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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 -
Eye (London, England) Jan 2021The aim of this review was to identify the imaging methods at our disposal to optimally manage posterior uveitis at the present time. The focus was put on methods that... (Review)
Review
The aim of this review was to identify the imaging methods at our disposal to optimally manage posterior uveitis at the present time. The focus was put on methods that have become available since the 1990s, some 30 years after fluorescein angiography had revolutionised imaging of posterior uveitis in particular imaging of the retinal vascular structures in the 1960s. We have focussed our review on precise imaging methods that have been standardised and validated and can be used universally thanks to commercially produced and available instruments for the diagnosis and follow-up of posterior uveitis. The second part of this imaging review will deal with invasive imaging methods and in particular ocular angiography.
Topics: Diagnostic Tests, Routine; Fluorescein Angiography; Humans; Retinal Vessels; Uveitis; Uveitis, Posterior
PubMed: 32778739
DOI: 10.1038/s41433-020-1072-0 -
Journal Francais D'ophtalmologie Oct 2023To describe the clinical characteristics, presentation and response to treatment in posterior uveitis patients with bacillary layer detachment (BLD) seen on optical...
PURPOSE
To describe the clinical characteristics, presentation and response to treatment in posterior uveitis patients with bacillary layer detachment (BLD) seen on optical coherence tomography (OCT).
MATERIALS AND METHODS
Retrospective review of patients with posterior uveitis and SD-OCT scans consistent with BLD. Data collected included demographics, uveitic etiology, treatment and duration of follow-up. Outcome measures included macular volume, central subfoveal thickness and visual acuity.
RESULTS
Sixteen patients (20 eyes) were included. Twelve were female (75%). The mean age was 43.68 ± 14.7 years. The most frequent etiology of the uveitis was Vogt-Koyanagi-Harada (VKH) disease (n=10), followed by sympathetic ophthalmia (n=2). BLD was bilateral in four patients. Eight patients were treated with intravenous methylprednisolone boluses. Immunosuppressive therapies were required in 8 patients. The mean follow-up was 70 months (range: 2.0-216.0).
CONCLUSION
BLD was observed in a series of posterior uveitis cases of various etiologies, showing functional and structural resolution with treatment in most cases.
PubMed: 37210295
DOI: 10.1016/j.jfo.2022.12.031 -
Klinische Monatsblatter Fur... Jan 2024Intermediate and posterior uveitis can have multiple infectious and noninfectious causes, and posterior uveitis in particular is clinically multifaceted. Some entities...
Intermediate and posterior uveitis can have multiple infectious and noninfectious causes, and posterior uveitis in particular is clinically multifaceted. Some entities require prompt initiation of therapy to ensure visual prognosis. This article presents typical characteristics of intermediate and posterior uveitides and explains special features of their treatment.
Topics: Humans; Uveitis, Posterior; Uveitis; Uveitis, Intermediate
PubMed: 37977201
DOI: 10.1055/a-2193-2568 -
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 -
Progress in Retinal and Eye Research Mar 2020A diagnostic sign refers to a quantifiable biological parameter that is measured and evaluated as an indicator of normal biological, pathogenic, or pharmacologic... (Review)
Review
A diagnostic sign refers to a quantifiable biological parameter that is measured and evaluated as an indicator of normal biological, pathogenic, or pharmacologic responses to a therapeutic intervention. When used in translational research discussions, the term itself often alludes to a sign used to accelerate or aid in diagnosis or monitoring and provide insight into "personalized" medicine. Many new diagnostic signs are being developed that involve imaging technology. Optical coherence tomography is an imaging technique that provides in vivo quasi-histological images of the ocular tissues and as such it's able to capture the structural and functional modifications that accompany inflammation and infection of the posterior part of the eye. From the hyperreflective inflammatory cells and deposits in the vitreous and on the hyaloid, to the swollen photoreceptors bodies in multiple evanescent white dots syndrome, and from optical differences in the subretinal fluid compartments in Vogt-Koyanagi-Harada disease to the hyporeflective granulomas in the choroid, these tomographical signs can be validated to reach the status of biomarkers. Such non-invasive imaging diagnostic signs of inflammation can be very useful to clinicians seeking to make a diagnosis and can represent a dataset for machine learning to offer a more empirical approach to the detection of posterior uveitis.
