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Graefe's Archive For Clinical and... Apr 2023To evaluate the effectiveness of 0.19-mg fluocinolone acetonide implant (FAi) for preventing inflammatory relapses in noninfectious uveitis with posterior segment...
PURPOSE
To evaluate the effectiveness of 0.19-mg fluocinolone acetonide implant (FAi) for preventing inflammatory relapses in noninfectious uveitis with posterior segment involvement in standard clinical practice. Further, to assess the value of remission induction therapy with intraocular and periorbital administered high-dose corticosteroids before FAi.
METHODS
A retrospective cohort study in a tertiary referral center specialized in uveitis management. The primary study outcomes were the best-corrected visual acuity (BVCA) and central retinal thickness (CRT) within a 12-month observation period. The secondary outcomes were intraocular pressure (IOP) and intraocular inflammation. The main safety measures were IOP increase and cataract formation.
RESULTS
In total, 76 eyes of 57 patients received FAi. Locally administered high-dose corticosteroids were applied in 68.4% of all eyes before FAi. BCVA remained stable within the 12-month observation period (63.21 vs. 62.95, difference 0.26 letters; 95% CI: - 6.31 to 6.84; p > 0.9). Significant CRT reduction upon FAi was sustained after 12 months (362.7 vs. 309.1 μm, difference 53.57 μm; 95% CI: 1.55 to 105.6; p = 0.04). Intraocular inflammation was reduced until 9 months of follow-up (0.82 vs. 0.3, difference 0.53; 95% CI: 0.11 to 0.95; p = 0.007). A mean IOP increase (13.68 vs. 15.6; difference - 1.92; 95% CI: - 3.85 to 0.004; p = 0.0507) and cataract development (20% of all phakic eyes) were noted.
CONCLUSION
We observed similar levels of FAi effectiveness for the treatment of noninfectious uveitis in standard clinical practice compared to previous randomized clinical trials. Moreover, remission induction therapy before FAi can benefit patients with increased baseline uveitis activity.
Topics: Humans; Glucocorticoids; Retrospective Studies; Drug Implants; Neoplasm Recurrence, Local; Fluocinolone Acetonide; Uveitis; Intraocular Pressure; Inflammation; Cataract; Treatment Outcome; Uveitis, Posterior
PubMed: 36399176
DOI: 10.1007/s00417-022-05893-2 -
Ocular Immunology and Inflammation Dec 2023To report the causes of childhood-onset uveitis in a tertiary pediatric ophthalmology hospital in Egypt.
PURPOSE
To report the causes of childhood-onset uveitis in a tertiary pediatric ophthalmology hospital in Egypt.
METHODS
Retrospective study of the medical records of all uveitis patients following up at a tertiary pediatric ophthalmology hospital in Egypt from January 2017 to December 2020.
RESULTS
The present study included 388 patients. The most common anatomical category was intermediate uveitis (30.4%), and around half of these children had pars planitis. This was followed by panuveitis (25.5%), posterior uveitis (23.5%), and anterior uveitis (20.6%), in decreasing frequency. Juvenile idiopathic arthritis, toxoplasmosis, and Vogt-Koyanagi-Harada syndrome were the most common causes of anterior uveitis, posterior uveitis, and panuveitis respectively. Cataract (40.5%), glaucoma (33.8%), and cystoid macular edema (31.6%) were the most frequent ocular complications.
CONCLUSION
The present report provides the relative prevalence of the different anatomical types of uveitis, as well as their main causes in a cohort of Egyptian patients with childhood-onset uveitis.
Topics: Humans; Child; Egypt; Retrospective Studies; Uveitis; Panuveitis; Uveitis, Posterior; Tertiary Care Centers; Uveitis, Anterior; Acute Disease
PubMed: 36094930
DOI: 10.1080/09273948.2022.2117201 -
International Ophthalmology Clinics 1995
Review
Topics: Cataract; Cataract Extraction; Chronic Disease; Humans; Lenses, Intraocular; Uveitis, Posterior
PubMed: 7490176
DOI: 10.1097/00004397-199503520-00011 -
International Ophthalmology Clinics 1996The subretinal fibrosis and uveitis syndrome is a rare posterior uveitis characterized in the early stages by a multifocal choroiditis, followed by progressive... (Review)
Review
The subretinal fibrosis and uveitis syndrome is a rare posterior uveitis characterized in the early stages by a multifocal choroiditis, followed by progressive subretinal fibrosis. It usually is seen in otherwise healthy, young myopic women with no systemic disease. Symptoms include acute, unilateral visual loss, scotomas, metamorphopsia, and photopsias. Ophthalmic examination reveals a mild anterior or posterior uveitis, and transient, multiple, small, whitish-yellow RPE or choroidal lesions in the posterior pole and midperiphery. These lesions fade or enlarge and coalesce to create areas of white subretinal fibrosis, a progression that occurs over weeks to months. The visual prognosis generally is poor, and recurrences are common. Treatment is controversial, with some authors finding an early beneficial effect of steroids and chemotheraphy in severe cases. The etiology is not known, but is believed to be a localized autoimmune reaction to the RPE.
