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Ophthalmology Feb 2021The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular...
Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis-Report 2: Guidelines for Initiating Antitubercular Therapy in Anterior Uveitis, Intermediate Uveitis, Panuveitis, and Retinal Vasculitis.
TOPIC
The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular Immunological Society, set up an international, expert-led consensus project to develop evidence- and experience-based guidelines for the management of tubercular uveitis (TBU).
CLINICAL RELEVANCE
The absence of international agreement on the use of antitubercular therapy (ATT) in patients with TBU contributes to a significant heterogeneity in the approach to the management of this condition.
METHODS
Consensus statements for the initiation of ATT in TBU were generated using a 2-step modified Delphi technique. In Delphi step 1, a smart web-based survey based on background evidence from published literature was prepared to collect the opinion of 81 international experts on the use of ATT in different clinical scenarios. The survey included 324 questions related to tubercular anterior uveitis (TAU), tubercular intermediate uveitis (TIU), tubercular panuveitis (TPU), and tubercular retinal vasculitis (TRV) administered by the experts, after which the COTS group met in November 2019 for a systematic and critical discussion of the statements in accordance with the second round of the modified Delphi process.
RESULTS
Forty-four consensus statements on the initiation of ATT in TAU, TIU, TPU, and TRV were obtained, based on ocular phenotypes suggestive of TBU and corroborative evidence of tuberculosis, provided by several combinations of immunologic and radiologic test results. Experts agreed on initiating ATT in recurrent TAU, TIU, TPU, and active TRV depending on the TB endemicity. In the presence of positive results for any 1 of the immunologic tests along with radiologic features suggestive of past evidence of tuberculosis infection. In patients with a first episode of TAU, consensus to initiate ATT was reached only if both immunologic and radiologic test results were positive.
DISCUSSION
The COTS consensus guidelines were generated based on the evidence from published literature, specialists' opinions, and logic construction to address the initiation of ATT in TBU. The guidelines also should inform public policy by adding specific types of TBU to the list of conditions that should be treated as tuberculosis.
Topics: Algorithms; Antitubercular Agents; Chemotherapy, Adjuvant; Delphi Technique; Eye Infections, Bacterial; Glucocorticoids; Humans; Interferon-gamma Release Tests; Panuveitis; Radiography, Thoracic; Retinal Vasculitis; Retrospective Studies; Surveys and Questionnaires; Tomography, X-Ray Computed; Tuberculosis, Ocular; Uveitis, Anterior; Uveitis, Intermediate
PubMed: 32603726
DOI: 10.1016/j.ophtha.2020.06.052 -
Medicina Clinica Nov 2023
Topics: Humans; Listeria monocytogenes; Panuveitis; Food Microbiology; Listeriosis
PubMed: 37666684
DOI: 10.1016/j.medcli.2023.06.039 -
Journal Francais D'ophtalmologie May 2023
Topics: Humans; COVID-19 Vaccines; COVID-19; Panuveitis; Visual Acuity; RNA, Messenger
PubMed: 36934019
DOI: 10.1016/j.jfo.2022.10.002 -
Ocular Immunology and Inflammation May 2021: COVID-19 vaccination has been accompanied by reports of inflammatory events. This report details a case of panuveitis following vaccination for COVID-19 Case.: A 43...
: COVID-19 vaccination has been accompanied by reports of inflammatory events. This report details a case of panuveitis following vaccination for COVID-19 Case.: A 43 year old female developed panuveitis with decreased vision three days after her second dose of Pfizer-Biontech mRNA vaccine. The choroid was significantly thickened and there was anterior chamber and vitreous inflammation. Shortly after onset of ocular symptoms she was also found have an asymptomatic COVID-19 infection. Treatment with oral and topical corticosteroids resulted in improvement in the panuveitis, with a mild recurrence after the initial attempt to taper these drugs.: This report demonstrates a likely occurrence of vaccine-related panuveitis secondary to the Pfizer-Biotech mRNA vaccine for COVID-19.
