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Expert Review of Clinical Immunology Sep 2021: Noninfectious uveitis (NIU) is one of the leading causes of blindness worldwide. In adult patients, anterior NIU is usually managed with topical corticosteroids. In... (Review)
Review
: Noninfectious uveitis (NIU) is one of the leading causes of blindness worldwide. In adult patients, anterior NIU is usually managed with topical corticosteroids. In intermediate, posterior uveitis. and panuveitis, systemic corticosteroids are used especially in case of bilaterality or association with systemic disease. Biotherapies are recommended in case of inefficacy or intolerance to corticosteroids or conventional immunosuppressive drugs. Anti-TNF-α agents are by far the most widely used biotherapies. In case of failure or poor tolerance to anti-TNF-α, new targeted therapies can be proposed.: We present and discuss an updated overview on biologics and biotherapies in NIU.: In case of dependency to systemic or intravitreal steroids, sight-threatening disease, and/or failure of conventional immunosuppressive drugs, anti-TNF-α are used as first-line biologics to achieve quiescence of inflammation. Anti-interleukin-6 is another option that may be proposed as first-line biologic or in case of poor efficacy of anti-TNF-α. Interferon can be directly proposed in specific indications (e.g. refractory macular edema, sight-threatening Behçet's uveitis). In the rare cases that remain unresponsive to traditional biotherapies, novel molecules, such as Janus-associated-kinase and anti-phosphodiesterase-4-inhibitors can be used. Therapeutic response must always be evaluated by clinical and appropriate ancillary investigations.
Topics: Adult; Behcet Syndrome; Humans; Immunosuppressive Agents; Immunotherapy; Tumor Necrosis Factor Inhibitors; Uveitis
PubMed: 34264142
DOI: 10.1080/1744666X.2021.1956313 -
Cornea Oct 2022Oleander is a poisonous plant with extensively documented systemic side effects; however, oleander's ophthalmic side effects have not been detailed in the literature. We...
PURPOSE
Oleander is a poisonous plant with extensively documented systemic side effects; however, oleander's ophthalmic side effects have not been detailed in the literature. We report a case of oleander-associated keratitis with subsequent corneal edema and anterior uveitis.
METHODS
This is a case report and review of relevant literature.
RESULTS
A 58-year-old woman presented with large corneal epithelial defect after being struck in the eye with an oleander leaf. Despite treatment with topical moxifloxacin, she developed severe corneal edema and anterior uveitis. A diagnosis of oleander-associated ocular inflammation with secondary corneal edema was made, given the temporal relationship, and treatment was initiated with topical prednisolone and cyclopentolate. However, the corneal edema and inflammation continued to progress until oral prednisone and topical difluprednate were initiated. Visual acuity, anterior uveitis, and corneal edema significantly improved with aggressive immunomodulation. Follow-up at 1 month confirmed complete recovery of symptoms, corneal edema and anterior uveitis.
CONCLUSIONS
Severe corneal edema and anterior uveitis can be associated with oleander exposure. Aggressive treatment with oral and topical steroids may be required without persistent sequelae at the 5-month follow-up. Ophthalmologists should consider this inflammatory reaction if patients experience ocular exposure to oleander.
Topics: Corneal Edema; Cyclopentolate; Female; Humans; Inflammation; Keratitis; Middle Aged; Moxifloxacin; Nerium; Prednisolone; Prednisone; Uveitis, Anterior
PubMed: 36107850
DOI: 10.1097/ICO.0000000000003032 -
Practical Neurology Oct 2023Neurological involvement in Behçet's syndrome arises predominately through an inflammatory meningoencephalitis characterised by perivenular inflammation due to... (Review)
Review
Neurological involvement in Behçet's syndrome arises predominately through an inflammatory meningoencephalitis characterised by perivenular inflammation due to activation of Th-17 immunological pathways. The brainstem is involved in 50% of cases, the diencephalon and other areas of the brain in 30%, and the spinal cord in 10%. Movement disorders and epilepsy may occur. Psychiatric syndromes may arise with brain and brainstem involvement, and cognitive disorders relate to the brain disease, to circulating inflammatory factors, and to fatigue and despondency. Eighty per cent of cases begin with a relapsing disease course, of whom 70% have only one attack, and 30% have a progressive disease course either from onset or following an initially relapsing course. Venous thrombosis leading to intracranial hypertension and cerebral venous infarction is less common and caused by inflammation in affected veins and a circulating prothrombotic state. Arterial involvement is rare and relates to an arteritis affecting large-sized and medium-sized vessels within the brain leading to infarction, subarachnoid and parenchymal haemorrhage, aneurysm formation and arterial dissection. There is a newly recognised disorder of cerebral cortical hypoperfusion. Cranial neuropathy, peripheral neuropathy and myositis are rare. There has been significant progress in understanding the pathophysiology and treatment of the systemic disease, leading to improved outcomes, but there has been no randomised trial of treatment in the neurological disorder.
