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Ocular Immunology and Inflammation Jul 2022We report a case of bilateral panuveitis and its resolution based on multimodal retinal images after she was administered the first dose of a viral vector-based vaccine...
METHOD
We report a case of bilateral panuveitis and its resolution based on multimodal retinal images after she was administered the first dose of a viral vector-based vaccine against SARS-CoV-2.
CASE REPORT
A 72-year-old woman complained of bilateral blurred vision with headache, neck stiffness, and tinnitus 3 days after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. Initial examination revealed anterior chamber reactions, left optic disc hyperemia, and bilateral chorioretinal folds with choroidal thickening. Fluorescein and indocyanine green angiography revealed bilateral choroiditis and papillitis. Systemic steroid therapy dramatically alleviated panuveitis and meningeal signs. No recurrence was noted until 3 months after discontinuation of steroids.
CONCLUSIONS
Bilateral panuveitis mimicking Vogt-Koyanagi-Harada disease can develop shortly after the first dose of the ChAdOx1 nCoV-19 vaccine. Ophthalmologists should consider bilateral panuveitis as a presumed post-vaccination adverse event. Systemic steroid therapy may be effective for the nCoV-19 vaccine-associated panuveitis.
Topics: Aged; Female; Humans; ChAdOx1 nCoV-19; COVID-19; COVID-19 Vaccines; Fluorescein Angiography; Fluoresceins; Indocyanine Green; Panuveitis; SARS-CoV-2; Uveomeningoencephalitic Syndrome
PubMed: 35113750
DOI: 10.1080/09273948.2022.2026410 -
Ocular Immunology and Inflammation Apr 2023To report a case of bilateral panuveitis and occlusive vasculitis following COVID-19 vaccination.
PURPOSE
To report a case of bilateral panuveitis and occlusive vasculitis following COVID-19 vaccination.
STUDY DESIGN
Case report.
RESULTS
A 41-year-old otherwise healthy male presented with progressive vision loss and floaters starting 48 hours after a first dose of COVID-19 vaccine. Examination initially showed bilateral anterior uveitis, but this evolved into bilateral panuveitis with occlusive vasculitis despite topical corticosteroids over two weeks. The patient underwent extensive testing for other etiologies which were excluded. He was successfully treated with a gradual taper of topical and systemic corticosteroids leading to improvement of signs and symptoms. Follow-up is maintained for observation of avascular zones with possible neovascularization which could require laser as needed.
CONCLUSIONS
The temporal association between vaccine and presentation makes this a plausible etiology. This remains a rare adverse event, but clinicians should be aware of this possibility to include it in their differential diagnosis when confronted with idiosyncratic ocular presentations.
Topics: Humans; Male; Adult; COVID-19 Vaccines; COVID-19; Panuveitis; Vasculitis; Adrenal Cortex Hormones; Vaccination
PubMed: 35226580
DOI: 10.1080/09273948.2022.2042325 -
Ocular Immunology and Inflammation 2016To describe the clinical characteristics and surgical management of rhegmatogenous retinal detachment (RD) in patients with acute syphilitic panuveitis. (Review)
Review
PURPOSE
To describe the clinical characteristics and surgical management of rhegmatogenous retinal detachment (RD) in patients with acute syphilitic panuveitis.
METHODS
Retrospective case series and comprehensive literature review.
RESULTS
Including present and previously reported cases, we identified 11 eyes in 8 patients with acute syphilitic panuveitis that developed a rhegmatogenous RD. Seven of 11 eyes (63.6%) were repaired with a combined scleral buckling, vitrectomy, and endolaser photocoagulation surgery; 1 eye (9.1%) was repaired with scleral buckling only; and 2 eyes (18.2%) with vitrectomy only. Cryotherapy was used to treat a giant retinal tear in 1 eye (9.1%). Four eyes (36.4%) redetached and 3 underwent a second vitrectomy surgery.
CONCLUSIONS
Although uncommon, rhegmatogenous RD can occur in patients with moderate to severe acute syphilitic panuveitis. We believe scleral buckling, vitrectomy, endolaser photocoagulation, and silicone oil tamponade give the best chance for successful retinal reattachment.
