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Mediators of Inflammation 2020To examine demographic and clinical characteristics and long-term visual outcome in a cohort of Italian patients affected by Behçet's uveitis (BU).
OBJECTIVES
To examine demographic and clinical characteristics and long-term visual outcome in a cohort of Italian patients affected by Behçet's uveitis (BU).
MATERIALS AND METHODS
Retrospective chart review of 47 patients with BU attending our unit between January 2018 and December 2019. Ophthalmologic manifestations, best-corrected visual acuity (BCVA), fluoroangiography and optical coherence tomography findings, and ocular complications were recorded. Predictive factors of a poor visual outcome and long-term complications were also investigated.
RESULTS
Forty-seven patients (23 males and 24 females) for a total of 84 eyes were enrolled. Uveitis was bilateral in 37 (78.7%) patients with panuveitis being the most frequent anatomical pattern (40 out of 84 eyes), whereas 27 eyes presented a posterior uveitis. Isolated anterior uveitis was detected in 16 eyes. A significant improvement of median BCVA between baseline and last follow-up values was detected ( = 0.042). A higher risk of poor visual prognosis was observed in patients with uveitis duration greater than 15 years ( = 0.019). A significant resolution of retinal vasculitis was detected between baseline and last follow-up evaluation ( < 0.0001) whereas the mean ± SD macular thickness did not decrease significantly between baseline (376.00 ± 97.45 m) and last follow-up evaluation (338.08 ± 55.81 m). Forty-two eyes developed 57 complications during the disease course. Cataract was the most frequent ( = 12), followed by epiretinal membranes ( = 11) and cystoid macular edema ( = 6). The following variables were identified as predictors of long-term complications: human leukocyte antigen- (HLA-) B51 ( = 0.006), panuveitis ( = 0.037), and a uveitis duration of more than 15 years ( = 0.049).
CONCLUSIONS
In Italian patients, BU typically arises in the third decade and predominantly manifests as a bilateral posterior uveitis or panuveitis. Its duration is associated with a poor visual prognosis. Uveitis duration, the presence of HLA-B51, and panuveitis are predictors of long-term structural complications, thus representing main drivers in the treatment decision-making.
Topics: Adult; Behcet Syndrome; Cataract; Female; Fluorescein Angiography; HLA-B51 Antigen; Humans; Italy; Macular Edema; Male; Middle Aged; Ophthalmology; Panuveitis; Prognosis; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Uveitis; Young Adult
PubMed: 32508524
DOI: 10.1155/2020/6872402 -
Romanian Journal of Ophthalmology 2022To present the case of a 22-year-old man with a history of trauma on the right eye, followed by a sudden decrease of visual acuity on the left eye, but with a good...
To present the case of a 22-year-old man with a history of trauma on the right eye, followed by a sudden decrease of visual acuity on the left eye, but with a good recovery after surgical treatment. We reported a case of a 22-year-old patient with a sudden and painless decrease of visual acuity on the left eye, a month after a car accident, which led to the laceration of the right globe. At first, the patient received only medical treatment because he refused any surgical intervention. He had a favorable evolution during hospitalization, but he returned after a month with the same visual acuity as at his first admission. The patient accepted the medical treatment and the enucleation of the right eye, thus having a fast improvement in his visual acuity on the left eye. Although the enucleation was overdue, it had a strong favorable influence on the evolution of the disease. As a result of the surgery, the visual acuity has improved significantly in just a few days. OCT = optical coherence tomography.
Topics: Adult; Humans; Male; Ophthalmia, Sympathetic; Tomography, Optical Coherence; Visual Acuity; Young Adult
PubMed: 35531457
DOI: 10.22336/rjo.2022.17 -
Drugs & Aging May 2018Uveitis describes a group of inflammatory conditions of the eye that have various underlying causes and clinical presentations. Susceptibilities to uveitis in the... (Review)
Review
Uveitis describes a group of inflammatory conditions of the eye that have various underlying causes and clinical presentations. Susceptibilities to uveitis in the elderly may be attributed to age-related risk factors such as immunosenescence, increased immunological inflammatory mediators, and autoimmunity. Overall, anterior uveitis is more common than posterior and panuveitis in the general population and also in the elderly. Some causes of uveitis in the elderly are herpes simplex virus, ocular ischemic syndrome, sarcoidosis, and central nervous system lymphoma, and these will be discussed in detail herein. Eye care professionals need to consider the wide differential for uveitis, obtain the appropriate history, conduct a detailed clinical examination, and tailor management to the clinical presentation and underlying cause of disease. The challenges of polypharmacy and nonadherence in the elderly impact patient outcomes and must be taken into consideration when considering treatment.
Topics: Acute Disease; Age Factors; Humans; Panuveitis; Sarcoidosis; Uveitis
PubMed: 29663152
DOI: 10.1007/s40266-018-0545-3 -
BMC Ophthalmology Oct 2017Echinococcosis is a dangerous zoonotic parasitic disease. Ocular echinococcosis is very rare, especially the hydatid cysts in subretinal space. We present a case of...
