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Clinical & Experimental Ophthalmology 2024Epiretinal membrane (ERM) is a common finding in patients with uveitis that contributes to visual impairment. We describe the long-term visual acuity (VA) and...
BACKGROUND
Epiretinal membrane (ERM) is a common finding in patients with uveitis that contributes to visual impairment. We describe the long-term visual acuity (VA) and morphometric progression in patients with uveitis and epiretinal membrane (ERM).
METHODS
Retrospective cohort study of patients with uveitic ERM from a tertiary centre database. Multivariate analysis of risk factors for ERM progression was calculated using a marginal Cox regression model to estimate hazard ratios (HR).
RESULTS
Two hundred and sixteen eyes (4%) of a total 5450 eyes with uveitis were identified to have an ERM. The most common diagnosis was idiopathic uveitis in 45 patients (28.7%), followed by sarcoidosis in 21 (13.4%), HLAB27-related uveitis in 15 (9.6%) and toxoplasmosis in 15 (9.6%). Risk factors for ERM development include age (HR 1.03), intermediate uveitis (HR 2.33), posterior uveitis (HR 1.53) and ERM fellow eye (HR 18.28). Anterior uveitis (HR 0.53) and alternating disease (HR 0.53) were protective. Median VA was 20/40 at diagnosis of ERM and 20/40 at final follow up. Progression of ERM grade occurred in 17 eyes (7.9%) during the study period. ERM peel was performed in 44 eyes (20.4%). Median VA was 20/60 and 20/40 at baseline and 12 months after surgery, respectively. Improvement in visual acuity occurred in 23 eyes (60.5%) following surgery.
CONCLUSIONS
In addition to intermediate and posterior uveitis, fellow eye involvement is a strong risk factor for ERM development. In treated uveitis, the majority maintain their long-term vision and rates of ERM progression are low.
Topics: Humans; Epiretinal Membrane; Retrospective Studies; Tomography, Optical Coherence; Uveitis; Prognosis; Uveitis, Posterior; Vitrectomy; Treatment Outcome
PubMed: 38108156
DOI: 10.1111/ceo.14338 -
American Journal of Ophthalmology Aug 2021To determine classification criteria for multifocal choroiditis with panuveitis (MFCPU).
PURPOSE
To determine classification criteria for multifocal choroiditis with panuveitis (MFCPU).
DESIGN
Machine learning of cases with MFCPU and 8 other posterior uveitides.
METHODS
Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the posterior uveitides. The resulting criteria were evaluated on the validation set.
RESULTS
One thousand sixty-eight cases of posterior uveitides, including 138 cases of MFCPU, were evaluated by machine learning. Key criteria for MFCPU included (1) multifocal choroiditis with the predominant lesions size >125 µm in diameter; (2) lesions outside the posterior pole (with or without posterior involvement); and either (3) punched-out atrophic chorioretinal scars or (4) more than minimal mild anterior chamber and/or vitreous inflammation. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for MFCPU were 15% in the training set and 0% in the validation set.
CONCLUSIONS
The criteria for MFCPU had a reasonably low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
Topics: Adult; Anterior Chamber; Female; Humans; Machine Learning; Male; Middle Aged; Multifocal Choroiditis; Visual Acuity
PubMed: 33845016
DOI: 10.1016/j.ajo.2021.03.043 -
Journal Francais D'ophtalmologie Apr 2020Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized... (Review)
Review
Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized pre-therapeutic evaluation providing diagnostic certainty, but some simple tests allow us to identifiy the main etiologies. The ophthalmologist identifies the type of uveitis, and the internist completes the investigations according to the ophthalmologist's findings. Fundus photographs, optical coherence tomography, and fluorescein and indocyanine green angiography should be considered during diagnosis and follow-up. Ocular complications of uveitis are numerous. They require close monitoring and specific medical and sometimes surgical management. The growing number of available drugs makes it possible to optimize the management of these conditions with varied etiologies and presentations. Currently, systemic corticosteroids remain the mainstay of therapy, and other alternatives are considered in the case of poor tolerance, steroid resistance or dependence. The choice of a systemic, periocular or intravitreal treatment depends on several factors: chronicity or recurrence of uveitis, duration, bilaterality, association with a systemic inflammatory disease, the presence of contraindications to certain treatments, and also socioeconomic constraints. It is of the utmost importance to find the best compromise allowing tight control of ocular inflammation by means of adapted systemic and/or local treatment while avoiding the main complications.