Topics: Acute Disease; Adult; Cryotherapy; Eye Infections, Bacterial; HIV Infections; Humans; Laser Coagulation; Male; Middle Aged; Panuveitis; Retinal Detachment; Retinal Perforations; Retrospective Studies; Scleral Buckling; Syphilis; Vitrectomy
PubMed: 24960278
DOI: 10.3109/09273948.2014.925122 -
Indian Journal of Ophthalmology 2010Panuveitis is a generalized inflammation of not only the whole of the uveal tract but also involves the retina and vitreous humor. It differs from other anatomical sites... (Review)
Review
Panuveitis is a generalized inflammation of not only the whole of the uveal tract but also involves the retina and vitreous humor. It differs from other anatomical sites of inflammation in terms of causes as well as distribution. The common causes of panuveitis in our population are tuberculosis, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia, Behcet's disease and sarcoidosis. A large number of cases still remain idiopathic. A stepwise approach is essential while evaluating these patients to be able to identify and treat the disease timely and correctly. Ancillary tests can be appropriately applied once the anatomic site of inflammation is identified. An exhaustive approach comprising a full battery of tests is obsolete. Only specific tailored investigations are ordered as suggested by the preliminary clinical and ocular examination. The mainstay of the treatment of uveitis is corticosteroids. Immunosuppressive agents are administered if the inflammation is not adequately controlled with corticosteroids. One of the recent breakthroughs in the treatment of refractory uveitis includes the introduction of immunomodulating drugs: Tumor necrosis factor-alpha antagonist and Interferon-alpha. Vitrectomy has been used in uveitis for over a few decades for diagnostic and therapeutic purposes. When compared to other anatomical sites of inflammation, panuveitis has poor visual outcome due to more widespread inflammation. The side-effects of the chronic treatment that these patients receive cannot be overlooked and should be specifically monitored under the supervision of an internist with special interest in inflammatory diseases.
Topics: Animals; Diagnosis, Differential; Fluorescein Angiography; Fundus Oculi; Glucocorticoids; Humans; Immunosuppressive Agents; Panuveitis; Prognosis; Tomography, Optical Coherence; Vitrectomy
PubMed: 20029145
DOI: 10.4103/0301-4738.58471 -
Annals of the Academy of Medicine,... Jun 2021
Topics: Humans; Panuveitis; Retinal Detachment; Typhoid Fever; Visual Acuity
PubMed: 34195760
DOI: 10.47102/annals-acadmedsg.2020595 -
Klinische Monatsblatter Fur... Feb 2020
Topics: Humans; Panuveitis
PubMed: 30939619
DOI: 10.1055/a-0774-7962 -
Der Ophthalmologe : Zeitschrift Der... Sep 2021The standardization of uveitis nomenclature (SUN) working group is an international expert committee, which follows the aim to develop a standardized and... (Review)
Review
BACKGROUND
The standardization of uveitis nomenclature (SUN) working group is an international expert committee, which follows the aim to develop a standardized and internationally recognized terminology for the field of uveitis. This appears to be important in view of the demand for evidence-based medicine, especially for relatively rare diseases such as uveitis.
METHODS
A databank of > 4000 uveitis patients was compiled using formal consensus techniques, for whom a majority consensus was previously achieved in the diagnosis. The patient data were analyzed within the subclasses of uveitis and divided into a training set and a validation set. Multinomial logistic regressions with LASSO regularization were carried out on the training set with machine learning (ML). The accuracy of the rules that were developed to express the criteria of ML, were assessed by a masked observer in a random sample of 10%.
RESULTS
The estimations of total accuracy according to the uveitis classes in the validation set were high for all forms of uveitis: anterior uveitis 96.7% (95% confidence interval, CI 92.4-98.6%), intermediate uveitis 99.3% (95% CI 96.1-99.9%), posterior uveitis 98.0% (95% CI 94.3-99.3%), panuveitis 94.0% (95% CI 89.0-96.8%) and infectious posterior uveitis/panuveitis 93.3% (95% CI 89.1-96.3%).
CONCLUSION
Classification criteria are presented, which show a high degree of accuracy (low misclassification rates) and are therefore suitable for future clinical and translational research.
Topics: Humans; Panuveitis; Reference Standards; Uveitis; Uveitis, Anterior; Uveitis, Intermediate
PubMed: 34459962
DOI: 10.1007/s00347-021-01486-2 -
Ophthalmology Jun 2021To evaluate long-term efficacy and safety of extended treatment with adalimumab in patients with noninfectious intermediate, posterior, or panuveitis. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate long-term efficacy and safety of extended treatment with adalimumab in patients with noninfectious intermediate, posterior, or panuveitis.