Topics: Humans; Behcet Syndrome; Magnetic Resonance Imaging; Treatment Outcome; Inflammation; Infarction
PubMed: 37775123
DOI: 10.1136/pn-2023-003875 -
Vestnik Oftalmologii 2021This literature review is dedicated to the Behçet's disease - a multi-symptom, severe autoimmune condition, relatively rare among the population of the former Soviet... (Review)
Review
This literature review is dedicated to the Behçet's disease - a multi-symptom, severe autoimmune condition, relatively rare among the population of the former Soviet republics, and to one of its three most frequent manifestations - uveitis.
Topics: Behcet Syndrome; Humans; Uveitis
PubMed: 34726867
DOI: 10.17116/oftalma2021137051130 -
La Tunisie MedicaleBehçet's disease is a chronic vasulitis. The aphtous stomatitis is present in nearly the totality of patients having this disease.
INTRODUCTION
Behçet's disease is a chronic vasulitis. The aphtous stomatitis is present in nearly the totality of patients having this disease.
AIM
The purpose of this study was to evaluate the oral health of Behcet's disease (BD) patients and then compare it with healthy controls.
METHODS
Twenty patients with BD and 20 healthy subjects were included in this cross-sectional study conducted at the military hospital of Bizerta from 01/10/2017 to 31/05/2019. The level of plaque were recorded using the plaque index (PI). The gingival index (GI) was used to evaluate the gingival inflammation. The depths of the sulci/pockets were probed with a periodontal probe. The clinical attachment loss (CAL) was measured from the cementoenamel junction to the sulcus base. The caries status was scored by using DMFT introduced by Klein and Palmer.The diagnosis of oral lesions was performed using the visual tactile examination.
RESULTS
The two groups were age, sexe, and socioeconomic level matched. The percentage of oral ulcers was observed to be higher in BD patients compared with healthy controls (40% Vs 5%, p0.01). Statistical significant differences in the two groups' PI (1,19±0,38 Vs 0,86±0,37 ; p=0,011) and GI (1,10±0,30 Vs 0,75±0,36 ; p=0,03) were observed. The probing depth, the CAL and the DMF/T showed no associations with the BD.
CONCLUSION
Our results showed that gingival health is worse in BD patients. Therfore, the dentist must play an important part in the management of BD and the motivation for the oral hygiene.
Topics: Behcet Syndrome; Cross-Sectional Studies; Humans; Oral Health; Periodontal Index
PubMed: 36155901
DOI: No ID Found -
Archivos de La Sociedad Espanola de... Apr 2020
Topics: Adult; Biopsy; Brain Neoplasms; Eye Neoplasms; Humans; Intraocular Lymphoma; Magnetic Resonance Imaging; Male; Panuveitis; Recurrence
PubMed: 31899059
DOI: 10.1016/j.oftal.2019.11.007 -
Acta Medica Portuguesa Sep 2023Behçet's disease is a relapsing multisystemic inflammatory syndrome characterized by recurrent oral and/or genital ulcers, uveitis, arthritis, skin lesions, and... (Review)
Review
Behçet's disease is a relapsing multisystemic inflammatory syndrome characterized by recurrent oral and/or genital ulcers, uveitis, arthritis, skin lesions, and gastrointestinal and neurological involvement. Neuro-Behçet corresponds to nervous system involvement and is one of the most severe complications of Behçet disease. It occurs in 3% to 30% of cases and is categorized into parenchymal (most common) or non-parenchymal disease. The most common manifestation of parenchymal neuro-Behçet is meningoencephalitis with involvement of the brainstem, where patients present with cranial neuropathies, encephalopathy, sensory-motor syndromes, epilepsy, or myelitis. The main non-parenchymal manifestation is cerebral venous thrombosis. Neuro-Behçet has a predominantly subacute course, with remission within weeks, or clinical progression in one third of the cases. The diagnosis is essentially clinical and diagnostic tests help to corroborate the suspicion, distinguish from differential diagnoses, and exclude complications. Brain magnetic resonance imaging allows the identification of acute lesions (hypointense or isointense on T2-weighted and hypointense on T1-weighted sequences) contrast-enhanced, and chronic lesions characterized by non-contrast enhanced small lesions and brainstem atrophy. If non-parenchymal involvement is suspected, cerebral veno-magnetic resonance imaging /computed tomography should be performed. Cerebrospinal fluid shows elevated proteinorachia and pleocytosis in parenchymal and no changes in non-parenchymal neuro-Behçet (except increased opening pressure). Outbursts of parenchymal disease should be treated with high dose intravenous corticosteroid therapy, with subsequent switch to oral corticoids, followed by biologic therapy, usually an anti-TNF. The treatment of cerebral venous thrombosis is controversial and may consist of a combination of corticosteroids and anticoagulation.
Topics: Humans; Behcet Syndrome; Tumor Necrosis Factor Inhibitors; Brain; Magnetic Resonance Imaging; Diagnosis, Differential; Adrenal Cortex Hormones; Venous Thrombosis
PubMed: 37345389
DOI: 10.20344/amp.19734 -
New Zealand Veterinary Journal Nov 2023Medical records of four dogs diagnosed with protothecosis in New Zealand were reviewed. The dogs were aged between 4 and 9 years and three of the four dogs were female....
