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Scientific Reports Apr 2024Fuchs Uveitis Syndrome (FUS), also known as Fuchs Heterochromic Iridocyclitis, is a chronic form of uveitis characterized by mild inflammation primarily affecting one...
Fuchs Uveitis Syndrome (FUS), also known as Fuchs Heterochromic Iridocyclitis, is a chronic form of uveitis characterized by mild inflammation primarily affecting one eye. This study aimed to investigate the clinical and epidemiological features of FUS in an Iranian population. A retrospective analysis was conducted on 466 patients diagnosed with FUS at an ophthalmology center affiliated with Isfahan University of Medical Sciences between 2003 and 2021. The Kimura et al. criteria were used for FUS diagnosis. Demographic data, clinical characteristics, misdiagnosed cases, concurrent diseases, and associated ocular findings were analyzed. The study included 507 eyes of 466 FUS patients, with a mean age of 34.01 ± 11.25 years. Iris atrophy, keratic precipitates, and vitritis were common clinical findings. Heterochromia was an infrequent feature. Initial misdiagnosis occurred in 13 patients, with pars planitis being the most common incorrect diagnosis. Toxoplasmosis and multiple sclerosis were common concurrent diseases. Pediatric FUS cases were noted, possibly attributed to early-onset manifestations. Differences in clinical characteristics were observed when compared to other populations. This study provides insights into the clinical and epidemiological aspects of FUS in an Iranian population. Variations in clinical features, misdiagnosis patterns, and concurrent diseases were noted. Attention to specific clinical parameters can aid in accurate FUS diagnosis. Understanding these differences contributes to a better understanding of FUS presentation and its relationship with other diseases.
Topics: Humans; Child; Young Adult; Adult; Middle Aged; Iridocyclitis; Iran; Retrospective Studies; Eye; Iris Diseases
PubMed: 38616214
DOI: 10.1038/s41598-024-59393-w -
Turkish Journal of Ophthalmology Apr 2024In recent years, adalimumab has been increasingly used in the chronic treatment of non-infectious uveitis. This case report aimed to describe a drug-induced adverse...
In recent years, adalimumab has been increasingly used in the chronic treatment of non-infectious uveitis. This case report aimed to describe a drug-induced adverse event in a 34-year-old man who presented with blurred vision and floaters in the right eye and was being treated for intermediate uveitis. The patient had started topical treatment with a diagnosis of uveitis at another center. Best corrected visual acuity at presentation was 0.8 (decimal) in the right eye and 1.0 in the left eye. On examination, the anterior chamber in the right eye was clear, with anterior vitreous cells and mild haze, and snow banking and vitreous opacities in the inferior periphery. Fluorescein angiography (FA) showed hyperfluorescence in the right disc and leakage in the inferior periphery. As the inflammation did not resolve with local treatment, systemic cyclosporine was administered, after which the patient exhibited vomiting and weakness. Cyclosporine was discontinued and adalimumab treatment was started. On examination 5 months later, bilateral vitreous cells and mild vitreous opacity were noted, and FA showed mild leakage in the inferior periphery bilaterally. In addition, a depigmented patchy vitiligo lesion was observed on the chin. Due to the persistence of intraocular inflammation and on the recommendation of the dermatology clinic, adalimumab treatment was continued and topical tacrolimus was started for the lesion. On examination 3 months later, the inflammatory findings had resolved and there was no progression of the vitiligo lesion. The patient's treatment was continued. Taken together with the previous literature findings, no pathology was found in the patient's systemic examination, suggesting that this lesion was a side effect of the treatment. Ophthalmologists should be alert for this side effect in patients receiving adalimumab.
Topics: Humans; Adalimumab; Male; Adult; Fluorescein Angiography; Vitiligo; Anti-Inflammatory Agents; Visual Acuity; Fundus Oculi
PubMed: 38646109
DOI: 10.4274/tjo.galenos.2024.04575 -
Ocular Immunology and Inflammation May 2024To characterize and describe clinical experience with childhood-onset non-infectious uveitis.
