images. OCT latex microsphere concentration measurements were highly correlated to known particle concentrations (r = 1.000) and had an efficiency of 0.72. in 30 nongranulomatous and 12 granulomatous eyes, the OCT cell counts correlated well with slit-lamp grades in all three regions (Spearman's rho coefficient: >0.63). The average OCT cell count was 3.7 cells/grade in nongranulomatous eyes and 2.0 cells/grade in granulomatous eyes. OCT revealed significant amounts of inferior AC cells in 5 of 16 quiescent uveitis eyes (mean ± SD: 19.9 ± 7.4 cells). OCT captured rare cells in normal eyes (1.1 ± 1.1 cells centrally). CONCLUSIONS OCT provided quantitative information on AC inflammatory cells. The OCT cell counts correlated well with clinical grading, and particles in the inferior AC that were missed by slit-lamp examination were detected by OCT. OCT could be a valuable tool for the diagnosis and management of anterior uveitis.
Collapse
|
18
|
Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. ACTA ACUST UNITED AC 2011; 129:545-53. [PMID: 21220619 DOI: 10.1001/archophthalmol.2010.339] [Citation(s) in RCA: 474] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of 2 doses of dexamethasone intravitreal implant (DEX implant) for treatment of noninfectious intermediate or posterior uveitis. METHODS In this 26-week trial, eyes with noninfectious intermediate or posterior uveitis were randomized to a single treatment with a 0.7-mg DEX implant (n = 77), 0.35-mg DEX implant (n = 76), or sham procedure (n = 76). MAIN OUTCOME MEASURE The main outcome measure was the proportion of eyes with a vitreous haze score of 0 at week 8. RESULTS The proportion of eyes with a vitreous haze score of 0 at week 8 was 47% with the 0.7-mg DEX implant, 36% with the 0.35-mg DEX implant, and 12% with the sham (P < .001); this benefit persisted through week 26. A gain of 15 or more letters from baseline best-corrected visual acuity was seen in significantly more eyes in the DEX implant groups than the sham group at all study visits. The percentage of eyes with intraocular pressure of 25 mm Hg or more peaked at 7.1% for the 0.7-mg DEX implant, 8.7% for the 0.35-mg DEX implant, and 4.2% for the sham (P > .05 at any visit). The incidence of cataract reported in the phakic eyes was 9 of 62 (15%) with the 0.7-mg DEX implant, 6 of 51 (12%) with the 0.35-mg DEX implant, and 4 of 55 (7%) with the sham (P > .05). CONCLUSIONS In patients with noninfectious intermediate or posterior uveitis, a single DEX implant significantly improved intraocular inflammation and visual acuity persisting for 6 months. Application to Clinical Practice Dexamethasone intravitreal implant may be used safely and effectively for treatment of intermediate and posterior uveitis. Trial Registration clinicaltrials.gov Identifier: NCT00333814.
Collapse
|
19
|
[The relationship between the length of ciliary processes as measured by ultrasound biomicroscopy and the duration, localization and severity of uveitis]. Arq Bras Oftalmol 2007; 69:383-8. [PMID: 16936963 DOI: 10.1590/s0004-27492006000300018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 01/10/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine the relationship between the length of ciliary processes as measured by ultrasound biomicroscopy and the duration, localization and severity of uveitis. METHODS We analyzed in this prospective study, 58 individuals including patients with different stages of uveitis and normal patients (112 eyes including 18 normal), between August 2001 and August 2002, at the Cleveland Clinic Foundation, Ohio, USA. All patients were referred to ultrasound biomicroscopy by the Uveitis Department, after a complete ophthalmological examination. A 50 MHz-transducer UBM model 840 (Zeiss-Humphrey) was used under topical anesthesia and immersion technique. RESULTS The most frequent etiology was idiophatic uveitis (27.8%). Recurrent, aggressive and diffuse uveitis lead to significant damage of the ciliary processes. The most significant loss of the ciliary processes was found in the inferior quadrant and the highest in normal patients and in the temporal quadrant. Hypotonic eyes have their ciliary processes reduced. CONCLUSIONS Ultrasound biomicroscopy has proved to be useful in evaluating anatomical changes of ciliary processes in uveitis and in ocular hypotony, and provides a basis to, make recommendations regarding baseline screening of uveitis patients. Patients who are found to have atrophy of the ciliary processes may need a more aggressive treatment for any signs of inflammation to prevent further damage and eventual hypotony.
Collapse
|
20
|
Abstract
Uveitis is an inflammatory process that may affect one or several specific areas of the eye. But when a patient presents to an internist with eye symptoms, be it photophobia, "floaters," or red eye, the diagnosis is not always clear. If the diagnosis of uveitis is made, internists must search for an underlying cause, such as infection or an autoimmune disease.