Topics: Blindness; Female; Fibrosis; Humans; Male; Prognosis; Recurrence; Retina; Syndrome; Uveitis, Posterior
PubMed: 8778060
DOI: 10.1097/00004397-199603610-00015 -
Der Ophthalmologe : Zeitschrift Der... Apr 2011The commercially available interferon gamma release assays T-SPOT.TB and QuantiFERON-TB Gold/QuantiFERON-TB Gold In-Tube may be important, besides the direct detection...
The commercially available interferon gamma release assays T-SPOT.TB and QuantiFERON-TB Gold/QuantiFERON-TB Gold In-Tube may be important, besides the direct detection with culturing, PCR or the Mantoux skin test, for the diagnosis of tuberculosis as a possible cause of uveitis. It is important to know the limitations of these tests to get a fast and reliable diagnosis which may necessitate initiation of causative treatment of the tuberculosis to prevent further damage to the eye and to avoid multi-drug resistant tuberculosis strains.
Topics: Antitubercular Agents; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Latent Tuberculosis; Middle Aged; Tomography, Optical Coherence; Tuberculosis, Ocular; Uveitis, Posterior
PubMed: 20931202
DOI: 10.1007/s00347-010-2270-0 -
Optometry and Vision Science : Official... Jun 2020Vaccine-associated uveitis has appeared in recent years because of various vaccines, whereas cases for human papillomavirus (HPV) vaccination were rarely reported. With...
SIGNIFICANCE
Vaccine-associated uveitis has appeared in recent years because of various vaccines, whereas cases for human papillomavirus (HPV) vaccination were rarely reported. With more and more females becoming aware of its importance and choosing HPV vaccination, much more attention should be paid on the adverse effects of it.
PURPOSE
The purpose of this study was to report a rare case of posterior uveitis after divalent HPV vaccination in an Asian female.
CASE REPORT
A 29-year-old woman presented with acute vision loss accompanied by symptoms of headache, tinnitus, and myalgia after the third injection of HPV vaccination. The best-corrected visual acuity dropped to 20/500 for both eyes, and optical coherence tomography revealed bilateral multifocal submacular fluid. A short course of oral prednisone as well as Ozurdex intravitreal injection resulted in the reversal of all signs and symptoms.
CONCLUSIONS
Although this case resembled Harada disease, we diagnosed it as vaccine-induced uveitis rather than coincidental autoimmune disease based on the rapid response to a short course of systemic corticosteroids. Because vaccine-induced uveitis is rare and difficult to distinguish from coincidental autoimmune disease, our case reminds eye care providers to be aware of the possible association between vaccination and a Harada-like reaction and to ask appropriately directed questions when obtaining history from young patients with uveitis. Based on this case, we also suggest Ozurdex intravitreal injection as a potential therapeutic choice, especially for patients with contraindication or personal concern to systemic corticosteroid.
Topics: Administration, Oral; Adult; Asian People; China; Dexamethasone; Drug Implants; Female; Fluorescein Angiography; Glucocorticoids; Humans; Injections, Intramuscular; Intravitreal Injections; Papillomaviridae; Papillomavirus Infections; Papillomavirus Vaccines; Prednisone; Tomography, Optical Coherence; Uveitis, Posterior; Vaccination; Vision Disorders; Visual Acuity
PubMed: 32511159
DOI: 10.1097/OPX.0000000000001523 -
Indian Journal of Ophthalmology Jul 2022To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent...
PURPOSE
To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent Vogt-Koyanagi-Harada (VKH) disease.
METHODS
This was a prospective study of 29 eyes of 16 patients with posterior uveitis in chronic recurrent VKH disease. All patients received previous systemic steroid and immunosuppressive regimens. All patients underwent a comprehensive ophthalmic examination, including best-corrected visual acuity (BCVA), Indocyanine green angiography (ICGA), fundus fluorescein angiography (FFA), and spectral-domain optical coherence tomography (SD-OCT). All patients underwent intravitreal injection with sustained-release dexamethasone 0.7 mg implant (Ozurdex®). Primary outcome measures included mean change in BCVA and central foveal thickness (CFT) at 24 months of follow-up compared to the baseline.
RESULTS
At 24 month of follow-up, the mean BCVA improved from 0.82 ± 0.13 to 0.38 ± 0.06 logMAR (P < 0.0001). The mean CFT reduced from 505 ± 29 to 244 ± 23 um (P < 0.0001). The mean intraocular pressure (IOP) changed from 15.1 ± 2.2 to 16.9 ± 3.1 mmHg with no significant value (P-value = 0.0955). Twenty-one eyes (72.4%) received one injection, whereas eight eyes (27.6%) required two injections. The mean number of injections was 1.2 ± 0.60. The mean follow-up time was 24.75 ± 0.9 months. No serious ocular or systemic adverse events were noted during the follow-up period. Ocular hypertension was recorded in three (10.3%) eyes and controlled by IOP lowering medications. Cataract progression occurred in 11 (37.9%) eyes.