Topics: Adult; Anterior Chamber; COVID-19; COVID-19 Vaccines; Female; Humans; Panuveitis; SARS-CoV-2; Tomography, Optical Coherence; Vaccination
PubMed: 34213988
DOI: 10.1080/09273948.2021.1949478 -
Ocular Immunology and Inflammation 2019: This review aims to provide a detailed update in Seasonal hypercute panuveitis (SHAPU) which is a blinding disease of unknown etiology reported only from Nepal,... (Review)
Review
: This review aims to provide a detailed update in Seasonal hypercute panuveitis (SHAPU) which is a blinding disease of unknown etiology reported only from Nepal, occurring every odd year since 1975 predominantly in children. : Data sources were literature reviewed using PubMed, Medline, and ISI Databases (since 1975 to late 2017). Search items included SHAPU, seasonal endophthalmitis, hypopyon uveitis, caterpillar induced uveitis alone or in combination with white moth, panuveitis, and review. : Epidemics of SHAPU occur between August to December usually in odd years. Two thirds of the children present with unilateral blind eye which eventually becomes soft with shallowing of anterior chamber called as Malignant Hypotension. Hypopyon, fibrinous exudates in anterior chamber, difficult to dilate pupil and inability to visualize the retina because of massive exudation into vitreous producing a "White pupil in a Red eye" with little or no pain is its characteristic features. Contact with moths has been suspected. Because of presence of microbial agents in few cases, an infectious etiology has not been ruled out. : Although SHAPU has been reported only from Nepal, lack of its report from ecologically similar terrain along Hindukush Mountains and possible association with moths remain intriguing.
Topics: Age Distribution; Animals; Anti-Bacterial Agents; Antiviral Agents; Humans; Immunosuppressive Agents; Moths; Nepal; Panuveitis; Seasons; Visual Acuity
PubMed: 29543556
DOI: 10.1080/09273948.2018.1439643 -
Indian Journal of Ophthalmology Sep 2020Ocular manifestations of Sweet syndrome, or acute febrile neutrophilic dermatosis, are usually limited to the anterior segment. We report the case of a patient with...
Ocular manifestations of Sweet syndrome, or acute febrile neutrophilic dermatosis, are usually limited to the anterior segment. We report the case of a patient with bilateral panuveitis and retinal vasculitis associated with Sweet syndrome. A 45-year-old Asian female with an undiagnosed febrile illness with rash presented with bilateral panuveitis with haemorrhagic occlusive retinal vasculitis. Skin biopsy confirmed Sweet Syndrome. Intraocular inflammation resolved with a combination of topical and systemic corticosteroids as well as intravenous cyclophosphamide, with resulting permanent severe right visual impairment. Although an uncommon condition, Sweet syndrome should be considered in any febrile patient with skin lesions and uveitis.
Topics: Biopsy; Female; Humans; Middle Aged; Panuveitis; Retinal Vasculitis; Skin; Sweet Syndrome
PubMed: 32823459
DOI: 10.4103/ijo.IJO_1667_19 -
Ophthalmic Surgery, Lasers & Imaging... Mar 2021Although a small number of cases of secondary uveitis have been documented in the setting of ibrutinib therapy, panuveitis has not previously been described with this...
Although a small number of cases of secondary uveitis have been documented in the setting of ibrutinib therapy, panuveitis has not previously been described with this medication. The authors describe a presumed case of panuveitis in a patient on ibrutinib for chronic lymphocytic leukemia. The purpose of this report is to document a case of asymmetric, bilateral panuveitis in the setting of ibrutinib use. Panuveitis may develop in the setting of ibrutinib use, and local steroid therapy can be successfully used for treatment without cessation of systemic cancer therapy. .
Topics: Adenine; Humans; Panuveitis; Piperidines; Uveitis
PubMed: 34038692
DOI: 10.3928/23258160-20210302-08 -
Indian Journal of Ophthalmology Jun 2022Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within... (Review)
Review
Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within the first year of trauma occurrence but can be delayed by several years. It manifests as acute/chronic granulomatous uveitis with yellowish-white choroidal lesions or Dalen-Fuchs nodules. Initially, patients respond rapidly to corticosteroid therapy, but a majority require long-term use of corticosteroid-sparing agents to prevent recurrences. The purpose of this review is to elaborate on the current understanding of the pathophysiology, the importance of multimodal imaging in early diagnosis, and the role of newer immunomodulatory and biological agents in recalcitrant cases.
