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Journal Francais D'ophtalmologie Jun 2017Vogt-Koyanagi-Harada (VKH) disease is defined as a severe bilateral, chronic granulomatous panuveitis associated with serous retinal detachments, disk edema, and... (Review)
Review
Vogt-Koyanagi-Harada (VKH) disease is defined as a severe bilateral, chronic granulomatous panuveitis associated with serous retinal detachments, disk edema, and vitritis, with central nervous system, auditory, and integumentary manifestations. It is an autoimmune inflammatory condition mediated by T cells that target melanocytes in individuals genetically susceptible to the disease. Vogt-Koyanagi-Harada disease presents clinically in 4 different phases: prodromal, acute inflammatory, chronic, and recurrent, with extraocular manifestations including headache, meningitis, hearing loss, poliosis, and vitiligo. Optical coherence tomography (OCT) allows earlier diagnosis of VKH disease by revealing heterogeneous exudative detachments of the retina in the acute stage and choroidal thickening, and by demonstrating choroidal thinning in the chronic stage. Treatment of this disease is initially with intravenous corticosteroids, with, if needed, a transition to immunosuppressant drugs for long-term control. Patients with VKH disease can have good final visual outcomes if treated promptly and aggressively.
Topics: Diagnosis, Differential; Humans; Panuveitis; Prognosis; Retinal Detachment; Tomography, Optical Coherence; Uveomeningoencephalitic Syndrome
PubMed: 28579215
DOI: 10.1016/j.jfo.2017.02.006 -
Survey of Ophthalmology 2017Posner-Schlossman syndrome, or glaucomatocyclitic crisis, is a unilateral ocular condition characterized by recurrent attacks of nongranulomatous anterior uveitis and... (Review)
Review
Posner-Schlossman syndrome, or glaucomatocyclitic crisis, is a unilateral ocular condition characterized by recurrent attacks of nongranulomatous anterior uveitis and raised intraocular pressure that can result in chronic secondary glaucoma. This relatively rare disease is most likely the result of recurrent cytomegalovirus infection and affects predominantly middle-aged males. Diagnosis is largely clinical, with aqueous and blood sampling aiding the identification of any underlying infectious cause. Successful disease management is often achieved by topical treatment, although systemic therapy and even surgical intervention may be required. We discuss our current understanding of Posner-Schlossman syndrome, from its pathophysiology through to recommended treatment options.
Topics: Disease Management; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Iridocyclitis; Syndrome
PubMed: 28012873
DOI: 10.1016/j.survophthal.2016.12.005 -
Ocular Immunology and Inflammation Jun 2017Anterior uveitis is the most common group of uveitis worldwide, with a diverse spectrum ranging from autoimmune and infectious to masquerade etiologies. Elucidation of... (Review)
Review
Anterior uveitis is the most common group of uveitis worldwide, with a diverse spectrum ranging from autoimmune and infectious to masquerade etiologies. Elucidation of the underlying etiology may be challenging, but it remains important, especially for recurrent uveitis. Multimodal imaging has improved our understanding and management of many posterior uveitis and panuveitis. Similarly, a wide variety of anterior segment ophthalmic imaging techniques are available to allow the monitoring of the structural changes that may develop during anterior uveitis. These include anterior segment photography, specular microscopy, in vivo confocal microscopy, anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), laser flare photometry, and less commonly used techniques such as anterior segment fluorescein and indocyanine green angiography, iris autofluorescence, and infrared imaging. This review recapitulates the past and recent application of these ophthalmic imaging modalities to the diagnosis and management of anterior uveitis.
Topics: Diagnostic Techniques, Ophthalmological; Fluorescein Angiography; Humans; Microscopy, Acoustic; Multimodal Imaging; Optical Imaging; Tomography, Optical Coherence; Uveitis, Anterior
PubMed: 28696173
DOI: 10.1080/09273948.2017.1327601 -
American Journal of Ophthalmology Sep 2014To describe the clinical presentation of uveitis with coincident onset of raised and indurated tattooed skin.
PURPOSE
To describe the clinical presentation of uveitis with coincident onset of raised and indurated tattooed skin.
DESIGN
Case series.
METHODS
Seven consecutive patients were evaluated at a tertiary ophthalmologic facility with coincident uveitis and cutaneous tattoo induration over an 18-month period. All subjects underwent complete ophthalmic examination and a focused systemic medical evaluation including serologic testing and imaging studies. Two participants underwent biopsy of their tattoos. The patients' clinical courses and responses to treatment over a follow-up period of 1-20 months are reported (mean follow-up = 9 months). Main outcome measures included degree of intraocular inflammation, ocular complications, visual acuity, clinically observable tattooed skin changes, and biopsy results.