Topics: Choroid; Humans; Tomography, Optical Coherence; Uveitis, Posterior; Visual Acuity
PubMed: 31513851
DOI: 10.1016/j.preteyeres.2019.100797 -
European Journal of Ophthalmology May 2023To report recurrence of tubercular choroiditis following anti-SARS-CoV-2 vaccination in two patients with quiescent disease activity for more than a year.
PURPOSE
To report recurrence of tubercular choroiditis following anti-SARS-CoV-2 vaccination in two patients with quiescent disease activity for more than a year.
METHODS
Retrospective observational case reports.
RESULTS
Two patients (one female and one male) under follow-up for posterior uveitis having stable course with absence of ocular inflammation for more than a year presented with recurrence of choroiditis lesions 2-6 weeks following anti-SARS-CoV-2 vaccination. Both the patients were managed with intravitreal dexamethasone implant (Ozurdex®, Allergan, Inc., Irvine, CA, USA) and showed resolution of choroiditis lesions upon follow-up.
CONCLUSIONS
Acute onset recurrence of inflammation, in absence of any change in health status or treatment suggests the potential role of vaccination being the trigger of this reactivation. Given large-scale vaccination against novel coronavirus- SARS-CoV-2, careful vigilance is warranted to pick up the disease recurrence in patients with posterior uveitis.
Topics: Humans; Male; Female; Retrospective Studies; COVID-19; SARS-CoV-2; Choroiditis; Dexamethasone; Uveitis, Posterior; Inflammation
PubMed: 35306917
DOI: 10.1177/11206721221088439 -
Journal Francais D'ophtalmologie Mar 2020Placoid pigment epitheliopathy and serpiginous choroiditis are among the white dot retinal syndromes and possess similarities that can cause confusion between these two... (Review)
Review
Placoid pigment epitheliopathy and serpiginous choroiditis are among the white dot retinal syndromes and possess similarities that can cause confusion between these two diseases. However, they are very different in terms of their progression and prognosis, which requires a diagnosis of certainty in order to better manage the patients with the diseases and identify potentially serious progressive complications. The clinical presentation, results of testing, differential diagnoses and treatment of these two pathologies are discussed in this article.
Topics: Choroiditis; Diagnosis, Differential; Disease Progression; Humans; Pigment Epithelium of Eye; Pigmentation Disorders; Prognosis; Retinal Diseases; White Dot Syndromes
PubMed: 32007311
DOI: 10.1016/j.jfo.2019.04.022 -
Saudi Journal of Ophthalmology :... 2022Posterior uveitis is sight-threatening disease entity that can be caused by infectious and non-infectious entities. Vision loss in posterior uveitis can be following...
Interpreting posterior uveitis by integrating indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography data: A narrative review.
Posterior uveitis is sight-threatening disease entity that can be caused by infectious and non-infectious entities. Vision loss in posterior uveitis can be following complications such as cystoid macular edema, epiretinal membrane, artery and vein occlusions, vasculitis, papillitis, choroidal neovascular membrane, retinal neovascularization, tractional retinal detachment, vitreous hemorrhage, glaucoma, cataract, among others. Diagnosis of posterior uveitic entities have been revolutionized following introduction of choroidal imaging with techniques such as indocyanine green angiography (ICGA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Med Line search and PubMed search was performed pertaining to causes of posterior uveitis, ICGA in posterior uveitis, OCT in posterior uveitis, OCTA in posterior uveitis, retinal and choroidal vascular changes in posterior uveitis, quantification of choriocapillaris lesion area in posterior uveitis, subfoveal choroidal thickness in posterior uveitis, quantification of choriocapillaris in posterior uveitis, vascular indices for quantification of choriocapillaris. This review article highlights various changes in the choroid and the quantification of choroid using various parameters in ICGA, OCT and OCTA.
PubMed: 36618566
DOI: 10.4103/sjopt.sjopt_69_22