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Klinische Monatsblatter Fur... May 2022Uveitis is a collective term for a variety of different intraocular inflammations. The underlying etiologies vary greatly depending on the uveitis subtype, and in...
Uveitis is a collective term for a variety of different intraocular inflammations. The underlying etiologies vary greatly depending on the uveitis subtype, and in particular the anatomical focus. The most common forms of anterior uveitis are acute fibrinous unilateral uveitis, often associated with the HLA-B27 haplotype, and granulomatous inflammation, typically associated with sarcoidosis or herpes infections. Intermediate uveitis is usually idiopathic in nature but can also be associated with multiple sclerosis or sarcoidosis, while vitreoretinal lymphoma must also be considered as a masquerade syndrome in patients aged over 45. Posterior uveitis, on the other hand, as well as retinal vasculitis and panuveitis, have a very broad variety of etiologies; these can, however, be narrowed down through a similar findings-centered approach. Retinitis, for example, is often associated with infections (Toxoplasma gondii and viruses of the herpes group), whereas chorioditis is frequently idiopathic, although infections such as tuberculosis may occur. Therefore, the medical history and laboratory diagnosis should be tailored in patients with uveitis based on the anatomic focus of inflammation (anterior, intermediate, or posterior uveitis, or panuveitis) and the clinical picture (e.g., granulomatous versus nongranulomatous).
Topics: Diagnostic Techniques and Procedures; Humans; Inflammation; Medical History Taking; Panuveitis; Retinal Neoplasms; Sarcoidosis; Uveitis; Uveitis, Anterior; Uveitis, Posterior; Vitreous Body
PubMed: 35320872
DOI: 10.1055/a-1737-4306 -
Current Aging Science 2021Behçet's disease is frequent in Tunisia and potentially serious, which can endanger both the vital and visual prognosis. Late occurrence of the disease is uncommon and...
Behçet's disease is frequent in Tunisia and potentially serious, which can endanger both the vital and visual prognosis. Late occurrence of the disease is uncommon and less frequently investigated. ; Aims: The aim of this study was to analyse the demographic characteristics and ocular manifestations of patients with late-onset Behçet disease in Tunisia, North Africa. ; Methods: A retrospective study was performed on 38 eyes of 21 oculo-Behçet patients over a seven- year period. ; Results: The mean age of our patients was 54.81 years. The sex ratio M/F was 2.5. The period between the onset of the first symptom and diagnosis of Behçet's disease varied from 3 days to 2 years. The primary complaint was a decrease in visual acuity, reported in 8 patients. Ocular involvement revealed Behçet's disease in 2 patients, bilateral in 17 patients, and active in 31 eyes. The ocular manifestations in late-onset Behçet's disease were dominated by uveal involvement (30 eyes). The most frequent form of uveitis was panuveitis noted in 13 eyes. Ocular complications were dominated by macular involvement in 8 patients (14 eyes). Blindness was noted in 4 eyes of 4 patients (10.5%). Topical corticosteroids were used in 30 eyes. Three patients were treated only with oral corticosteroid and 9 patients with a combination of oral corticosteroid and immunosuppressive agents. ; Conclusion: Since the course of the ocular involvement in late-onset Behçet's disease is regarded to be relatively mild, it is noteworthy that our study revealed that blindness was noted in 10,5% and posterior uveitis and panuveitis were the most common uveal lesion.
Topics: Behcet Syndrome; Humans; Immunosuppressive Agents; Retrospective Studies; Uveitis; Visual Acuity
PubMed: 31994475
DOI: 10.2174/1874609813666200128110820 -
Orvosi Hetilap Aug 2022Introduction: Biological therapy can be used in uveitis in children since 2016. With ophthalmological indication only adalimumab therapy can be started. Adalimumab is a...