Collapse
|
21
|
Abstract
PURPOSE Ocular side effects attributable to intravenous fluorescein dye are not well characterized. The purpose of this report was to describe three patients with an unusual ocular reaction after the intravenous administration of fluorescein dye. METHODS Retrospective review of the clinical and photographic records of three patients. RESULTS Each patient had some type of preexisting ocular inflammatory disease. Each patient described the subacute onset of a unilateral burning sensation and tearing several minutes after the administration of intravenous fluorescein dye. Findings included a new onset of or a worsening of unilateral conjunctival chemosis and injection in all three patients and yellowish discoloration of the conjunctiva in two patients. In each patient, the noninflamed (fellow) eye did not develop any symptoms or show any visible reaction. The symptoms and findings resolved promptly in the affected eye without specific treatment or effect on vision. CONCLUSIONS Ocular side effects of intravenous fluorescein dye can include transient symptomatic burning and tearing associated with conjunctival chemosis, injection, and yellowish discoloration. Eyes with active inflammatory diseases may be predisposed to this rare effect through an unclear mechanism.
Collapse
|
22
|
|
23
|
Abstract
PURPOSE To describe an unusual and possibly new keratopathy in human immunodeficiency virus (HIV)-positive patients. DESIGN Retrospective observational case series. PARTICIPANTS : Six HIV-positive patients at four centers. METHODS A complete medical history was obtained and a thorough ophthalmic examination was performed on each of the patients. RESULTS Each patient had bilaterally symmetrical keratopathy consisting of variably pigmented round and reticular posterior intracorneal precipitates at the level of Descemet's membrane. The precipitates were diffuse, but larger and more prominent near the limbus and finer toward the central cornea. None of the eyes were inflamed, and all had normal vision. No patient had uveitis on presentation or any history of cytomegalovirus retinitis. CONCLUSION These patients have a unique posterior keratopathy, which requires further investigation.
Collapse
|
24
|
Abstract
PURPOSE To delineate the clinical features, course, complications, and associated systemic diseases in patients with HLA-B27-associated uveitis. METHODS We reviewed the records of 148 patients with HLA-B27-associated uveitis from two large uveitis practices. RESULTS There were 127 (86%) white and 21 (14%) nonwhite patients, and a male-to-female ratio of 1.5:1. The median age at onset of uveitis was 32 years; eight patients (5%) had their first attack after age 55 years. Acute anterior uveitis was noted in 129 patients (87%), and nonacute inflammation was noted in 19 (13%). Ocular involvement was categorized as unilateral or unilateral alternating in 138 patients (93%), but ten patients (7%) had bilateral, concurrent disease. The median duration of an attack was six weeks, and the median number of recurrences for patients with more than 12 months of follow-up was three. Cataracts were associated with posterior synechiae (P = .03), increased intraocular pressure (P = .003), and cystoid macular edema (P = .04). An HLA-B27-associated systemic disorder was present in 83 patients (58%), 30 of whom were women, and it was diagnosed in 43 of the 83 patients as a result of the ophthalmologic consultation. Thirty-four (30%) of 112 patients had a family history of a spondyloarthropathy. CONCLUSIONS Although HLA-B27-associated uveitis is usually described as a disease of young white men, women and nonwhites may also be affected. A subgroup of patients have severe disease and consequently more complications. Most patients have an associated systemic disease, including women, who appear to have more atypical spondyloarthropathies. The systemic diseases were frequently undiagnosed before the onset of the ocular disease and before the uveitis consultation.
Collapse
|
25
|
Use of computer network bulletin board systems by disabled persons. PROCEEDINGS. SYMPOSIUM ON COMPUTER APPLICATIONS IN MEDICAL CARE 1992:151-5. [PMID: 1482858 PMCID: PMC2248003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Computer-based electronic support groups are being used by persons facing physical and emotional challenges. Twenty-six users of disability-related electronic support groups responded to a survey designed to determine computer network use and benefits users gain through their network use. The survey included questions about network use for general communication and support, enhancement of communication ability, attainment of knowledge on specific topics, and employment enhancement. Statistically significant results were obtained concerning the perceived benefits of emotional support and communication in relation to network use. Only a small number (n = 9) reported use of the network for employment purposes. These results demonstrate the feasibility of using networks to provide information, services, assistance, and support for disabled and their care providers.
Collapse
|
26
|
Clinical features of Behçet's disease. Report of four cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 72:30-4. [PMID: 1891242 DOI: 10.1016/0030-4220(91)90185-f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Behçet's disease is a multisystem inflammatory disorder of unknown etiology. The unifying histologic reaction pattern is a leukocytoclastic vasculitis that affects predominantly the skin, oral mucosa, and eyes. Many other sites of involvement have been reported but are inconsistently found in individual patients. Early recognition and treatment of Behçet's disease may help prevent devastating permanent sequelae such as blindness. Because oral involvement is often the first manifestation of this disorder, dental practitioners are in a unique position to help these patients. We report four cases of Behçet's disease in North American patients. Diagnostic criteria and treatment options are reviewed.
Collapse
|