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JAMA Ophthalmology Apr 2015
Topics: Anti-Bacterial Agents; Eye Infections, Bacterial; Female; Fluorescein Angiography; Humans; Infusions, Intravenous; Middle Aged; Penicillin G; Syphilis; Tomography, Optical Coherence; Uveitis, Posterior
PubMed: 25856651
DOI: 10.1001/jamaophthalmol.2014.4630 -
Ocular Immunology and Inflammation Jul 2022To report four cases of uveitis after treatment with dupilumab for atopic dermatitis.
PURPOSE
To report four cases of uveitis after treatment with dupilumab for atopic dermatitis.
METHODS
Retrospective case series.
RESULTS
Data was collected from four patients with inflammation that developed after treatment with dupilumab. The first patient was thought to have developed posterior scleritis or Harada's-type disease related to her treatment with dupilumab, with recurrence of intraocular inflammation upon restarting treatment. The second patient developed anterior and intermediate uveitis as well as cystoid macular edema in her right eye about two years after starting dupilumab treatment. The third patient developed a distinct relentless placoid chorioretinitis while on therapy with dupilumab. The fourth patient developed bilateral cystoid macular edema while on treatment with dupilumab.
CONCLUSION
We report a case series of patients treated with dupilumab who developed intraocular manifestations of inflammatory disease.
Topics: Antibodies, Monoclonal, Humanized; Chorioretinitis; Female; Humans; Inflammation; Macular Edema; Retrospective Studies; Uveomeningoencephalitic Syndrome
PubMed: 33826474
DOI: 10.1080/09273948.2020.1861305 -
Acta Ophthalmologica Aug 2014To assess tuberculous uveitis in Chinese patients. (Observational Study)
Observational Study
PURPOSE
To assess tuberculous uveitis in Chinese patients.
METHODS
The hospital-based observational case series study included patients who attended a third-referral hospital and presented with chronic and recurrent uveitis without primarily detected aetiology. The patients underwent the tuberculin skin test (TST) and/or interferon gamma release test (IGRA). Patients with positive test results received standard antituberculous therapy. Patients who responded to the therapy and did not show recurrence of uveitis in the follow-up period were diagnosed as tuberculous uveitis and formed the study group. The remaining patients were diagnosed as non-tuberculous uveitis and formed the control group. The clinical characteristics were compared between both groups.
RESULTS
The study group with tuberculous uveitis included 46 patients and the non-tuberculous group 38 patients. Multifocal choroiditis [n = 9 (20%) versus n = 1(3%); p = 0.04] and retinal vasculitis [n = 25(54%) versus 8 = (21.1%); p = 0.002] were significantly more common in the study group. Of 25 patients with retinal vasculitis in the study group, 11 patients (44%) additionally showed choroiditis lesions, compared with only one (13%) of eight patients in the control group (p = 0.01). In multivariate regression analysis, multifocal choroiditis [odds ratio (OR): 32.1], choroidal granuloma (OR: 21.4) and retinal vasculitis (OR: 11.2) were independent predictors of tubercular uveitis.
CONCLUSIONS
About 50% of a group of 84 patients with primarily unexplained chronic posterior uveitis had tuberculosis and showed multifocal choroiditis, choroidal granuloma and retinal vasculitis. These features had a high predictive value for the diagnosis of tuberculous uveitis. Tuberculosis is an important part in the differential diagnosis of unexplained uveitis.
