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Anales de Pediatria Jun 2023
Topics: Humans; Bartonella henselae; Retinitis; Cat-Scratch Disease
PubMed: 37164827
DOI: 10.1016/j.anpede.2023.04.006 -
Deutsches Arzteblatt International Jul 2022
Topics: Humans; Cytomegalovirus Retinitis; Antiviral Agents
PubMed: 36342101
DOI: 10.3238/arztebl.m2022.0126 -
Investigative Ophthalmology & Visual... Feb 2024Necrotizing viral retinitis is a serious eye infection that requires immediate treatment to prevent permanent vision loss. Uncertain clinical suspicion can result in...
PURPOSE
Necrotizing viral retinitis is a serious eye infection that requires immediate treatment to prevent permanent vision loss. Uncertain clinical suspicion can result in delayed diagnosis, inappropriate administration of corticosteroids, or repeated intraocular sampling. To quickly and accurately distinguish between viral and noninfectious retinitis, we aimed to develop deep learning (DL) models solely using noninvasive blood test data.
METHODS
This cross-sectional study trained DL models using common blood and serology test data from 3080 patients (noninfectious uveitis of the posterior segment [NIU-PS] = 2858, acute retinal necrosis [ARN] = 66, cytomegalovirus [CMV], retinitis = 156). Following the development of separate base DL models for ARN and CMV retinitis, multitask learning (MTL) was employed to enable simultaneous discrimination. Advanced MTL models incorporating adversarial training were used to enhance DL feature extraction from the small, imbalanced data. We evaluated model performance, disease-specific important features, and the causal relationship between DL features and detection results.
RESULTS
The presented models all achieved excellent detection performances, with the adversarial MTL model achieving the highest receiver operating characteristic curves (0.932 for ARN and 0.982 for CMV retinitis). Significant features for ARN detection included varicella-zoster virus (VZV) immunoglobulin M (IgM), herpes simplex virus immunoglobulin G, and neutrophil count, while for CMV retinitis, they encompassed VZV IgM, CMV IgM, and lymphocyte count. The adversarial MTL model exhibited substantial changes in detection outcomes when the key features were contaminated, indicating stronger causality between DL features and detection results.
CONCLUSIONS
The adversarial MTL model, using blood test data, may serve as a reliable adjunct for the expedited diagnosis of ARN, CMV retinitis, and NIU-PS simultaneously in real clinical settings.
Topics: Humans; Cross-Sectional Studies; Deep Learning; Cytomegalovirus Retinitis; Retinal Necrosis Syndrome, Acute; Eye Infections, Viral; Cytomegalovirus; Herpesvirus 3, Human; Immunoglobulin M
PubMed: 38306107
DOI: 10.1167/iovs.65.2.5 -
Journal of Investigative Medicine High... 2023Neuroretinitis is a condition typically characterized by unilateral optic neuropathy and is most commonly a sequelae of cat scratch disease (CSD) due to infection with ....
Neuroretinitis is a condition typically characterized by unilateral optic neuropathy and is most commonly a sequelae of cat scratch disease (CSD) due to infection with . Ophthalmologic examination will reveal a swollen optic nerve and may eventually reveal a canonical macular star; optical coherence tomography (OCT) will reveal flattening of the fovea, a thickened neurosensory retina, and subretinal fluid accumulation. Although CSD rarely presents with isolated neuorretinitis, it should be considered in patients presenting with unilateral visual changes. The differential diagnosis for neuroretinitis includes optic neuritis, inflammatory optic neuropathies (sarcoid, para-infectious, autoimmune), compressive, toxic, and more. We describe a pediatric patient presenting with visual changes that were initially concerning for optic neuritis and the diagnostic workup that ultimately led to a diagnosis of CSD neuroretinitis.
Topics: Humans; Cat-Scratch Disease; Bartonella henselae; Retinitis; Chorioretinitis; Optic Neuritis
PubMed: 36738077
DOI: 10.1177/23247096221150635 -
Romanian Journal of Ophthalmology 2023This study aimed to analyze retinal layers in the macular region using spectral-domain optical coherence tomography (SD-OCT). Additionally, we examined the retinal...