RESULTS
Five of 7 patients had bilateral nongranulomatous anterior uveitis: 4 with chronic and 1 with recurrent disease. The remaining 2 patients had bilateral chronic granulomatous panuveitis. Biopsies of raised and indurated tattoos were performed in 2 patients and demonstrated noncaseating granulomatous inflammation surrounding tattoo ink in the dermis. The skin changes resolved in all patients, with a faster response noted in those treated with high-dose oral prednisone for intraocular inflammation. Five patients subsequently experienced recurrent flares of intraocular inflammation in conjunction with the recurrence of raised and indurated tattoos.
CONCLUSIONS
These cases represent a subset of patients in whom skin tattooing may have incited an immune response leading to simultaneous inflammation of the eyes and tattooed skin.
Topics: Adult; Biopsy; Female; Fluocinolone Acetonide; Follow-Up Studies; Glucocorticoids; Humans; Male; Prognosis; Recurrence; Retrospective Studies; Skin; Tattooing; Uveitis, Anterior; Visual Acuity; Young Adult
PubMed: 24875002
DOI: 10.1016/j.ajo.2014.05.019 -
Der Ophthalmologe : Zeitschrift Der... Jul 2018Zoledronate-induced (Aclasta®) uveitis is a rare iatrogen-induced inflammation of ocular structures, which can result in substantial morphological and functional...
Zoledronate-induced (Aclasta®) uveitis is a rare iatrogen-induced inflammation of ocular structures, which can result in substantial morphological and functional limitations. This case report describes the clinical course of a female patient with zoledronate-induced panuveitis. Additionally, the diagnostic procedure, therapy and follow-up are presented.
Topics: Female; Glucocorticoids; Humans; Panuveitis; Zoledronic Acid
PubMed: 28748264
DOI: 10.1007/s00347-017-0538-3 -
Revista de La Facultad de Ciencias... Mar 2022To provide a complete picture and to improve understanding of the serpiginous-like choroiditis caused by Mycobacterium Tuberculosis. (Review)
Review
OBJECTIVE
To provide a complete picture and to improve understanding of the serpiginous-like choroiditis caused by Mycobacterium Tuberculosis.
MATERIALS AND METHODS
Literature review of serpiginous-like choroiditis. A number of scientific search engines were searched including Medline (PubMed), Scielo, and Cochrane Library. Using MeSH and DeCS terms.
RESULTS
107 articles were obtained, of which 44 met inclusion criteria.
DISCUSSION
serpiginous-like choroiditis is described as its etiology, pathogenesis, ocular findings, diagnosis, differential diagnosis and treatment.
CONCLUSIONS
Modern studies are needed to understand the pathophysiology, new diagnostic strategies, and future treatments of serpiginous-like choroiditis
Topics: Choroiditis; Diagnosis, Differential; Humans
PubMed: 35312256
DOI: 10.31053/1853.0605.v79.n1.32223 -
Current Opinion in Ophthalmology Nov 2014Birdshot chorioretinopathy remains incompletely understood, but new insights into its pathogenesis have been reported recently, and treatment and monitoring options have... (Review)
Review
PURPOSE OF REVIEW
Birdshot chorioretinopathy remains incompletely understood, but new insights into its pathogenesis have been reported recently, and treatment and monitoring options have also expanded. Central visual acuity may remain good until the late stages of the disease, but loss of visual field and peripheral retinal function is common.
RECENT FINDINGS
The underlying pathogenesis of the disease has long been believed to be T-cell driven, but examination of the IL-17 pathway has now further refined the potential underlying mechanism. New imaging techniques, including extended depth imaging of the choroid with optical coherence tomography, have demonstrated promise in detecting disease activity earlier, enabling targeted treatment to be given. Treatment options have expanded with the advent of the biological agents, and these may yet improve outcomes, particularly in refractory patients.
SUMMARY
Laboratory research continues to investigate the underlying mechanisms of disease, but our understanding remains frustratingly incomplete for a disease with such a clear HLA association. Clinical research is increasingly being driven to improve the phenotyping of affected patients so that those at risk of visual loss can be identified early and treated more aggressively with individually targeted therapies such as the newer biological agents, but how successful this approach will ultimately prove to be remains to be seen.
