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Archivos de La Sociedad Espanola de... May 2022In developed countries, the main etiology of posterior uveitis is of infectious origin, Herpes is the most common viral agent as it has a wide spectral of ocular...
In developed countries, the main etiology of posterior uveitis is of infectious origin, Herpes is the most common viral agent as it has a wide spectral of ocular manifestations. These manifestations could depend on the patient's immunologic state, ranging from a mild focal form of non-necrotizing herpetic renitis (NNHR) to a severe form of Acute retinal necrosis (ARN). We present a case of NNHR by VHS 2 and the different differential diagnostics previous to its diagnosis: atypical ocular toxoplasmosis, ocular tuberculosis and ARN. During its evolution, it presented a drastic drop in the visual acuity despite of the antiviral treatment, and with systemic corticoids and the injury's clinical improvement. This event led to reevaluate the suspected entities, establishing the NNHR as a definitive diagnostic by exclusion that constituted a challenging diagnostic.
Topics: Herpes Simplex; Herpesviridae Infections; Humans; Retinal Necrosis Syndrome, Acute; Retinitis; Uveitis, Posterior
PubMed: 35526954
DOI: 10.1016/j.oftale.2020.12.019 -
American Journal of Ophthalmology Aug 2021To determine classification criteria for pars planitis.
PURPOSE
To determine classification criteria for pars planitis.
DESIGN
Machine learning of cases with pars planitis and 4 other intermediate uveitides.
METHODS
Cases of intermediate uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the 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 intermediate uveitides. The resulting criteria were evaluated on the validation set.
RESULTS
Five hundred eighty-nine cases of intermediate uveitides, including 226 cases of pars planitis, were evaluated by machine learning. The overall accuracy for intermediate uveitides was 99.8% in the training set and 99.3% in the validation set (95% confidence interval 96.1, 99.9). Key criteria for pars planitis included unilateral or bilateral intermediate uveitis with either 1) snowballs in the vitreous or 2) snowbanks on the pars plana. Key exclusions included: 1) multiple sclerosis, 2) sarcoidosis, and 3) syphilis. The misclassification rates for pars planitis were 0% in the training set and 1.7% in the validation set, respectively.
CONCLUSIONS
The criteria for pars planitis had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
Topics: Adolescent; Adult; Child; Female; Humans; Machine Learning; Male; Pars Planitis; Visual Acuity; Young Adult
PubMed: 33845006
DOI: 10.1016/j.ajo.2021.03.045 -
American Journal of Ophthalmology Jan 2021To elucidate molecular risk factors for posterior segment uveitis using a functional genomics approach.
OBJECTIVE
To elucidate molecular risk factors for posterior segment uveitis using a functional genomics approach.
DESIGN
Genetic association cohort study.
METHODS
Setting: Single-center study at an academic referral center.
STUDY POPULATION
164 patients with clinically diagnosed uveitis of the posterior segment.
MAIN OUTCOME MEASURES
Exome sequencing was used to detect variants identified in 164 patients with posterior segment uveitis. A phenotype-driven analysis, protein structural modeling, and in silico calculations were then used to rank and predict the functional consequences of key variants.
RESULTS
A total of 203 single nucleotide variants, in 23 genes across 164 patients, were included in this study. Both known and novel variants were identified in genes previously implicated in specific types of syndromic uveitis-such as NOD2 (Blau syndrome) and CAPN5 NIV (neovascular inflammatory vitreoretinopathy)-as well as variants in genes not previously linked to posterior segment uveitis. Based on a ranked list and protein-protein-interaction network, missense variants in NOD-like receptor family genes (NOD2, NLRC4, NLRP3, and NLRP1), CAPN5, and TYK2 were characterized via structural modeling and in silico calculations to predict how specific variants might alter protein structure and function. The majority of analyzed variants were notably different from wild type.
CONCLUSIONS
This study implicates new pathways and immune signaling proteins that may be associated with posterior segment uveitis susceptibility. A larger cohort and functional studies will help validate the pathogenicity of the mutations identified. In specific cases, whole-exome sequencing can help diagnose nonsyndromic uveitis in patients harboring known variants for syndromic inflammatory diseases.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calpain; Child; Child, Preschool; Female; Genetic Association Studies; Humans; Inflammasomes; Male; Middle Aged; Mutation, Missense; NLR Proteins; Proteomics; TYK2 Kinase; Uveitis, Posterior; Exome Sequencing
PubMed: 32707200
DOI: 10.1016/j.ajo.2020.07.021 -
Ocular Immunology and Inflammation Apr 2022To describe eight patients with toxoplasma retinochoroiditis following exposure to wild game.