Topics: Glucocorticoids; Humans; Immunosuppressive Agents; Panuveitis; Tomography, Optical Coherence; Uveitis, Intermediate; Uveitis, Posterior; Vision Disorders
PubMed: 31818505
DOI: 10.1016/j.jfo.2019.03.033 -
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 -
Ocular Immunology and Inflammation Dec 2023To report demographic and clinical profiles of children with uveitis in theTurkishpopulation.
PURPOSE
To report demographic and clinical profiles of children with uveitis in theTurkishpopulation.
METHODS
The data of the pediatric uveitis cases in the nation wide uveitis database were analyzed.
RESULTS
The study included 697 eyes of 442 patients with a meanage of 10.8 ± 3.8 years. There were 333 patients (75.3%) with non-infectious uveitis and 69 patients (15.6%) with infectious uveitis. Pars planitis (20.1%) was leading clinical form followed by idiopathic cases with uveitis other than pars planitis (18.8%), juvenile idiopathic arthritis(JIA) related uveitis (12.4%), Behçet uveitis (9.3%) and toxoplasma retinochoroiditis (7.9%). Ocular involvement was unilateral in 187 patients (42.3%) and bilateral in 255 patients (57.7%). The most common anatomiclocation of uveitis was anterior uveitis (39.1%), followed by intermediate uveitis (29.4%), panuveitis (16.1%) and posterior uveitis (15.4%).
CONCLUSION
The most common systemic association was JIA in the younger children and Behçet disease in the older children.
Topics: Child; Humans; Adolescent; Pars Planitis; Turkey; Retrospective Studies; Uveitis; Behcet Syndrome; Arthritis, Juvenile; Registries
PubMed: 36083691
DOI: 10.1080/09273948.2022.2110900 -
Annals of Palliative Medicine Dec 2021Uveitis is a not uncommon potentially sight-threatening intraocular inflammatory disorder and a major cause of blindness worldwide. Early diagnosis and effective...
BACKGROUND
Uveitis is a not uncommon potentially sight-threatening intraocular inflammatory disorder and a major cause of blindness worldwide. Early diagnosis and effective treatment are very important to reduce complications and protect vision.
METHODS
In a retrospective series, we enrolled 263 (390 eyes) consecutive uveitis patients, comprising 126 males and 137 females. The clinical types of uveitis, treatment efficacy, complications and visual prognosis were evaluated by detailed clinical examination, laboratory tests and treatment observation.
RESULTS
There were 101 cases of panuveitis (38.4%), 85 cases of anterior uveitis (32.3%), 75 cases of posterior uveitis (28.5%), and 2 cases of intermediate uveitis (8%). There was a statistically significant difference in (I) visual acuity between the acute and recovery periods (F=13.12, P<0.05); (II) visual acuity between first-time and recurrent patients (F=9.26, P<0.05); (III) visual acuity in the affected and healthy eyes in the total, anterior and posterior uveitis groups (P<0.05); and (IV) the presence of ocular complications. There was also a statistically significant difference in the presence or absence of ocular complications between patients with initial disease and those with a recurrence of disease (F=59.51, P<0.05).
CONCLUSIONS
In all its varying presentations, uveitis has a great impact on visual acuity. A careful clinical history should be taken and specific laboratory tests should be performed in order to improve the diagnosis and determine the etiology, and practitioners should provide appropriate treatment to avoid ocular complications, which can further damage visual acuity.