Topics: Adrenal Cortex Hormones; Choroid; Humans; Ophthalmia, Sympathetic
PubMed: 35647958
DOI: 10.4103/ijo.IJO_2363_21 -
Ocular Immunology and Inflammation May 2023Morvan syndrome (MoS) is a neurologic disorder belonging to a spectrum of autoimmune encephalitis, Contactin-associated protein-like 2 (Caspr2) antibody syndrome. We... (Review)
Review
PURPOSE
Morvan syndrome (MoS) is a neurologic disorder belonging to a spectrum of autoimmune encephalitis, Contactin-associated protein-like 2 (Caspr2) antibody syndrome. We report a case of bilateral panuveitis associated with MoS.
METHODS
Case report and review of the literature.
RESULTS
A 57-year-old male with Morvan syndrome presented with painless vision loss and floaters. Initial visual acuities were 20/50 and 20/60. Hallmarks of this uveitis included persistently active vitritis, and nonhemorrhagic retinitis with nonperfusion and neovascularization. Uveitis consistently flared with attempted immunosuppressive tapers. Vision deteriorated to count fingers (2 ft) OU over 2.5 years despite corticosteroids, mycophenolate mofetil, intravenous immunoglobulin, adalimumab, and rituximab. Explanations for reduced final visual acuity included macular atrophy, disruption of retinal architecture, epiretinal membrane, vitritis, and cataract.
CONCLUSIONS
This case constitutes the first report of uveitis associated with MoS and Caspr2 antibody syndrome, raising the question of autoimmunity targeting the retinal inner and/or outer plexiform layers.
Topics: Male; Humans; Middle Aged; Panuveitis; Uveitis; Adrenal Cortex Hormones; Retina; Encephalitis; Syndrome; Vision Disorders
PubMed: 35404744
DOI: 10.1080/09273948.2022.2054823 -
European Journal of Ophthalmology Jan 2022Intraocular lymphoma (IOL) is an uncommon ophthalmic malignancy and poses a diagnostic challenge. Uveitis associated with systemic lymphoma (USL) has been predominantly... (Review)
Review
BACKGROUND
Intraocular lymphoma (IOL) is an uncommon ophthalmic malignancy and poses a diagnostic challenge. Uveitis associated with systemic lymphoma (USL) has been predominantly attributed to non-Hodgkin lymphoma (NHL) and rarely reported with Hodgkin lymphoma (HL) in the literature.
METHODS
Case report with review of the literature.
RESULTS
A 25-year-old healthy male presented with bilateral granulomatous panuveitis including vasculitis and discrete chorioretinal yellowish-white lesions. Macular optical coherence tomography (OCT) of both eyes revealed a disruption of ellipsoid and interdigitation zones over the areas of subretinal lesions as well as a small sub-retinal pigment epithelium (RPE) deposit in one eye. Thorough uveitis workup revealed clavicular, axillary and cervical lymphadenopathy, and biopsy of lymph nodes confirmed the diagnosis of nodular lymphocyte-predominant (NLP) HL. Six months later and after receiving chemotherapy, all symptoms and most of clinical signs resolved.
CONCLUSIONS
Clinical features of USL do not differ between HL and NHL. However, the age of presentation may be much younger in HL. Ocular manifestations can precede systemic HL diagnosis, as shown in our patient. Therefore, USL should be part of the differential diagnosis of panuveitis. Paraneoplastic inflammation is thought be the cause of uveitis associated with HL. The sub-RPE deposit and disruption of ellipsoid and interdigitation zones on OCT have not been documented before as a manifestation of uveitis secondary to HL. In addition, the NLP subtype of HL was reported in only 1 case with uveitis in the literature.
Topics: Adult; Hodgkin Disease; Humans; Male; Panuveitis; Retinal Pigment Epithelium; Tomography, Optical Coherence; Uveitis
PubMed: 33153312
DOI: 10.1177/1120672120969036