Introduction: Biological therapy can be used in uveitis in children since 2016. With ophthalmological indication only adalimumab therapy can be started. Adalimumab is a monoclonal antibody that inhibits tumor necrosis factor alpha.Objective: To summarize our experience with patients receiving adalimumab for pediatric non-infectious uveitis.Patients and methods: We investigated our juvenile patients of non-infectious uveitis treated with adalimumab be-tween 2017 and 2021 in a retrospective case series at the Department of Ophthalmology, Szeged University. Results: Between 01 January, 2017 and 31 May, 2021, we examined 46 children with uveitis. The mean age of these 23 girls and 23 boys was 11 years. 21 of them had juvenile idiopathic arthritis, 14 had infectious uveitis, 3 had hae-matological disorders, 8 had idiopathic uveitis. Adalimumab was given to 11 patients because of severe, chronic uveitis. There were 3 boys and 8 girls, their mean age was 10 years. Adalimumab was given according to the licence of the European Medicines Agency. Indication was anterior uveitis at 6 children, panuveitis at 5 children. Adali-mumab can be given to children over 2 years, who have chronic, non-infectious, anterior uveitis. Children with panuveitis received the therapy by the help of a pediatric rheumatologist.Conclusion: The significance of pediatric uveitis and its therapy is emergent. Our aim was to preserve vision and de-crease the possibilities of side effects and to provide a better life for these uveitic children. Early diagnosis, adequate therapy and regular ophthalmological check-ups are important. Children treated with adalimumab have good visual acuity due to the effectiveness of the therapy. No new ocular side effect was detected at the children treated with adalimumab.
Topics: Adalimumab; Child; Female; Humans; Male; Panuveitis; Retrospective Studies; Treatment Outcome; Uveitis; Uveitis, Anterior
PubMed: 36030422
DOI: 10.1556/650.2022.32578 -
Pediatric Rheumatology Online Journal Oct 2023Pediatric uveitis is a severe inflammatory ocular condition that can lead to sight-threatening complications and can negatively impact quality of life. The retinal...
BACKGROUND
Pediatric uveitis is a severe inflammatory ocular condition that can lead to sight-threatening complications and can negatively impact quality of life. The retinal microcirculation is often affected in intermediate uveitis and panuveitis. Here, we examined the extraocular (i.e., systemic) microcirculation in pediatric uveitis cases and healthy controls using nailfold capillaroscopy (NFC).
METHODS
We performed NFC in 119 children with noninfectious uveitis and 25 healthy pediatric controls, and assessed the following parameters: capillary density (number of capillaries/mm), dilated capillaries (apex > 20 µm), avascular area, the presence of microhemorrhages, and capillary morphology. Differences in NFC parameters between cases and controls were calculated using regression analysis after adjusting for age and sex.
RESULTS
The mean (± SD) age of the patient group was 13.7 (± 3) years, with 56% females; 46%, 18%, and 36% of cases presented as anterior uveitis, intermediate uveitis, and panuveitis, respectively, with an overall mean disease duration of 4.7 (± 4.0) years. Compared to the control group, the pediatric uveitis cases had a significantly higher number of dilated capillaries/mm and a higher prevalence of ramified capillaries. Moreover, compared to the control group the intermediate uveitis cases had a significantly higher number of dilated capillaries, whereas the anterior uveitis cases had a lower capillary density and a higher prevalence of ramified capillaries.
CONCLUSIONS
Children with uveitis without systemic disease can present with changes in systemic microcirculation. These changes vary amongst the subtypes of uveitis.
Topics: Female; Humans; Child; Adolescent; Male; Microcirculation; Quality of Life; Nails; Uveitis; Uveitis, Anterior; Uveitis, Intermediate; Panuveitis; Microscopic Angioscopy
PubMed: 37784087
DOI: 10.1186/s12969-023-00896-7 -
Indian Journal of Ophthalmology Jun 2023Vogt-Koyanagi-Harada (VKH) disease, a bilateral granulomatous panuveitis associated with multisystem involvement, is a T-cell-mediated autoimmune disorder in which...
