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Indian Journal of Ophthalmology Jul 2023To study the clinical presentation and treatment outcome of epidemic retinitis (ER) during pregnancy. (Observational Study)
Observational Study
PURPOSE
To study the clinical presentation and treatment outcome of epidemic retinitis (ER) during pregnancy.
METHODS
This is a retrospective, observational chart review of pregnant patients diagnosed with ER from January 2014 to February 2023. Demographic details, month of pregnancy at the onset of ocular symptoms, history of present illness, clinical manifestations, and treatment outcomes were studied.
RESULTS
In 9 years, ER was seen in 86 females, of whom 12 (13.9%) were pregnant. Twenty-one eyes of those 12 patients were studied. Most of the patients presented in the sixth month of pregnancy (range: 5-9 months, mean: 6.3 months). Physicians diagnosed viral exanthematous fever in six, typhoid in three, and suspected rickettsia in one patient. Medical termination of pregnancy (MTP) was performed in two patients before presentation. Weil-Felix test was positive in five, Brucella in one, WIDAL in three, and coronavirus disease 2019 (COVID-19) IgG and dengue IgG in one patient each. Oral antibiotics were given in five patients (two post-medical termination of pregnancy [MTP]) for the retinitis. All except four received oral steroids. Mean presenting corrected distant visual acuity (n = 21) was 20/125 (range: 20/20-20/20,000), which improved to (n = 18) 20/30 (range: 20/20-20/240). Macular edema (n = 11) resolved in 33.18 days (range: 20-50 days), and retinitis (n = 13) resolved in 58 days (range: 30-110 days). Ocular and systemic examination of newborn was possible in two and the babies were normal.
CONCLUSION
ER is seen commonly at the beginning of the third trimester. Lack of antibiotics may delay the resolution of retinitis. Ocular health needs to be assessed in larger series to conclude absence of retinal involvement in newborns.
Topics: Infant, Newborn; Female; Humans; Pregnancy; COVID-19; Retinitis; Retina; Anti-Bacterial Agents; Immunoglobulin G; Retrospective Studies
PubMed: 37417121
DOI: 10.4103/IJO.IJO_3169_22 -
American Journal of Ophthalmology Aug 2021To determine classification criteria for toxoplasmic retinitis.
PURPOSE
To determine classification criteria for toxoplasmic retinitis.
DESIGN
Machine learning of cases with toxoplasmic retinitis and 4 other infectious posterior uveitides / panuveitides.
METHODS
Cases of infectious posterior uveitides / panuveitides 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
Eight hundred three cases of infectious posterior uveitides / panuveitides, including 174 cases of toxoplasmic retinitis, were evaluated by machine learning. Key criteria for toxoplasmic retinitis included focal or paucifocal necrotizing retinitis and either positive polymerase chain reaction assay for Toxoplasma gondii from an intraocular specimen or the characteristic clinical picture of a round or oval retinitis lesion proximal to a hyperpigmented and/or atrophic chorioretinal scar. Overall accuracy for infectious posterior uveitides / panuveitides was 92.1% in the training set and 93.3% (95% confidence interval 88.2, 96.3) in the validation set. The misclassification rates for toxoplasmic retinitis were 8.2% in the training set and 10% in the validation set.
CONCLUSIONS
The criteria for toxoplasmic retinitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
Topics: Adult; Animals; Antibodies, Protozoan; Aqueous Humor; DNA, Protozoan; Eye Infections, Parasitic; Female; Humans; Machine Learning; Male; Retinitis; Toxoplasma; Toxoplasmosis, Ocular; Young Adult
PubMed: 33845002
DOI: 10.1016/j.ajo.2021.03.042 -
Progress in Retinal and Eye Research Mar 2021Ocular toxoplasmosis is a retinitis -almost always accompanied by vitritis and choroiditis- caused by intraocular infection with Toxoplasma gondii. Depending on retinal... (Review)
Review
Ocular toxoplasmosis is a retinitis -almost always accompanied by vitritis and choroiditis- caused by intraocular infection with Toxoplasma gondii. Depending on retinal location, this condition may cause substantial vision impairment. T. gondii is an obligate intracellular protozoan parasite, with both sexual and asexual life cycles, and infection is typically contracted orally by consuming encysted bradyzoites in undercooked meat, or oocysts on unwashed garden produce or in contaminated water. Presently available anti-parasitic drugs cannot eliminate T. gondii from the body. In vitro studies using T. gondii tachyzoites, and human retinal cells and tissue have provided important insights into the pathogenesis of ocular toxoplasmosis. T. gondii may cross the vascular endothelium to access human retina by at least three routes: in leukocyte taxis; as a transmigrating tachyzoite; and after infecting endothelial cells. The parasite is capable of navigating the human neuroretina, gaining access to a range of cell populations. Retinal Müller glial cells are preferred initial host cells. T. gondii infection of the retinal pigment epithelial cells alters the secretion of growth factors and induces proliferation of adjacent uninfected epithelial cells. This increases susceptibility of the cells to parasite infection, and may be the basis of the characteristic hyperpigmented toxoplasmic retinal lesion. Infected epithelial cells also generate a vigorous immunologic response, and influence the activity of leukocytes that infiltrate the retina. A range of T. gondii genotypes are associated with human ocular toxoplasmosis, and individual immunogenetics -including polymorphisms in genes encoding innate immune receptors, human leukocyte antigens and cytokines- impacts the clinical manifestations. Research into basic pathogenic mechanisms of ocular toxoplasmosis highlights the importance of prevention and suggests new biological drug targets for established disease.