Topics: Birdshot Chorioretinopathy; Chorioretinitis; Fluorescein Angiography; Humans; Tomography, Optical Coherence; Visual Acuity; Visual Fields
PubMed: 25211040
DOI: 10.1097/ICU.0000000000000101 -
Ocular Immunology and Inflammation May 2023Sympathetic ophthalmia (SO) is rare, bilateral granulomatous panuveitis that typically occurs following penetrating or perforating ocular trauma or surgery. This review... (Review)
Review
INTRODUCTION
Sympathetic ophthalmia (SO) is rare, bilateral granulomatous panuveitis that typically occurs following penetrating or perforating ocular trauma or surgery. This review aims to provide an update on the etiopathogenesis, clinical presentations, diagnosis and treatment of SO.
METHODS
Reports cited in MEDLINE database, that analyzed SO in at least 5 patients, published prior to December 1st, 2021 were included.
RESULTS
Initially, SO was associated with penetrating ocular trauma, however, various studies reported an increased incidence of SO after surgical procedures including vitreoretinal surgeries. Multimodal imaging including fluorescein and indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography have added further insights into the understanding of SO. While pulse dose corticosteroids & immunosuppressive drugs are still the treatment of choice, TNF-α blockers & other biologic drugs represent new promising agents.
CONCLUSION
There is a growing pool of evidence in understanding the pathogenesis of SO. Novel treatment options have provided better prognosis for this potentially blinding condition.
Topics: Humans; Ophthalmia, Sympathetic; Immunosuppressive Agents; Immunologic Factors; Prognosis; Tomography, Optical Coherence; Eye Injuries; Fluorescein Angiography
PubMed: 35579612
DOI: 10.1080/09273948.2022.2058554 -
Journal Francais D'ophtalmologie Jun 2019Behçet's disease is a chronic multisystem disorder characterized by relapsing inflammation for which the underlying histopathology is an occlusive vasculitis. The... (Review)
Review
Behçet's disease is a chronic multisystem disorder characterized by relapsing inflammation for which the underlying histopathology is an occlusive vasculitis. The disease has a high prevalence in the Mediterranean region, Far and Middle Eastern countries. It is clinically characterized by oral and genital ulcerations, ocular inflammatory involvement, skin lesions, vascular involvement and numerous other systemic manifestations. Uveitis is by far the most common ocular manifestation of Behçet's disease. It typically presents in the form of relapsing-remitting panuveitis with retinal vasculitis that may result in severe visual loss. Management of Behçet's uveitis relies on corticosteroid therapy, conventional immunosuppressive drugs and biological agents and requires a close collaboration between ophthalmologist and internist. A better understanding of the auto-inflammatory process and of the role of cytokines implicated in the pathogenesis of Behçet's disease will enable researchers to develop more specific and effective therapy.
Topics: Adult; Age of Onset; Anterior Eye Segment; Behcet Syndrome; Biological Factors; Glucocorticoids; Humans; Immunosuppressive Agents; Posterior Eye Segment; Recurrence; Retinal Vasculitis; Uveitis; Vision Disorders
PubMed: 31164292
DOI: 10.1016/j.jfo.2018.09.027 -
Frontiers in Public Health 2023Cytomegalovirus anterior uveitis is the most common ocular inflammatory disease caused by cytomegalovirus infection. It mainly occurs in middle-aged males with competent... (Review)
Review
Cytomegalovirus anterior uveitis is the most common ocular inflammatory disease caused by cytomegalovirus infection. It mainly occurs in middle-aged males with competent immunologic function, and the incidence is higher in Asia. The clinical manifestations vary from Posner-Schlossman syndrome and corneal endotheliitis to Fuchs uveitis syndrome, and are often accompanied by intraocular hypertension. Secondary glaucoma is a potentially blinding ocular complication with a pathogenesis that includes complicated immunological factors, intraocular inflammation, different types of angle abnormalities, and the administration of steroids, which may result in physical discomfort and visual impairment. Diagnostic tests, such as the polymerase chain reaction, optical coherence tomography, ocular microscopy, and confocal microscopy, might help in identifying anterior uveitis caused by other viruses. Combinations of antiviral medications and anti-inflammatory agents are effective treatments. If pharmacological therapy cannot reduce intraocular pressure or slow the progression of glaucomatous optic neuropathy, surgical intervention is required as a last resort.
Topics: Male; Middle Aged; Humans; Cytomegalovirus; Glaucoma; Uveitis, Anterior; Eye; Cytomegalovirus Infections
PubMed: 36935679
DOI: 10.3389/fpubh.2023.1117412