OBJECTIVE
To characterize and describe clinical experience with childhood-onset non-infectious uveitis.
STUDY DESIGN
A multicenter retrospective multidisciplinary national web-based registry of 507 patients from 21 hospitals was analyzed. Cases were grouped as immune disease-associated (IMDu), idiopathic (IDIu) or ophthalmologically distinct. Characteristics of juvenile idiopathic arthritis-associated (non-HLA-B27-related) uveitis (JIAu), IDIu, and pars planitis (PP) were compared.
RESULTS
IMDu (62.3%) and JIAu (51.9%) predominated in young females; and IDIu (22.7%) and PP (13.6%) in older children, without sex imbalance. Ocular complications occurred in 45.3% of cases (posterior synechiae [28%], cataracts [16%], band keratopathy [14%], ocular hypertension [11%] and cystoid macular edema [10%]) and were associated with synthetic (86%) and biologic (65%) disease-modifying antirheumatic drug (DMARD) use. Subgroups were significantly associated ( < 0.05) with different characteristics. JIAu was typically anterior (98%), insidious (75%), in ANA-positive (69%), young females (82%) with fewer complications (31%), better visual outcomes, and later use of uveitis-effective biologics. In contrast, IDIu was characteristically anterior (87%) or panuveitic (12.1%), with acute onset (60%) and more complications at onset (59%: synechiae [31%] and cataracts [9.6%]) and less DMARD use, while PP is intermediate, and was mostly bilateral (72.5%), persistent (86.5%) and chronic (86.8%), with more complications (70%; mainly posterior segment and cataracts at last visit), impaired visual acuity at onset, and greater systemic (81.2%), subtenon (29.1%) and intravitreal (10.1%) steroid use.
CONCLUSION
Prognosis of childhood uveitis has improved in the "biologic era," particularly in JIAu. Early referral and DMARD therapy may reduce steroid use and improve outcomes, especially in PP and IDIu.
PubMed: 38728578
DOI: 10.1080/09273948.2024.2336609 -
Ophthalmology and Therapy Jun 2020To determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of...
INTRODUCTION
To determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of intraocular lenses.
METHODS
Uveitis ophthalmologists and pediatric ophthalmologists were surveyed via an online poll regarding their therapeutic management of pediatric uveitic cataract and intraocular lens (IOL) placement.
RESULTS
Sixty-two responses from uveitis ophthalmologists and 47 responses from pediatric ophthalmologists were recorded. According to 79% of all responses, uveitis was not a contraindication for primary IOL implantation in patients with controlled intraocular inflammation. Pediatric ophthalmologists were more likely to respond that the presence of chronic juvenile idiopathic arthritis-associated iridocyclitis, pars planitis, or recurrent acute anterior uveitis is a contraindication for primary IOL implantation in pediatric cases with full control of intraocular inflammation. There was no consensus within either specialty with regard to the preferred IOL material for lens implantation. Uveitis ophthalmologists were more likely to report the use of intravenous and intravitreal steroids for perioperative treatment. In cataract surgery for a child with recurrent acute anterior uveitis, a higher percentage of uveitis ophthalmologists (71%) than pediatric ophthalmologists (50%) responded that the posterior capsule should be primarily opened. A higher percentage of uveitis ophthalmologists also stated that anterior vitrectomy should be performed at the time of cataract surgery in all three uveitis types.
CONCLUSIONS
Pediatric ophthalmologists and uveitis ophthalmologists have similar approaches to the management of pediatric uveitic cataract removal and IOL insertion, but several differences remain between these subspecialties. Continued collaboration between the subspecialties would be helpful to better develop consistent criteria to improve patient care.
PubMed: 32157612
DOI: 10.1007/s40123-020-00245-x -
Postgraduate Medicine May 2023Our aim in this study was to reveal the clinical features of pediatric uveitis in the pandemic period and to compare it with the pre-pandemic era.
OBJECTIVE
Our aim in this study was to reveal the clinical features of pediatric uveitis in the pandemic period and to compare it with the pre-pandemic era.