PURPOSE
To describe eight patients with toxoplasma retinochoroiditis following exposure to wild game.
METHODS
Retrospective, multicenter case series.
RESULTS
Eight men, aged 29 to 71 (mean, 56 years), developed toxoplasmic retinochoroiditis after hunting and/or consuming wild game in the United States, including seven deer and one bear. Five patients developed the disease after eating undercooked game meat, while three developed ocular findings after cleaning hunted animals. Seven patients were healthy prior to exposure. LogMAR visual acuity at presentation was 0.697 ± 0.745, improving to 0.256 ± 0.335 by last follow-up. Disease complications developed in five (62.5%) patients, of which recurrence of retinochoroiditis was the most common.
CONCLUSIONS
Contact with wild game is a potential source of primary ocular toxoplasmosis in immunocompetent adults. Hunters and consumers of rare game are at risk of serious ocular disease and appropriate contact precautions and cooking may reduce this complication.
Topics: Animals; Chorioretinitis; Deer; Humans; Retrospective Studies; Toxoplasma; Toxoplasmosis, Ocular; United States; Visual Acuity
PubMed: 33560166
DOI: 10.1080/09273948.2020.1854316 -
Frontiers in Medicine 2022To compare indocyanine green angiography (ICGA) and swept-source wide-field optical coherence tomography angiography (SS-OCTA) for the assessment of patients with...
PURPOSE
To compare indocyanine green angiography (ICGA) and swept-source wide-field optical coherence tomography angiography (SS-OCTA) for the assessment of patients with posterior uveitis.
METHOD
SS-OCTA montage images of 5 x 12 x 12 mm or 2 x 15 x 9 mm, covering ~70-90 degree of the retina of consecutive patients with posterior uveitis were acquired. The choriocapillaries and choroidal slabs were compared to findings on ICGA.
RESULTS
Sixty-eight eyes of 41 patients were included (mean age 47.2 ± 20.4 years; 58.5% female). In 23 (34%) lesions were visible on OCTA, but not discernable on ICGA. In turn, out of the 45 eyes with clearly discernable lesions on ICGA, 22 (49%) and 21 (47%) eyes showed no corresponding areas of flow deficit on OCTA in the CC and choroidal slab, respectively. Lesion size strongly correlated among ICGA and OCTA choriocapillaries- (CC) (r = 0.99, ≤ 0.0001) and choroidal slabs (r = 0.99, ≤ 0.0001), respectively. The mean lesion size on the late frames of ICGA (8.45 ± 5.47 mm) was larger compared to the lesion size on OCTA CC scan (7.98 ± 5.47 mm, ≤ 0.0001) and choroidal scan (7.69 ± 5.10 mm, = 0.002), respectively. The lesion size on OCTA CC scan was significantly larger than on the OCTA choroidal scan ( ≤ 0.0001).
CONCLUSION
SS-wide field OCTA may be a promising tool to assess posterior uveitis patients and may replace ICGA to a certain extent in the future.
PubMed: 35586074
DOI: 10.3389/fmed.2022.853315 -
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 -
Ocular Immunology and Inflammation Dec 2023To report the causes of childhood-onset uveitis in a tertiary pediatric ophthalmology hospital in Egypt.
PURPOSE
To report the causes of childhood-onset uveitis in a tertiary pediatric ophthalmology hospital in Egypt.
METHODS
Retrospective study of the medical records of all uveitis patients following up at a tertiary pediatric ophthalmology hospital in Egypt from January 2017 to December 2020.
RESULTS
The present study included 388 patients. The most common anatomical category was intermediate uveitis (30.4%), and around half of these children had pars planitis. This was followed by panuveitis (25.5%), posterior uveitis (23.5%), and anterior uveitis (20.6%), in decreasing frequency. Juvenile idiopathic arthritis, toxoplasmosis, and Vogt-Koyanagi-Harada syndrome were the most common causes of anterior uveitis, posterior uveitis, and panuveitis respectively. Cataract (40.5%), glaucoma (33.8%), and cystoid macular edema (31.6%) were the most frequent ocular complications.