Topics: Animals; Chorioretinitis; Eye Infections, Parasitic; Humans; Toxoplasma; Toxoplasmosis, Ocular
PubMed: 32717377
DOI: 10.1016/j.preteyeres.2020.100882 -
Journal Francais D'ophtalmologie Oct 2021
Topics: Antiviral Agents; Cytomegalovirus Retinitis; Humans
PubMed: 34481673
DOI: 10.1016/j.jfo.2020.01.008 -
The New England Journal of Medicine Mar 2021
Topics: Bartonella henselae; Cat-Scratch Disease; Female; Humans; Macular Edema; Middle Aged; Ophthalmoscopy; Retina; Retinitis
PubMed: 33705615
DOI: 10.1056/NEJMicm2005549 -
Ocular Immunology and Inflammation Dec 2023To describe the most important cause of infectious posterior uveitis in pediatric patients. (Review)
Review
PURPOSE
To describe the most important cause of infectious posterior uveitis in pediatric patients.
METHODS
Review of the literature.
RESULTS
The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas.
CONCLUSION
Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
Topics: Animals; Humans; Child; Uveitis, Posterior; Uveitis; Retinitis; Eye Infections; Eye Infections, Bacterial; Choroid; Granuloma
PubMed: 38096404
DOI: 10.1080/09273948.2023.2284990 -
Die Ophthalmologie Jun 2024
Topics: Humans; Retinitis
PubMed: 38507088
DOI: 10.1007/s00347-024-02019-3 -
Indian Journal of Ophthalmology Sep 2020Post-fever retinitis (PFR) is an infectious or para-infectious uveitic entity caused by bacterial or viral agents and seen mainly in tropical countries. Systemic... (Review)
Review
Post-fever retinitis (PFR) is an infectious or para-infectious uveitic entity caused by bacterial or viral agents and seen mainly in tropical countries. Systemic symptoms such as joint pain, skin rash are common during the febrile stage. On the basis of only clinical presentation, it is difficult to pin-point the exact etiology for PFR. Serological investigations, polymerase chain reaction, and knowledge of concurrent epidemics in the community may help to identify the etiological organism. Bacterial causes of PFR such as rickettsia and typhoid are treated with systemic antibiotics, with or without systemic steroid therapy, whereas PFR of viral causes such as chikungunya, dengue, West Nile virus, and Zika virus have no specific treatment and are managed with steroids. Nevertheless, many authors have advocated mere observation and the uveitis resolved with its natural course of the disease. In this article, we have discussed the clinical features, pathogenesis, investigations, and management of PFR.
Topics: Chikungunya Fever; Dengue; Humans; Retinitis; Zika Virus; Zika Virus Infection
PubMed: 32823394
DOI: 10.4103/ijo.IJO_1352_20 -
Progress in Retinal and Eye Research Jan 2020Quantitative fundus autofluorescence (qAF) is an approach that is built on a confocal scanning laser platform and used to measure the intensity of the inherent... (Review)
Review
Quantitative fundus autofluorescence (qAF) is an approach that is built on a confocal scanning laser platform and used to measure the intensity of the inherent autofluorescence of retina elicited by short-wavelength (488 nm) excitation. Being non-invasive, qAF does not interrupt tissue architecture, thus allowing for structural correlations. The spectral features, cellular origin and topographic distribution of the natural autofluorescence of the fundus indicate that it is emitted from retinaldehyde-adducts that form in photoreceptor cells and accumulate, under most conditions, in retinal pigment epithelial cells. The distributions and intensities of fundus autofluorescence deviate from normal in many retinal disorders and it is widely recognized that these changing patterns can aid in the diagnosis and monitoring of retinal disease. The standardized protocol employed by qAF involves the normalization of fundus grey levels to a fluorescent reference installed in the imaging instrument. Together with corrections for magnification and anterior media absorption, this approach facilitates comparisons with serial images and images acquired within groups of patients. Here we provide a comprehensive summary of the principles and practice of qAF and we highlight recent efforts to elucidate retinal disease processes by combining qAF with multi-modal imaging.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Macular Degeneration; Ophthalmoscopy; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 31472235
DOI: 10.1016/j.preteyeres.2019.100774 -
Practical Neurology Dec 2020
Topics: Chorioretinitis; Humans; Retinitis
PubMed: 32546515
DOI: 10.1136/practneurol-2020-002629