METHODS
This retrospective study included 187 children diagnosed with uveitis between the 11 of March 2017 and the 11 of March 2022. The patients were divided into two groups based on the date of diagnosis as follows; Group 1: Patients diagnosed in the pre-pandemic period (11 March 2017-11 March 2020); Group 2: Patients diagnosed in the pandemic period (12 March 2020-11 March 2022). Demographic data, characteristics of uveitis, underlying diseases, systemic treatment modalities, and complications were compared between the two groups.
RESULTS
A total of 187 (pre-pandemic 71, and pandemic 114) pediatric uveitis patients were recruited to the study. Fifty one percent (51%) of the patients were female. The number of patients diagnosed with uveitis increased approximately twice during the pandemic period compared to the pre-pandemic period. The frequency of anterior uveitis was found to be significantly higher in the pandemic period than in the pre-pandemic period (p = 0.037). It was mostly presented as symptomatic uveitis. There was a decrease in the diagnosis of JIA-related uveitis. ANA positivity increased in the pandemic period (p = 0.029). The response to treatment was better and the complication rate decreased in the pandemic period.
CONCLUSION
The present study involved a large number of pediatric patients with uveitis. There are some differences in the characteristics of pediatric uveitis cases comparing the pandemic period and the pre-pandemic period. This increased frequency and changing clinical features of pediatric uveitis seems to be a result of COVID-19 infection.
Topics: Child; Humans; Female; Male; Retrospective Studies; Pandemics; COVID-19; Uveitis; Administration, Cutaneous
PubMed: 36851832
DOI: 10.1080/00325481.2023.2184092 -
Journal Francais D'ophtalmologie Jun 2024Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case...
INTRODUCTION
Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case of a child with toxocariasis associated with serous retinal detachment.
OBSERVATION
A 8-year-old child with no previous history of toxocariasis was referred for a 1-year decline in visual acuity, unimproved by optical correction, with vitreous condensation on examination, without central or peripheral granulomas, and serous retinal detachment on OCT. The diagnosis was made after extensive questioning, with evidence of contact with dogs and positive serology. Medical treatment combining corticosteroid therapy and antiparasitic therapy was initiated, and the clinical picture improved.
DISCUSSION
Ocular toxocariasis is a rare infection, unilateral in 90% of cases. Its clinical manifestation in children is pars planitis, posterior uveitis with a posterior pole chorioretinal focus associated with vitreoretinal traction and/or peripheral granuloma. In our case, the patient presented with vitreous condensation only, with OCT serous retinal detachment and no peripheral or central granulomas. Positive plasma serology or ocular samples confirmed the diagnosis.
CONCLUSION
Ocular toxocariasis should not be ruled out in the absence of a typical clinical picture, and seropositivity enables confirmation of the diagnosis when clinical suspicion arises.
Topics: Humans; Toxocariasis; Child; Eye Infections, Parasitic; Retinal Detachment; Male; Dogs; Animals
PubMed: 38713931
DOI: 10.1016/j.jfo.2024.104191 -
Graefe's Archive For Clinical and... Sep 2019To describe the characteristics of de novo uveitis in patients ≥ 60 years old. (Comparative Study)
Comparative Study
PURPOSE
To describe the characteristics of de novo uveitis in patients ≥ 60 years old.
METHODS
Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared.
RESULTS
A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group.
CONCLUSION
In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.
Topics: Age Factors; Aged; Animals; Behcet Syndrome; Eye Neoplasms; Female; Fluorescein Angiography; France; Fundus Oculi; Humans; Incidence; Male; Middle Aged; Ophthalmoscopy; Retrospective Studies; Sarcoidosis; Tertiary Care Centers; Tomography, Optical Coherence; Uveitis
PubMed: 31312906
DOI: 10.1007/s00417-019-04411-1 -
Medical Science Monitor : International... Dec 2019BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye....
Comparison of Methods of Endotamponade Used During 23-Gauge Pars Plana Vitrectomy and the Risk of Raised Intraocular Pressure During 24-Month Follow-Up: A Retrospective Study of 196 Patients.
BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye. Complications following PPV include raised intraocular pressure (IOP). This retrospective study aimed to compare methods of endotamponade used during 23-gauge PPV and the risk of raised IOP during 24-month follow-up at a single center. MATERIAL AND METHODS The study included 196 patients (age, 15-86 years; mean, 63.5 years) (196 eyeballs). There were 93 patients (47.45%) with a preoperative history of type 2 diabetes mellitus and 14 patients (7.14%) with a history of myopia. IOP was measured with Goldmann applanation tonometry at one-, three-, six-, 12-, and 24-month follow-up. The outcome was compared following endotamponade with silicone oil, sulfur hexafluoride (SF6), and balanced salt solution (BSS). RESULTS Mean IOP at one-month follow-up was 17.2 mmHg (±3.61 mmHg; range, 9-45 mmHg), and at 24-month follow-up was 17.3 mmHg (±3.23 mmHg; range, 7-30 mmHg). IOP following PPV was significantly associated with the indication for PPV (P=0.023), and the type of endotamponade used (P=0.049). In patients with silicone oil endotamponade, the risk of IOP at 24 months was increased by 2.3 times compared with SF6 or BSS endotamponade. Patients with SF6 endotamponade had a risk of IOP that was 3.3 times lower than for silicone oil tamponade or BSS tamponade. CONCLUSIONS Silicone oil endotamponade in PPV was associated with an increased risk of IOP at 24-month follow-up.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Endotamponade; Female; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Pars Planitis; Poland; Prospective Studies; Retinal Detachment; Retinal Diseases; Retrospective Studies; Risk Factors; Silicone Oils; Tonometry, Ocular; Vitrectomy; Vitreous Body
PubMed: 31811816
DOI: 10.12659/MSM.918114 -
Retina (Philadelphia, Pa.) Aug 2023To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal.
A New Technique of Pars Plana Vitrectomy With Microinterventional Nucleus Disassembly to Reduce the Energy of Fragmatome Lensectomy for Posteriorly Dislocated Crystalline Lens Removal.
PURPOSE
To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal.
METHODS
A microinterventional microfilament loop device was introduced through the sclerotomy created for the fragmatome to cleave the lens into smaller, manageable pieces.
RESULTS
Five cases were performed with this technique with improved visual acuity and no complications.
CONCLUSION
The use of microinterventional nucleus disassembly during pars plana vitrectomy for retained lens material is a novel approach with potential advantages including decreased operating time and reduced complications secondary to excessive production of ultrasound energy.
Topics: Humans; Pars Planitis; Vitrectomy; Lens, Crystalline; Postoperative Complications; Cataract Extraction
PubMed: 33315829
DOI: 10.1097/IAE.0000000000003048 -
European Journal of Ophthalmology Mar 2024To report a rare case of a 65 year old patient with a single caterpillar hair with localised lenticular opacity around it and no active inflammation.
PURPOSE
To report a rare case of a 65 year old patient with a single caterpillar hair with localised lenticular opacity around it and no active inflammation.
OBSERVATIONS
A single quiescent caterpillar hair embedded in the anterior lens capsule causing localised cataract around it. There was no other sign of ocular toxicosis and the patient was unaware of the presence of this intraocular foreign body.
CONCLUSIONS
Caterpillar hair (also known as setae) are a common cause of ophthalmia nodosa. These setae can penetrate intraocularly with ease to cause various forms of ocular toxicosis ranging from conjunctivitis, keratitis, pars planitis, chorioretinitis to even severe vitritis warranting enucleation. As per our knowledge and experience, no case of caterpillar hair without inflammation has been reported till date. We hereby report a rare case of a 65 year old patient with a single caterpillar hair embedded in the anterior lens capsule causing localised cataract around it without any active inflammation. In our opinion, if the eye is quiescent, the patient should be kept on close and long term follow-up and active intervention can be undertaken at the first instance of inflammation or if cataract progresses.
Topics: Animals; Humans; Aged; Lepidoptera; Eye Foreign Bodies; Cataract; Hair; Inflammation
PubMed: 37649334
DOI: 10.1177/11206721231199274