DESIGN
Open-label, multicenter, phase 3 extension study (VISUAL III).
PARTICIPANTS
Adults who had completed a randomized, placebo-controlled phase 3 parent trial (VISUAL I or II) without treatment failure (inactive uveitis) or who discontinued the study after meeting treatment failure criteria (active uveitis).
METHODS
Patients received subcutaneous adalimumab 40 mg every other week. Data were collected for ≤ 362 weeks. Adverse events (AEs) were recorded until 70 days after the last dose.
MAIN OUTCOME MEASURES
Long-term safety and quiescence; other efficacy variables included inflammatory lesions, anterior chamber cell and vitreous haze grade, macular edema, visual acuity, and dose of uveitis-related systemic corticosteroids.
RESULTS
At study entry, 67% of patients (283/424) showed active uveitis and 33% (141/424) showed inactive uveitis; 60 patients subsequently met exclusion criteria, and 364 were included in the intention-to-treat analysis. Efficacy variables were analyzed through week 150, when approximately 50% of patients (214/424) remained in the study. Patients showing quiescence increased from 34% (122/364) at week 0 to 85% (153/180) at week 150. Corticosteroid-free quiescence was achieved by 54% (66/123) and 89% (51/57) of patients with active or inactive uveitis at study entry. Mean daily dose of systemic corticosteroids was reduced from 9.4 ± 17.1 mg/day at week 0 (n = 359) to 1.5 ± 3.9 mg/day at week 150 (n = 181). The percentage of patients who achieved other efficacy variables increased over time for those with active uveitis at study entry and was maintained for those with inactive uveitis. The most frequently reported treatment-emergent AEs of special interest were infections (n = 275; 79 events/100 patient-years [PY]); AEs and serious AEs occurred at a rate of 396 events/100 PY and 15 events/100 PY, respectively.
CONCLUSIONS
Long-term treatment with adalimumab led to quiescence and reduced corticosteroid use for patients who entered VISUAL III with active uveitis and led to maintenance of quiescence for those with inactive uveitis. AEs were comparable with those reported in the parent trials and consistent with the known safety profile of adalimumab.
Topics: Adalimumab; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Injections, Subcutaneous; Male; Middle Aged; Panuveitis; Retrospective Studies; Time Factors; Treatment Outcome; Uveitis, Intermediate; Uveitis, Posterior; Visual Acuity; Young Adult
PubMed: 33157077
DOI: 10.1016/j.ophtha.2020.10.036 -
The Lancet. Global Health Jan 2022
Topics: Age Factors; Disease Outbreaks; Humans; Nepal; Panuveitis; Seasons; Sex Factors
PubMed: 34919853
DOI: 10.1016/S2214-109X(21)00513-1 -
International Ophthalmology Aug 2023To identify the characteristics and outcome of panuveitis of undetermined origin (PUO) after diagnostic vitrectomy.
PURPOSE
To identify the characteristics and outcome of panuveitis of undetermined origin (PUO) after diagnostic vitrectomy.
METHODS
Retrospective analysis of all patients who underwent vitrectomy for diagnostic/therapeutic purposes from 2013 to 2020, whose vitreous biopsies turned out negative and final diagnoses were not clinically supported.
RESULTS
Of 122 operated eyes, 36 eyes (29.5%) were defined as PUO (67.8 ± 14.9 years). The presenting clinical picture revealed a predominantly bilateral condition (70% of eyes) with significant posterior segment involvement: 3.1 ± 0.6 vitritis, 61.1% of eyes with retinal vasculitis, 44.4% with macular edema, and 30.6% with exudative retinal detachment. Presenting visual acuity was 1.2 ± 0.7 logMAR, and up to 90% remained stable or improved vision over a ~ 3.5 year observation period. None of the presenting clinical features turned out to be predictive of final visual outcome or survival.
CONCLUSIONS
PUO is present in up to 30% of cases after diagnostic/therapeutic vitrectomy. This mainly bilateral condition shows chronic and overall stable long-term outcome, generally with retained steady visual function.
Topics: Humans; Vitrectomy; Retrospective Studies; Tertiary Care Centers; Retinal Detachment; Panuveitis; Treatment Outcome
PubMed: 36913167
DOI: 10.1007/s10792-023-02683-5