Topics: Adult; Aged; Antitubercular Agents; China; Choroiditis; Female; Follow-Up Studies; Humans; Interferon-gamma Release Tests; Male; Middle Aged; Multifocal Choroiditis; Prevalence; Retinal Vasculitis; Tuberculin Test; Tuberculosis, Ocular; Uveitis, Posterior
PubMed: 24479692
DOI: 10.1111/aos.12351 -
Journal Francais D'ophtalmologie Jun 2016Birdshot retinochoroidopathy (BRC) is a potentially blinding posterior autoimmune uveitis that affects Caucasian patients in their fifties. Strongly associated with the... (Review)
Review
Birdshot retinochoroidopathy (BRC) is a potentially blinding posterior autoimmune uveitis that affects Caucasian patients in their fifties. Strongly associated with the HLA A 29 phenotype, BRC is characterized by the presence of suggestive choroidal lesions on the fundus, but their apparition can be delayed. Visual acuity is not a good descriptive factor of visual function. Ancillary tests can therefore help establish the diagnosis and allow proper follow-up of BRC patients: optical coherence tomography can reveal either oedema or atrophy of the macula. Fluorescein and infracyanine green angiograms can show signs of inflammatory activity and give further diagnostic clues. Electroretinograms and visual fields can be useful for the diagnosis and follow-up. BCR patients should be examined periodically and undergo exhaustive clinical and paraclinical tests to insure the best prognosis. Corticosteroids should be associated with immunosuppressive treatments as early as possible in the presence of factors that are predictive of the worse prognoses.
Topics: Choroiditis; Electroretinography; Fluorescein Angiography; Fundus Oculi; Humans; Multifocal Choroiditis; Tomography, Optical Coherence; Visual Acuity; Visual Field Tests
PubMed: 27341760
DOI: 10.1016/j.jfo.2016.05.001 -
Ocular Immunology and Inflammation Apr 2023To search findings that can explain the heterogeneity between Resistant and Responsive patients with birdshot chorioretinopathy. (Observational Study)
Observational Study
PURPOSE
To search findings that can explain the heterogeneity between Resistant and Responsive patients with birdshot chorioretinopathy.
PATIENTS AND METHODS
This was a retrospective observational case series on "Responsive" versus "Resistant" birdshot chorioretinopathy.
RESULTS
One-hundred-eighty and Ninety-nine patients were included in the Responsive and Resistant groups respectively. Multivariate analysis of paraclinical variables at the first visit demonstrated that mean deviation (p = .04), pattern standard deviation (p < .001), optic nerve head leakage (p = .012), large vessel leakage and staining (p = .01), and macular small vessel leakage (p = .03) were statistically significantly different between the two groups; however, at the visit preceding successful therapy, only macular small vessel leakage (p = .01) was statistically significantly different between the two groups.
CONCLUSION
.Small vessel leakage in the macular area and/or optic nerve head leakage at the earliest visit might be risk factors for resistant birdshot chorioretinopathy.
Topics: Humans; Birdshot Chorioretinopathy; Fluorescein Angiography; Retrospective Studies; Visual Acuity; Chorioretinitis
PubMed: 35353656
DOI: 10.1080/09273948.2022.2032193 -
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 -
Seminars in Ophthalmology Jul 2023Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms,... (Review)
Review
PURPOSE
Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium.
METHODS
A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid.
RESULTS
The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed.
CONCLUSION
The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
Topics: Humans; Diabetic Retinopathy; Choroid; Choroiditis; Central Serous Chorioretinopathy; Tomography, Optical Coherence; Macular Degeneration; Fluorescein Angiography
PubMed: 35982638
DOI: 10.1080/08820538.2022.2109939 -
Expert Opinion on Biological Therapy Dec 2014Noninfectious posterior uveitis is a leading cause of visual impairment. Although conventional immunosuppressive agents have been successfully used, these are... (Review)
Review
INTRODUCTION
Noninfectious posterior uveitis is a leading cause of visual impairment. Although conventional immunosuppressive agents have been successfully used, these are nonspecific and their long-term use may induce significant adverse effects. The purpose of this article is to identify recent advances and future therapeutic options in noninfectious posterior uveitis.
AREAS COVERED
A MEDLINE database search was conducted through May 2014 using the terms: uveitis, treatment, intravitreal and corticosteroid, biological. To provide ongoing and future perspectives in treatment options, also clinical trials as registered at ClinicalTrials.gov were included.