CONCLUSION
The present report provides the relative prevalence of the different anatomical types of uveitis, as well as their main causes in a cohort of Egyptian patients with childhood-onset uveitis.
Topics: Humans; Child; Egypt; Retrospective Studies; Uveitis; Panuveitis; Uveitis, Posterior; Tertiary Care Centers; Uveitis, Anterior; Acute Disease
PubMed: 36094930
DOI: 10.1080/09273948.2022.2117201 -
Health Technology Assessment... Nov 2017Non-infectious intermediate uveitis, posterior uveitis and panuveitis are a heterogeneous group of inflammatory eye disorders. Management includes local and systemic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Non-infectious intermediate uveitis, posterior uveitis and panuveitis are a heterogeneous group of inflammatory eye disorders. Management includes local and systemic corticosteroids, immunosuppressants and biological drugs.
OBJECTIVES
To evaluate the clinical effectiveness and cost-effectiveness of subcutaneous adalimumab (Humira; AbbVie Ltd, Maidenhead, UK) and a dexamethasone intravitreal implant (Ozurdex; Allergan Ltd, Marlow, UK) in adults with non-infectious intermediate uveitis, posterior uveitis or panuveitis.
DATA SOURCES
Electronic databases and clinical trials registries including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the World Health Organization's International Clinical Trials Registry Platform were searched to June 2016, with an update search carried out in October 2016.
REVIEW METHODS
Review methods followed published guidelines. A Markov model was developed to assess the cost-effectiveness of dexamethasone and adalimumab, each compared with current practice, from a NHS and Personal Social Services (PSS) perspective over a lifetime horizon, parameterised with published evidence. Costs and benefits were discounted at 3.5%. Substantial sensitivity analyses were undertaken.
RESULTS
Of the 134 full-text articles screened, three studies (four articles) were included in the clinical effectiveness review. Two randomised controlled trials (RCTs) [VISUAL I (active uveitis) and VISUAL II (inactive uveitis)] compared adalimumab with placebo, with limited standard care also provided in both arms. Time to treatment failure (reduced visual acuity, intraocular inflammation, new vascular lesions) was longer in the adalimumab group than in the placebo group, with a hazard ratio of 0.50 [95% confidence interval (CI) 0.36 to 0.70; < 0.001] in the VISUAL I trial and 0.57 (95% CI 0.39 to 0.84; = 0.004) in the VISUAL II trial. The adalimumab group showed a significantly greater improvement than the placebo group in the 25-item Visual Function Questionnaire (VFQ-25) composite score in the VISUAL I trial (mean difference 4.20; = 0.010) but not the VISUAL II trial (mean difference 2.12; = 0.16). Some systemic adverse effects occurred more frequently with adalimumab than with placebo. One RCT [HURON (active uveitis)] compared a single 0.7-mg dexamethasone implant against a sham procedure, with limited standard care also provided in both arms. Dexamethasone provided significant benefits over the sham procedure at 8 and 26 weeks in the percentage of patients with a vitreous haze score of zero ( < 0.014), the mean best corrected visual acuity improvement ( ≤ 0.002) and the percentage of patients with a ≥ 5-point improvement in VFQ-25 score ( < 0.05). Raised intraocular pressure and cataracts occurred more frequently with dexamethasone than with the sham procedure. The incremental cost-effectiveness ratio (ICER) for one dexamethasone implant in one eye for a combination of patients with unilateral and bilateral uveitis compared with limited current practice, as per the HURON trial, was estimated to be £19,509 per quality-adjusted life-year (QALY) gained. The ICER of adalimumab for patients with mainly bilateral uveitis compared with limited current practice, as per the VISUAL trials, was estimated to be £94,523 and £317,547 per QALY gained in active and inactive uveitis respectively. Sensitivity analyses suggested that the rate of blindness has the biggest impact on the model results. The interventions may be more cost-effective in populations in which there is a greater risk of blindness.
LIMITATIONS
The clinical trials did not fully reflect clinical practice. Thirteen additional studies of clinically relevant comparator treatments were identified; however, network meta-analysis was not feasible. The model results are highly uncertain because of the limited evidence base.