Vogt-Koyanagi-Harada (VKH) disease, a bilateral granulomatous panuveitis associated with multisystem involvement, is a T-cell-mediated autoimmune disorder in which cytotoxic T-cell target melanocytes in genetically susceptible individuals. Recently, there has been an increase in literature on the new onset of uveitis and reactivation of previously diagnosed cases of uveitis following Covid-19 vaccinations. It has been postulated that Covid-19 vaccines can lead to an immunomodulatory change resulting in an autoimmune phenomenon in the recipients. VKH following COVID-19 infection was reported in four patients and a total of 46 patients developing VKH or VKH-like disease following COVID-19 vaccinations. There are reports of four patients who had been recovering or recovered from VKH after receiving the first dosage of the vaccine and developed worsening of ocular inflammation after receiving the second dose of the vaccine.
Topics: Humans; Uveomeningoencephalitic Syndrome; COVID-19 Vaccines; COVID-19; Panuveitis; Uveitis
PubMed: 37322685
DOI: 10.4103/IJO.IJO_172_23 -
Clinics in Dermatology 2019Erythema elevatum et diutinum (EED) is a rare, chronic dermatosis. It has been associated with extracutaneous findings, including arthralgias, scleritis, panuveitis,... (Review)
Review
Erythema elevatum et diutinum (EED) is a rare, chronic dermatosis. It has been associated with extracutaneous findings, including arthralgias, scleritis, panuveitis, peripheral ulcerative keratitis, oral and penile ulcers, and neuropathy. Additionally, EED is connected with various systemic diseases, including HIV, IgA paraproteinemia, myelomas, neutrophilic dermatoses, and inflammatory bowel diseases. The presence of such extracutaneous manifestations in EED patients suggests that EED may be a multiorgan entity. Extracutaneous manifestations in EED may involve deposition of circulating immune complexes; thus, patients with EED should be evaluated for systemic manifestations to ensure targeted management.
Topics: Antigen-Antibody Complex; Arthralgia; Corneal Ulcer; HIV Infections; Humans; Inflammatory Bowel Diseases; Panuveitis; Paraproteinemias; Rare Diseases; Scleritis; Vasculitis, Leukocytoclastic, Cutaneous
PubMed: 31864448
DOI: 10.1016/j.clindermatol.2019.07.028 -
Ocular Immunology and Inflammation Jul 2022The immune checkpoint inhibitors (ICPIs) comprise a class of oncologic immunotherapies. The most recent US Food and Drug Administration-approved ICPI is cemiplimab...
PURPOSE
The immune checkpoint inhibitors (ICPIs) comprise a class of oncologic immunotherapies. The most recent US Food and Drug Administration-approved ICPI is cemiplimab (Libtayo®). Cemiplimab, like the other ICPIs, blocks checkpoint receptors in order to disinhibit T-cells so that they may detect and eliminate tumor cells. Consequently, treatment with ICPIs is associated with immune-related adverse events including uveitis.
METHODS
Case report.
RESULTS
A 63-year-old man with a history of metastatic squamous cell carcinoma developed blurry vision 3 months after starting treatment with cemiplimab. The patient was found to have posterior uveitis with retinal vasculitis that was successfully controlled with discontinuation of the medication as well as treatment with local and systemic steroids.
CONCLUSION
Similar to other ICPIs, uveitis may be associated with cemiplimab. In the setting of posterior uveitis, treatment may require cessation of cemiplimab and intensive steroid treatment.