BACKGROUND
Echinococcosis is a dangerous zoonotic parasitic disease. Ocular echinococcosis is very rare, especially the hydatid cysts in subretinal space. We present a case of subretinal echinococcosis and management.
CASE PRESENTATION
A 37-year-old man with subretinal echinococcosis who developed panuveitis and visual impairment. The patient lives on agriculture and animal husbandry, which made him susceptible to parasitic infection. He had severe panuveitis and blurred vision on arrival at hospital. According to his ocular examination and systemic review, the subretinal echinococcosis diagnosis was made. The patient received pars plana lensectomy and pars plana vitrectomy. The lesion underneath his retina was removed, and histopathology examination confirmed the subretinal echinococcosis diagnosis.
CONCLUSIONS
Echinococcosis is a dangerous zoonotic parasitic disease in pastoral areas. Ocular echinococcosis is usually secondary to systemic infection. Although the incidence is rare, the disease could lead to destructive visual function impairment.
Topics: Adult; Angiogenesis Inhibitors; Combined Modality Therapy; Echinococcosis; Echinococcosis, Pulmonary; Eye Infections, Parasitic; Glucocorticoids; Humans; Magnetic Resonance Imaging; Male; Panuveitis; Prednisolone; Ranibizumab; Retinal Diseases; Tomography, Optical Coherence; Tomography, X-Ray Computed; Triamcinolone Acetonide; Vision Disorders; Visual Acuity; Vitrectomy
PubMed: 28982354
DOI: 10.1186/s12886-017-0581-5 -
Acta Ophthalmologica Feb 2022To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during...
PURPOSE
To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy.
METHODS
Patients with MFC or PIC and a pregnancy in 2011-2019 from two academic centres were enrolled. For the most recent pregnancy, data on best-corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait-and-see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated.
RESULTS
Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait-and-see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti-VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP).
CONCLUSIONS
Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti-VEGF injections, though one patient developed ICP while treated with azathioprine.
Topics: Angiogenesis Inhibitors; Choroiditis; Female; Fluorescein Angiography; Fundus Oculi; Humans; Immunosuppressive Agents; Intravitreal Injections; Pregnancy; Pregnancy Complications; Prognosis; Receptors, Vascular Endothelial Growth Factor; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; White Dot Syndromes
PubMed: 34009733
DOI: 10.1111/aos.14898 -
Frontiers in Immunology 2023Non-infectious uveitis is a complex disease characterized by intraocular inflammation of the uveal area and the leading cause of vision impairment and blindness in young...
PURPOSE
Non-infectious uveitis is a complex disease characterized by intraocular inflammation of the uveal area and the leading cause of vision impairment and blindness in young people globally. However, what triggers inflammation and contributes to its recurrence remains unclear. The complement system has been linked to various immunological and inflammatory conditions. In the present study, we have systematically evaluated the role of the alternative complement pathway in the pathogenesis of non-infectious uveitis.
METHODOLOGY
Quantitative PCR was done in the peripheral leukocytes to study the expression of genes and regulatory miRNA in both anterior and posterior uveitis (n=28 in each category). Multiplex ELISA was performed to measure alternative pathway complement components, such as C3b, factor B, and CFH, and aqueous humor of infectious and non-infectious uveitis patients and non-inflammatory controls (n=10 each). Western blotting was done to validate the ELISA findings in a subset of patients and controls.
RESULTS
Downregulation of and mRNA in the peripheral blood was shown by quantitative PCR in the group of anterior uveiits (AU), while the opposite result was found in the group of posterior uveitis (PU). ELISA levels of C3b and CFH proteins were significantly higher in aqueous humor of infectious and non-infectious uveitis (*p = 0.03 and **p = 0.0007 respectively) as compared to the control group. Western blotting further validated (VitH) the activation of the complement cascade in the aqueous (AH) and vitreous humor of patients with non-infectious uveitis, with an increased level of C3b (n=6) and CFH (n=4) in aqueous humor. C3b level was significantly increased while CFH was reduced relative to controls in the vitreous humor (VitH) of posterior uveitis patients compared to controls (n=27 in each category). A C3b to CFH ratio was computed to assess the regulation of complement activation and this index was several folds higher in both anterior and posterior uveitis (n=10 each). The expression of miRNA-hsa-miR-146a and miRNA-hsa-miR-155-5p that regulates CFH was downregulated and nicely correlated with the increased complement proteins in both anterior and posterior uveitis (n=10 each).
CONCLUSION
Our results demonstrate a clear role of CFH and the activation of the alternative complement pathway in the pathogenesis of non-infectious uveitis; however, its therapeutic potential warrants further investigations.
Topics: Humans; Adolescent; Complement Pathway, Alternative; Uveitis; Uveitis, Posterior; MicroRNAs; Inflammation
PubMed: 38187376
DOI: 10.3389/fimmu.2023.1222998 -
Ceska a Slovenska Oftalmologie :... 2016Punctate Inner Choroidopathy (PIC) is a rare idiopathic ocular inflammatory disease. It occurs mostly in young, myopic, otherwise healthy women. Symptoms of the disease...