Topics: Female; Humans; Male; Panuveitis; Retrospective Studies; Uveitis; Uveitis, Intermediate; Uveitis, Posterior
PubMed: 35016443
DOI: 10.21037/apm-21-3549 -
Documenta Ophthalmologica. Advances in... Dec 2020The electroretinogram (ERG) has proven to be useful in the evaluation and monitoring of patients with posterior uveitis. ERG oscillatory potentials (OPs) are sometimes... (Comparative Study)
Comparative Study
PURPOSE
The electroretinogram (ERG) has proven to be useful in the evaluation and monitoring of patients with posterior uveitis. ERG oscillatory potentials (OPs) are sometimes reduced in many uveitic eyes with otherwise grossly normal ERG responses. This study compares ERG parameters, including OPs, between patients with birdshot chorioretinopathy, other posterior uveitis, and controls.
METHODS
This was a retrospective case-control study. Sixty-four patients seen at a clinical practice had a total of 93 visits during which ERG was performed on both eyes. ERG data from 93 age-matched controls were also collected. Root-mean-squared (RMS) energy of the OPs was calculated using Fourier analysis for 88 patients and 88 age-matched controls for whom complete data were available. Photopic flicker amplitudes, photopic flicker latencies, scotopic b-wave amplitudes, and OP RMS values were compared between patients and controls. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves.
RESULTS
The mean ages of patients and controls were 55.9 ± 10.8 (SD) years and 55.1 ± 11.5, respectively. 83% of the patients had a diagnosis of BCR. The mean OP RMS value was significantly different in patients (15.6 µV ± 9.7 µV) versus control eyes (33.0 µV ± 12.7 µV), p < 0.001. Area under the ROC curves (AUROC) was 0.75 for photopic flicker amplitudes, 0.77 for photopic flicker latencies, 0.72 for scotopic b-wave amplitudes, and 0.88 for OP RMS. AUROC was significantly different between OP RMS and photopic flicker amplitudes (p < 0.001), between OP RMS and flicker latencies (p = 0.0032), and between OP RMS and scotopic b-wave amplitudes (p < 0.0001).
CONCLUSION
Analysis of OPs shows greater sensitivity and specificity in the diagnosis and evaluation of patients with birdshot chorioretinopathy than photopic and scotopic ERG amplitudes and photopic flicker latencies.
Topics: Adolescent; Adult; Aged; Birdshot Chorioretinopathy; Case-Control Studies; Electroretinography; Female; Humans; Male; Middle Aged; Oscillometry; Photic Stimulation; ROC Curve; Retina; Retrospective Studies; Uveitis, Posterior; Visual Acuity
PubMed: 32542469
DOI: 10.1007/s10633-020-09776-x -
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 -
Ocular Immunology and Inflammation Apr 2022Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The... (Review)
Review
PURPOSE
Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The purpose of this study is to review role of OCT and OCTA in differential diagnosis of certain posterior uveitic entities.
METHODS
Narrative review.
RESULTS
In this review, we have comprehensively summarized the utility of OCT and OCTA in helping the clinician diagnose common but challenging inflammatory conditions including ocular toxoplasmosis, viral retinitis, and vitreoretinal lymphoma, among others. OCT and OCTA can also be used to assess the choriocapillaris involvement in conditions such as multiple evanescent white dot syndrome, and choroidal granulomas in tubercular and sarcoid uveitis.
CONCLUSIONS
Fundus imaging with OCT and OCTA has assumed a significant role in establishing the diagnosis in uveitis apart from microbiological and other laboratory analysis. Advantages such as rapidity and non-invasiveness make these imaging modalities very useful and convenient.
Topics: Diagnosis, Differential; Fluorescein Angiography; Humans; Retinal Neoplasms; Tomography, Optical Coherence; Uveitis; Vitreous Body; White Dot Syndromes
PubMed: 35593586
DOI: 10.1080/09273948.2022.2071743 -
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