CASE HISTORIES
Medical records of four dogs diagnosed with protothecosis in New Zealand were reviewed. The dogs were aged between 4 and 9 years and three of the four dogs were female. Breeds were one Labrador, one Miniature Schnauzer and two crossbreeds. The reasons for initial veterinary evaluation were a cough and opaque appearance of the right eye (Case 1), diarrhoea (Cases 2 and 3), and cutaneous disease (Case 4).
CLINICAL FINDINGS
The ocular signs were characterised by panuveitis, retinal detachment and secondary glaucoma. Gastrointestinal signs included chronic haemorrhagic diarrhoea due to colitis. Three cases had disseminated infection and developed both bilateral, blinding, ocular disease and chronic gastrointestinal disease. Cutaneous signs consisted of draining fistulae over the olecranon, multifocal cutaneous nodules, and ulceration and tracts of the foot pads. Disseminated protothecosis was confirmed by histopathology of biopsied ocular tissues in Cases 1 and 2 and by gastrointestinal biopsies in Case 3. spp. were also identified in cytological specimens from Cases 1 and 4 and recovered by culture in Cases 2 and 4. Cutaneous protothecosis was diagnosed in Case 4 initially by cytology and histopathology of skin lesions, and was confirmed by PCR of cultured organisms.
TREATMENT AND OUTCOME
Prior to diagnosis of protothecosis, a variety of treatments were prescribed to treat the gastrointestinal and ocular signs. After diagnosis, only Cases 2 and 4 received medication aimed at treating the protothecal infection, which was itraconazole in both cases. Following the progression of clinical signs and concerns about quality of life, all four dogs were euthanised.
DIAGNOSIS
Disseminated protothecosis in three dogs, cutaneous protothecosis in one dog.
CLINICAL RELEVANCE
Canine protothecosis is rarely reported, despite the ubiquity of the causal algae, and the disease usually carries an extremely grave prognosis when infection is generalised. In New Zealand, protothecosis should be considered as a differential diagnosis in dogs with panuveitis, chorioretinitis or retinal detachment, colitis, or nodular, ulcerative or fistulating cutaneous lesions.
Topics: Dogs; Animals; Female; Male; Infections; Retinal Detachment; New Zealand; Quality of Life; Plant Breeding; Colitis; Panuveitis; Dog Diseases; Prototheca
PubMed: 37584100
DOI: 10.1080/00480169.2023.2248066 -
American Journal of Ophthalmology Aug 2021To determine classification criteria for serpiginous choroiditis.
PURPOSE
To determine classification criteria for serpiginous choroiditis.
DESIGN
Machine learning of cases with serpiginous choroiditis 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 infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set.
RESULTS
One thousand sixty-eight cases of posterior uveitides, including 122 cases of serpiginous choroiditis, were evaluated by machine learning. Key criteria for serpiginous choroiditis included (1) choroiditis with an ameboid or serpentine shape; (2) characteristic imaging on fluorescein angiography or fundus autofluorescence; (3) absent to mild anterior chamber and vitreous inflammation; and (4) the exclusion of tuberculosis. 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 serpiginous choroiditis were 0% in both the training set and the validation set.
CONCLUSIONS
The criteria for serpiginous choroiditis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
Topics: Adult; Choroid; Female; Fluorescein Angiography; Fundus Oculi; Humans; Machine Learning; Male; Middle Aged; White Dot Syndromes
PubMed: 33845013
DOI: 10.1016/j.ajo.2021.03.038 -
American Journal of Ophthalmology Aug 2021The purpose of this study was to determine classification criteria for sympathetic ophthalmia.
PURPOSE
The purpose of this study was to determine classification criteria for sympathetic ophthalmia.
DESIGN
Machine learning of cases with sympathetic ophthalmia and 5 other panuveitides.
METHODS
Cases of panuveitides 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 in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the panuveitides. The resulting criteria were evaluated in the validation set.
RESULTS
A total of 1,012 cases of panuveitides, including 110 cases of sympathetic ophthalmia, were evaluated by machine learning. The overall accuracy for panuveitides was 96.3% in the training set and 94.0% in the validation set (95% confidence interval: 89.0-96.8). Key criteria for sympathetic ophthalmia included bilateral uveitis with 1) a history of unilateral ocular trauma or surgery and 2) an anterior chamber and vitreous inflammation or a panuveitis with choroidal involvement. The misclassification rates for sympathetic ophthalmia were 4.2% in the training set and 6.7% in the validation set.
CONCLUSIONS
The criteria for sympathetic ophthalmia had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
Topics: Adult; Anterior Chamber; Female; Humans; Male; Middle Aged; Ophthalmia, Sympathetic; Tomography, Optical Coherence
PubMed: 33845005
DOI: 10.1016/j.ajo.2021.03.048