EXPERT OPINION
For individuals who do not respond to conventional immunotherapy, two major lines of treatments can be identified as focus in recent years: i) the intraocular application of anti-inflammatory drugs and ii) the introduction of new agents, for example, biologicals and small-molecule inhibitors. Whereas intravitreal treatments have the beauty of avoiding systemic side effects, new agents are gaining increased importance because of their highly targeted molecular effects. Even when current treatment strategies are still hampered by the paucity of randomized controlled trials, promising progress and continuous efforts are undertaken to close this gap. Still, a critical evaluation of new agents has to be made because 'new' agents are almost exclusively based on experience in other autoimmune disorders.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Biological Products; Humans; Immunosuppressive Agents; Immunotherapy; Intravitreal Injections; Ophthalmic Solutions; Uveitis, Posterior
PubMed: 25243865
DOI: 10.1517/14712598.2014.956074 -
Progress in Retinal and Eye Research Jan 2015Birdshot chorioretinopathy (BSCR) is a bilateral chronic intraocular inflammation or posterior uveitis that preferentially affects middle-aged Caucasians. BSCR is... (Review)
Review
Birdshot chorioretinopathy (BSCR) is a bilateral chronic intraocular inflammation or posterior uveitis that preferentially affects middle-aged Caucasians. BSCR is characterized by distinctive multiple choroidal hypopigmented lesions in combination with retinal vasculitis and vitritis, and the extraordinary feature that virtually all patients are HLA-A29 positive. Its pathophysiology is still poorly understood. BSCR is the strongest documented association between HLA and disease in humans, which makes it an excellent model for studying the underlying immuno-genetic mechanisms of HLA class I-associated diseases. Although the association with HLA-A29 suggests that it is directly involved in the presentation of peptide antigens to T cells, the exact contribution of HLA-A29 to the pathophysiology of BSCR remains enigmatic. This article revisits the HLA-A29 peptidome using insights from recent studies and discusses why HLA-A29 can be considered a canonical antigen presenting molecule. The first genome-wide association study facilitated novel concepts into a disease mechanism beyond HLA-A29 that includes strong genetic predisposition for the ERAP2 gene that affects antigen processing for HLA class I. Furthermore, patients manifest with pro-inflammatory cytokine profiles and pathogenic T cell subsets that are associated with IL-17-linked inflammation. We are beginning to understand that the underlying biology of BSCR comprises various pathologic aspects branched into multiple molecular pathways. We propose to employ Systems Medicine to reveal their dynamic interplay for a holistic view of the immunopathology of this intriguing archetypal HLA class I-associated disease.
Topics: Aminopeptidases; Animals; Autoimmunity; Birdshot Chorioretinopathy; Chorioretinitis; Disease Models, Animal; Genome-Wide Association Study; HLA-A Antigens; Humans; T-Lymphocytes; Th17 Cells
PubMed: 25434765
DOI: 10.1016/j.preteyeres.2014.11.003 -
Archivos de La Sociedad Espanola de... Dec 2023A 66-year-old man with posterior uveitis and recurrent cystic macular edema related to possible previously treated Lyme disease is presented. Due to the recurrence of...
A 66-year-old man with posterior uveitis and recurrent cystic macular edema related to possible previously treated Lyme disease is presented. Due to the recurrence of macular edema despite systemic and local corticosteroid treatment with intravitreal dexamethasone, biological treatment with Adalimumab was established. During follow-up, the patient developed bilateral subretinal lesions compatible with Vitreoretinal Lymphoma (VRL), so vitrectomy was performed, confirming the diagnosis of large B-cell lymphoma. Treatment with systemic chemotherapy with BRAM-Carmustine, Metrotexate, Ara C, and Rituximab was started with a good answer. Two years later, the patient remains without ocular or systemic recurrences. Vitreoretinal Lymphoma is a rare type of primary central nervous system lymphoma. The diagnosis is frequently delayed due to the nonspecific symptoms, which mimic chronic posterior uveitis, hence the importance with a diagnostic suspicion.
Topics: Male; Humans; Aged; Retinal Neoplasms; Vitreous Body; Macular Edema; Eye Neoplasms; Lymphoma, Large B-Cell, Diffuse; Uveitis, Posterior
PubMed: 37813184
DOI: 10.1016/j.oftale.2023.10.002