UNLABELLED
Punctate Inner Choroidopathy (PIC) is a rare idiopathic ocular inflammatory disease. It occurs mostly in young, myopic, otherwise healthy women. Symptoms of the disease include acute vision decrease associated with central and paracentral scotoma. In 80% of cases PIC occur bilaterally. We report the case of a woman at the age of twenty-five, who was treated for PIC. Due to the finding of active inflammatory deposit in the retina of the left eye and low visual acuity was recommended corticosteroid therapy with a good therapeutic effect.
KEY WORDS
Punctate Inner Choroidopathy (PIC), white dot syndromes.
Topics: Adult; Chorioretinitis; Female; Fluorescein Angiography; Glucocorticoids; Humans; Scotoma; Vision, Low; Visual Acuity
PubMed: 27341099
DOI: No ID Found -
La Tunisie Medicale Feb 2023Infectious uveitis (IU), one of the main causes of ocular inflammation in Tunisia, has various etiologies and clinical presentations. (Observational Study)
Observational Study
INTRODUCTION
Infectious uveitis (IU), one of the main causes of ocular inflammation in Tunisia, has various etiologies and clinical presentations.
AIM
To report the causes and clinical features of IU in a Tunisian population.
METHODS
Patients with IU referred to our department from February 2019 to January 2022 were included in a retrospective observational study. Ophthalmic examination and appropriate ancillary tests were performed.
RESULTS
Eighty eyes of 63 patients were included (37 female and 26 male). The mean age was 45 years. IU was unilateral in 43 cases, bilateral in 17, and unilateral alternating in three cases. Panuveitis was the most common anatomic location (35% of cases) followed by posterior (31%), anterior (18 eyes), intermediate (6 eyes) and anterior and intermediate uveitis (3 eyes). Non granulomatous uveitis (55%) occurred more frequently than granulomatous uveitis (45%). Etiologies were dominated by bacterial infections (29 patients; 46%), mainly tuberculosis (23 patients), followed by viruses (19 patients), mainly Herpes simplex virus. Fungal infection was found in one patient, while parasites accounted for 14 cases, mostly toxoplasmosis. Mean initial diagnostic delay was 16 months. The most common complications included occlusive retinal vasculitis (19 eyes), cataract (17 eyes), cystoid macular edema (17 eyes) and papilledema (15 eyes).
CONCLUSION
This study highlighted the causes and clinical features of IU in our setting. Tuberculosis remains one of its most frequent etiologies in Tunisia. However, a larger multicenter national study would allow a more precise evaluation.
Topics: Humans; Female; Male; Middle Aged; Delayed Diagnosis; Uveitis; Eye Infections, Bacterial; Panuveitis; Cataract
PubMed: 37682270
DOI: No ID Found -
The Korean Journal of Gastroenterology... May 2019In patients with inflammatory bowel disease (IBD), ocular extraintestinal manifestations (EIM) are less common than EIM of other systems, but they are clinically... (Review)
Review
In patients with inflammatory bowel disease (IBD), ocular extraintestinal manifestations (EIM) are less common than EIM of other systems, but they are clinically important because they can lead to complications that can cause catastrophic damage to the visual acuity and ocular structure. Anterior uveitis and episcleritis are the most common ocular EIM. Involvement of the orbit, posterior segment, and optic nerve can also occur. A variety of treatments are available ranging from topical steroids to systemic immunosuppressive therapies. The treatment of IBD is also essential if the activity of inflammatory bowel disease affects the ocular symptoms.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Eye Diseases; Humans; Inflammatory Bowel Diseases; Retinal Diseases; Scleritis; Steroids; Uveitis, Anterior
PubMed: 31132833
DOI: 10.4166/kjg.2019.73.5.269 -
Indian Journal of Ophthalmology Dec 2022A 35-year-old Asian Indian female previously diagnosed with bilateral anterior uveitis and on oral methotrexate developed bilateral anterior uveitis following...
A 35-year-old Asian Indian female previously diagnosed with bilateral anterior uveitis and on oral methotrexate developed bilateral anterior uveitis following first/second dose of coronavirus disease 2019 (COVID-19) vaccination. She had skipped her weekly dose of oral methotrexate following first dose of vaccination. Following the second dose, she reduced her oral methotrexate from 25 to 15 mg on her own, but did not stop like the previous occasion. She had extensive workup for her uveitis in the past with only positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) antibodies. She developed unilateral anterior uveitis after she had COVID-19 in July 2022, which resolved with topical steroids and continuation of immunosuppression. This report illustrates that COVID-19 or its vaccination may presumably play a role in triggering the immune system and can cause recurrent ocular inflammation even in the absence of an extraocular inflammation.
Topics: Female; Humans; Adult; COVID-19; SARS-CoV-2; COVID-19 Vaccines; Methotrexate; Uveitis, Anterior; Vaccination; Acute Disease; Inflammation
PubMed: 36453363
DOI: 10.4103/ijo.IJO_1089_22