This study aimed to analyze retinal layers in the macular region using spectral-domain optical coherence tomography (SD-OCT). Additionally, we examined the retinal vascular plexus densities of the eyes using optical coherence tomography angiography (OCT-A), specifically in patients with retinitis pigmentosa (RP). In the study, 36 eyes from patients with retinitis pigmentosa (RP) and 36 eyes from healthy controls were included. Measurements involved assessing the thicknesses of each retinal layer at the central fovea, parafoveal, and perifovea using spectral domain optical coherence tomography (SD-OCT). Moreover, the study involved the evaluation of retinal capillary plexus densities (RCPD), encompassing deep capillary plexus density values, superficial capillary plexus, and radial peripapillary capillary plexus. This assessment was performed using optical coherence tomography angiography (OCT-A). No statistically significant difference in retinal thickness was found in the central fovea between the two groups. The thicknesses of the INL, OPL, and PRL in the parafoveal regions as well as the RPE in the perifoveal regions increased in the RP group. Nonetheless, the ONL, IPL, GCL, and RNFL demonstrated reduced thickness in both the perifoveal and parafoveal areas. The OCT-A findings indicated that patients with RP exhibited lower values for all RCPD. The retinal layers and RCPD were significantly impacted at varying rates of RP. It is essential to acknowledge that this alteration may be significant in the context of the retinal findings in patients with RP. SD-OCT = Spectral-domain optical coherence tomography, OCT-A = Optical coherence tomography angiography, RP = Retinitis pigmentosa, ETDRS = Early Treatment Diabetic Retinopathy Study, SD = standard deviation, TRT = Total Retinal Thickness, IRT = Inner Retinal Thickness, ORT = Outer Retinal Thickness, RNFL = Retinal Nerve Fiber Layer, GCL = Ganglion Cell Layer, IPL = Inner Plexiform Layer, INL = inner nuclear layer, OPL = Outer Plexiform Layer, ONL = Outer Nuclear Layer, PRL = Photoreceptor layer, RPE = Retinal Pigment Epithelium, µm = micrometer, PaFoSu = parafovea superior, PeFoSu = perifovea superior, PaFoNa = parafovea nasal, PeFoNa = perifovea nasal, PaFoTe = parafovea temporal, PeFoTe = perifovea temporal, PaFoIn = parafovea inferior, PeFoIn = perifovea inferior.
Topics: Humans; Retinal Ganglion Cells; Retina; Retinitis Pigmentosa; Tomography, Optical Coherence; Fovea Centralis
PubMed: 38239428
DOI: 10.22336/rjo.2023.53 -
Medicine Mar 2021Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. Necrotizing retinitis is a rare manifestation of ocular...
RATIONALE
Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. Necrotizing retinitis is a rare manifestation of ocular syphilis and mimics ARN.
PATIENT CONCERNS
We report a male patient who presented with bilateral dense vitritis obscuring fundus details similar to ARN, as a rare reported manifestation of syphilis, who was initially given intravitreal ganciclovir.
DIAGNOSIS
After the results for herpes viral PCR disclosed negative, the diagnosis of syphilitic necrotizing retinitis was made based on positive RPR.
INTERVENTION AND OUTCOMES
With the clinical diagnosis of ocular syphilis, treatment with intravenous penicillin was promptly initiated. His visual acuity improved to 20/100 in the right eye and still light perception in the left. Pars plana vitrectomy with silicon oil tamponade was performed in his left eye.
LESSONS
Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. However, whenever ARN is clinically suspected, empiric treatment against herpetic viruses should be promptly administered while awaiting further infectious disease study results. Recognition of syphilitic retinitis and prompt initiation of intravenous penicillin is of critical important for clinicians.