Topics: Antibodies, Monoclonal, Humanized; Humans; Immune Checkpoint Inhibitors; Male; Middle Aged; Skin Neoplasms; Uveitis; Uveitis, Posterior
PubMed: 33793370
DOI: 10.1080/09273948.2021.1872649 -
Retina (Philadelphia, Pa.) Jan 2022
Topics: Adult; Antitubercular Agents; Autoimmunity; Choroiditis; DNA, Bacterial; Eye Infections, Bacterial; Female; Fluorescein Angiography; Fundus Oculi; Glucocorticoids; Humans; Mycobacterium tuberculosis; Panuveitis; Tomography, Optical Coherence; Tuberculosis, Ocular
PubMed: 34935769
DOI: 10.1097/IAE.0000000000003134 -
Medicina (Kaunas, Lithuania) Jan 2022Primary inflammatory choriocapillaropathies (PICCPs) belong to a group of intraocular inflammatory diseases with the common characteristic of inflammatory... (Review)
Review
PURPOSE
Primary inflammatory choriocapillaropathies (PICCPs) belong to a group of intraocular inflammatory diseases with the common characteristic of inflammatory choriocapillaris hypo- or non-perfusion as the main clinicopathological mechanism. The purpose of our article is to describe clinical characteristics and multimodal imaging, that can help the diagnosis and treatment of PICCPs.
METHODS
Narrative review with multimodal imaging analysis.
RESULTS
Choriocapillaris non-perfusion can affect the end-choriocappilaries, at the benign end of the PICCP spectrum (MEWDS), to larger choriocapillaris vessels or precapillary vessels at the origin of more severe forms such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), idiopathic multifocal choroiditis (MFC) and Serpiginous Choroiditis (SC). Diagnosis is mostly based on multimodal imaging and especially on indocyanine green angiography (ICGA), fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT)/OCT-angiography (OCT-A). ICGA shows the typical pattern of patchy lobular hypofluorescence reflecting hypo- or non-perfusion of the choriocapillaris that can also take the aspect of geographic areas in the more severe forms. Treatment depends on the severity of the disease and goes from observation in MEWDS and some mild cases of APMPPE, to oral corticosteroid and/or immunomodulator agents in the more severe conditions of APMPPE and MFC and SC cases. Close multimodal monitoring is crucial in order to introduce or adjust treatment.
CONCLUSION
PICCPs are resulting from one common clinicopathological mechanism, inflammatory choriocapillaris hypo- or non-perfusion. ICGA findings are essential for the diagnosis and follow-up of PICCPs, but non-invasive methods such as FAF and SD-OCT/OCT-A also have their role especially in follow-up of the diseases. Treatment should be individualized according to the pathology and the evolution of lesions.
Topics: Choroid; Choroiditis; Fluorescein Angiography; Humans; Multifocal Choroiditis; Tomography, Optical Coherence
PubMed: 35208488
DOI: 10.3390/medicina58020165 -
Current Opinion in Ophthalmology May 2020Local therapeutics play an important role in the management of infectious and noninfectious uveitis (NIU) as well as certain masquerade syndromes. This review highlights... (Review)
Review
PURPOSE OF REVIEW
Local therapeutics play an important role in the management of infectious and noninfectious uveitis (NIU) as well as certain masquerade syndromes. This review highlights the established therapeutics and those under investigation for the management of uveitis.
RECENT FINDINGS
An injectable long-acting fluocinolone acetonide insert was recently approved by the Food and Drug Administration for the treatment of NIU affecting the posterior segment. Intravitreal methotrexate, sirolimus, and anti-vascular endothelial growth factor (VEGF) agents are being evaluated for efficacy in NIU. Intravitreal foscarnet and ganciclovir are important adjuncts in the treatment of viral retinitis as are methotrexate and rituximab for the management of vitreoretinal lymphoma.
SUMMARY
Local injectable steroids with greater durability are now available for NIU but comparative efficacy to other treatment modalities remains to be determined. Local steroid-sparing immunosuppressive agents are undergoing evaluation for efficacy in NIU as are anti-VEGF agents for uveitic macular edema. Local antivirals may improve outcomes in cases of viral retinitis. Local chemotherapeutics can help induce remission in vitreoretinal lymphoma.
Topics: Anti-Infective Agents; Drug Implants; Eye Infections, Bacterial; Fluocinolone Acetonide; Glucocorticoids; Humans; Immunosuppressive Agents; Methotrexate; Panuveitis; Rituximab; Sirolimus; Uveitis, Intermediate; Uveitis, Posterior
PubMed: 32168001
DOI: 10.1097/ICU.0000000000000651