CONCLUSIONS
Two RCTs of systemic adalimumab and one RCT of a unilateral, single dexamethasone implant showed significant benefits over placebo or a sham procedure. The ICERs for adalimumab were estimated to be above generally accepted thresholds for cost-effectiveness. The cost-effectiveness of dexamethasone was estimated to fall below standard thresholds. However, there is substantial uncertainty around the model assumptions. In future work, primary research should compare dexamethasone and adalimumab with current treatments over the long term and in important subgroups and consider how short-term improvements relate to long-term effects on vision.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42016041799.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Adalimumab; Adult; Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Cost-Benefit Analysis; Dexamethasone; Humans; Quality-Adjusted Life Years; Technology Assessment, Biomedical; Uveitis, Intermediate; Uveitis, Posterior
PubMed: 29183563
DOI: 10.3310/hta21680 -
Retina (Philadelphia, Pa.) Mar 2020To correlate demographics, retinal lesion characteristics, and host immune status with the pathogen found on polymerase chain reaction analysis of aqueous fluid in...
PURPOSE
To correlate demographics, retinal lesion characteristics, and host immune status with the pathogen found on polymerase chain reaction analysis of aqueous fluid in patients with suspected infectious posterior uveitis.
METHODS
Medical records of patients who underwent anterior chamber paracentesis for suspected infectious posterior uveitis and had retinal photographs between 2014 and 2016 at a single institution were reviewed. Data collection included demographics, clinical appearance of the lesions, and polymerase chain reaction results. Fundus photographs were evaluated by two masked observers for the clinical features of the retinitis.
RESULTS
Twenty-eight patients were included in the study. There was substantial to almost perfect agreement on retinitis location (κ = 0.67) and number (κ = 0.76) between the masked photograph graders. Polymerase chain reaction results were positive for herpes simplex virus or varicella zoster virus in 43%, cytomegalovirus in 11%, and toxoplasmosis in 3%; 43% had negative polymerase chain reaction results. Detection of herpes simplex virus or varicella zoster virus on polymerase chain reaction of the aqueous was associated with paucifocal lesions (82%, P = 0.021) and lesions involving the peripheral retina (91%, P = 0.023), consistent with the diagnosis of acute retinal necrosis.
CONCLUSION
These data suggest that the diagnosis of acute retinal necrosis can be reasonably inferred on clinical examination, providing a guide for initial empiric therapy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Uveitis, Posterior; Vitreous Body; Young Adult
PubMed: 30601389
DOI: 10.1097/IAE.0000000000002423 -
Ocular Immunology and Inflammation Apr 2020Causes of uveitis vary upon the epidemiologic, racial, and geographical variations.
BACKGROUND
Causes of uveitis vary upon the epidemiologic, racial, and geographical variations.
OBJECTIVE
The objective of the study is to analyze pattern and outcome of uveitis in Phramongkutklao Hospital.
METHODS
This is a retrospective study.
RESULTS
Rate of uveitis was 580 cases per 100 000 persons including infectious uveitis (20%), idiopathic (36%), and noninfectious (44%). The male-to-female ratio was 1.2:1. Anterior uveitis was the most common (50%) followed by panuveitis (25.6%), posterior uveitis (12.3%), and intermediate uveitis (7.3%). The three most common causes were Behçet's disease, HLA-B27-associated uveitis, and herpetic iridocyclitis. A total of 62 patients (10.6%) suffered from blindness, for which the most diagnostic disease was Behçet's disease. The most common complication was glaucoma (21%). Acute onset, unilateral, posterior uveitis, granulomatous inflammation, and complications differed significantly between the infectious and noninfectious groups ( < 0.001).
CONCLUSION
The rate of uveitis was 0.58% and noninfectious uveitis was common. Clinical presentations regarding acute onset, unilateral, posterior uveitis, and granulomatous inflammation suggest infectious causes.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Biopsy; Child; Cross-Sectional Studies; Female; Fluorescein Angiography; Fundus Oculi; Hospitals, Military; Humans; Incidence; Male; Middle Aged; Prognosis; Retrospective Studies; Severity of Illness Index; Tertiary Care Centers; Thailand; Tomography, Optical Coherence; Uveitis; Young Adult
PubMed: 31009267
DOI: 10.1080/09273948.2019.1589527