Topics: Eye Infections, Bacterial; Humans; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Retinitis; Syphilis; Treponema pallidum
PubMed: 33655916
DOI: 10.1097/MD.0000000000024452 -
International Ophthalmology Jul 2023To review management, treatment, and outcomes of patients with necrotizing herpetic retinitis (NHR) to propose an algorithm for first-line management of NHR.
PURPOSE
To review management, treatment, and outcomes of patients with necrotizing herpetic retinitis (NHR) to propose an algorithm for first-line management of NHR.
METHODS
Retrospective evaluation of a series of patients with NHR at our tertiary center between 2012 and 2021 using demographic, clinical, ophthalmologic, virological, therapeutic, and prognostic characteristics was performed. Patients were classified by NHR type: acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis.
RESULTS
Forty-one patients with NHR were included: 59% with ARN, 7% with PORN, and 34% with CMV retinitis. All patients with CMV retinitis and PORN were immunocompromised versus 21% of patients with ARN. CMV infection was found in 14 (34%) patients, varicella zoster virus infection in 14 (34%) patients, herpes simplex virus type 2 infection in 8 (20%) and type 1 infection in 5 (12%) patients. Intravenous antiviral therapy was received by 98% of patients and intravitreal antiviral injections by 90% of patients. The overall complication rate during follow-up was 83% of eyes. Most frequent complications were retinal detachment (33% eyes) and retinal break (29% eyes). Prognostic factors for poor visual outcomes were pre-existing monocular vision loss in contralateral eye among 17% of patients, bilateral NHR in 17% of patients, posterior pole involvement in 46% of eyes, and involvement > 2 retinal quadrants in 46% of eyes.
CONCLUSIONS
The visual prognosis of patients with NHR remains poor. Prompt investigation of immune status and presence of factors justifying intravitreal antiviral injections must be prioritized to initiate and adapt management while awaiting causative virus confirmation.
Topics: Humans; Prognosis; Retrospective Studies; Antiviral Agents; Retinal Necrosis Syndrome, Acute; Cytomegalovirus Retinitis; Eye Infections, Viral
PubMed: 36920634
DOI: 10.1007/s10792-023-02656-8 -
Genes Nov 2020RPE65 isomerase, expressed in the retinal pigmented epithelium (RPE), is an enzymatic component of the retinoid cycle, converting all-trans retinyl ester into 11-cis... (Review)
Review
RPE65 isomerase, expressed in the retinal pigmented epithelium (RPE), is an enzymatic component of the retinoid cycle, converting all-trans retinyl ester into 11-cis retinol, and it is essential for vision, because it replenishes the photon capturing 11-cis retinal. To date, almost 200 loss-of-function mutations have been identified within the gene causing inherited retinal dystrophies, most notably Leber congenital amaurosis (LCA) and autosomal recessive retinitis pigmentosa (arRP), which are both severe and early onset disease entities. We previously reported a mutation, D477G, co-segregating with the disease in a late-onset form of autosomal dominant RP (adRP) with choroidal involvement; uniquely, it is the only RPE65 variant to be described with a dominant component. Families or individuals with this variant have been encountered in five countries, and a number of subsequent studies have been reported in which the molecular biological and physiological properties of the variant have been studied in further detail, including observations of possible novel functions in addition to reduced RPE65 enzymatic activity. With regard to the latter, a human phase 1b proof-of-concept study has recently been reported in which aspects of remaining vision were improved for up to one year in four of five patients with advanced disease receiving a single one-week oral dose of 9-cis retinaldehyde, which is the first report showing efficacy and safety of an oral therapy for a dominant form of RP. Here, we review data accrued from published studies investigating molecular mechanisms of this unique variant and include hitherto unpublished material on the clinical spectrum of disease encountered in patients with the D477G variant, which, in many cases bears striking similarities to choroideremia.
Topics: Age of Onset; Amino Acid Substitution; Animals; Choroideremia; Clinical Trials, Phase I as Topic; DNA, Complementary; Enzyme Replacement Therapy; Female; Gene Knock-In Techniques; Genes, Dominant; Genetic Therapy; Genetic Vectors; Humans; Leber Congenital Amaurosis; Male; Mice; Mutation, Missense; Pedigree; Point Mutation; Proof of Concept Study; Protein Isoforms; Retinaldehyde; Retinitis Pigmentosa; cis-trans-Isomerases
PubMed: 33261050
DOI: 10.3390/genes11121420 -
Molecular Vision 2018The purpose of this study was to determine whether the blood-retina barrier is compromised by choroidal murine cytomegalovirus (MCMV) infection, using electron...
PURPOSE
The purpose of this study was to determine whether the blood-retina barrier is compromised by choroidal murine cytomegalovirus (MCMV) infection, using electron microscopy.
METHODS
BALB/c mice were immunosuppressed with methylprednisolone and monoclonal antibodies to CD4 and CD8. At several time points post-MCMV intraperitoneal inoculation, the eyes were removed and analyzed with western blotting and immunoelectron microscopy for the presence of MCMV early antigen (EA) and the host protein RIP3. Posterior eyecups from and mice were cultured and inoculated with MCMV. At days 4, 7, and 11 post-infection, cultures were collected and analyzed with plaque assay, immunohistochemical staining, and real-time PCR (RT-PCR).
RESULTS
MCMV EA was observed in the nuclei of vascular endothelial cells and pericytes in the choriocapillaris. Disruption of Bruch's membrane was observed, especially at sites adjacent to activated platelets, and a few RPE cells containing some enlarged vesicles were found directly beneath disrupted Bruch's membrane. Some virus particles were also observed in the enlarged vesicles of RPE cells. Levels of the RIP3 protein, which was observed mainly in the RPE cells and the basement membrane of the choriocapillaris, were greatly increased following MCMV infection, while depletion of RIP3 resulted in greatly decreased inflammasome formation, as well as expression of downstream inflammation factors.
CONCLUSIONS
The results suggest that systemic MCMV spreads to the choroid and replicates in vascular endothelia and pericytes of the choriocapillaris during immunosuppression. Choroidal MCMV infection is associated with in situ inflammation and subsequent disruption of Bruch's membrane and the outer blood-retina barrier.
Topics: Animals; Antibodies, Monoclonal; Antigens, Viral; Blood Platelets; Blood-Retinal Barrier; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Choroid; Cytomegalovirus Infections; Endothelial Cells; Eye Infections, Viral; Female; Immediate-Early Proteins; Immunocompromised Host; Inflammasomes; Methylprednisolone; Mice; Mice, Inbred BALB C; Muromegalovirus; Pericytes; Receptor-Interacting Protein Serine-Threonine Kinases; Retina; Retinal Pigment Epithelium; Retinitis
PubMed: 29853772
DOI: No ID Found -
Clinical & Experimental Optometry Jan 2016Necrotising retinopathies can be visually devastating. Most often associated with the viral family Herpesviridae and seen in both immune-competent and immunocompromised... (Review)
Review
Necrotising retinopathies can be visually devastating. Most often associated with the viral family Herpesviridae and seen in both immune-competent and immunocompromised hosts, possible complications of necrotising retinopathies include progressive retinal necrosis with or without macular involvement, optic neuropathy and ultimately, secondary retinal detachment. Examples include progressive outer retinal necrosis, acute retinal necrosis and cytomegaloviral retinitis. If diagnosed early and treated aggressively, visual complications can be prevented; however, there is no current consensus on the most appropriate antiviral regimen for each of the different varieties of necrotising herpetic retinopathy. This paper reviews aspects of varieties of necrotising herpetic retinopathy, including pathophysiology, treatment and diagnostic testing.
Topics: Adult; Herpes Zoster Ophthalmicus; Herpesviridae Infections; Humans; Male; Necrosis; Retina; Retinal Diseases; Retinal Necrosis Syndrome, Acute
PubMed: 26084658
DOI: 10.1111/cxo.12284