CONCLUSION
Our cohort highlights the beneficial effects of the dexamethasone implant of 0.7 mg in the treatment of VKH disease relapsing posterior uveitis improving visual acuity, reducing macular edema, and minimizing the burden of systemic steroids in this sample study.
Topics: Dexamethasone; Drug Implants; Humans; Prospective Studies; Retrospective Studies; Uveitis, Posterior; Uveomeningoencephalitic Syndrome
PubMed: 35791135
DOI: 10.4103/ijo.IJO_260_22 -
Indian Journal of Ophthalmology Aug 2022To analyze the structural features of subretinal hyper-reflective material (SHRM) in posterior uveitis using swept-source optical coherence tomography (SS-OCT) and... (Observational Study)
Observational Study
Morphological characterization of subretinal hyper-reflective material in posterior uveitis using swept-source optical coherence tomography and optical coherence tomography angiography.
PURPOSE
To analyze the structural features of subretinal hyper-reflective material (SHRM) in posterior uveitis using swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (SS-OCTA).
METHODS
In this observational study, subjects with quiescent posterior uveitis and the presence of SHRM on SS-OCT were subjected to SS-OCTA to identify the presence of an intrinsic choroidal neovascular (CNV) network. OCT features were compared for SHRM harboring CNV (vascular SHRM) with those without CNV network (avascular SHRM) to identify clinical signs pointing toward the presence of CNVM inside SHRM.
RESULTS
Forty-two eyes of 33 subjects (18 males; mean age: 29.52 ± 12.56 years) were evaluated. Two-thirds (28/42) of eyes having SHRM on SS-OCT harbored intrinsic neovascular network (vascular SHRM). Increased reflectivity of SHRM (P < 0.001) and increased transmission of OCT signal underlying SHRM (P = 0.03) were suggestive of the absence of CNVM. The presence of intra/subretinal fluid (P = 0.08) and pitchfork sign (P = 0.017) were important markers of vascular SHRM.
CONCLUSION
SHRM is an important OCT finding in eyes with posterior uveitis. Meticulous assessment of SHRM characteristics on SS-OCT can aid in identifying the underlying intrinsic neovascular network.
Topics: Adolescent; Adult; Choroid; Choroidal Neovascularization; Fluorescein Angiography; Humans; Male; Subretinal Fluid; Tomography, Optical Coherence; Uveitis, Posterior; Young Adult
PubMed: 35918956
DOI: 10.4103/ijo.IJO_343_22 -
Current Opinion in Ophthalmology May 2008Diagnostic vitrectomy is performed in cases of posterior segment inflammation that are suspicious for malignancy or infection and require tissue confirmation. Advances... (Review)
Review
PURPOSE OF REVIEW
Diagnostic vitrectomy is performed in cases of posterior segment inflammation that are suspicious for malignancy or infection and require tissue confirmation. Advances in vitrectomy technique and laboratory tests have improved the diagnostic yield in these challenging cases. The methods for obtaining vitreous specimens and the diagnostic tests used to analyze them are discussed.
RECENT FINDINGS
Ancillary tests have been invaluable in addressing the diagnostic limitations of traditional histopathologic and microbiologic analyses. Flow cytometry, gene rearrangement studies, and cytokine measurements are useful adjuncts to cytology for the diagnosis of malignancy, in particular primary intraocular lymphoma. Microbial DNA amplification by polymerase chain reaction and intraocular antibody measurement has been shown to detect the presence of infection by organisms that are difficult to culture.
SUMMARY
When performed appropriately, diagnostic vitrectomy with carefully selected ancillary testing can lead to a definitive diagnosis in a large proportion of cases.
Topics: Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Equipment Design; Humans; Reproducibility of Results; Uveitis, Posterior; Vitrectomy; Vitreous Body
PubMed: 18408497
DOI: 10.1097/ICU.0b013e3282fc261d -
Retina (Philadelphia, Pa.) Mar 2020To correlate demographics, retinal lesion characteristics, and host immune status with the pathogen found on polymerase chain reaction analysis of aqueous fluid in...
PURPOSE
To correlate demographics, retinal lesion characteristics, and host immune status with the pathogen found on polymerase chain reaction analysis of aqueous fluid in patients with suspected infectious posterior uveitis.
METHODS
Medical records of patients who underwent anterior chamber paracentesis for suspected infectious posterior uveitis and had retinal photographs between 2014 and 2016 at a single institution were reviewed. Data collection included demographics, clinical appearance of the lesions, and polymerase chain reaction results. Fundus photographs were evaluated by two masked observers for the clinical features of the retinitis.
RESULTS
Twenty-eight patients were included in the study. There was substantial to almost perfect agreement on retinitis location (κ = 0.67) and number (κ = 0.76) between the masked photograph graders. Polymerase chain reaction results were positive for herpes simplex virus or varicella zoster virus in 43%, cytomegalovirus in 11%, and toxoplasmosis in 3%; 43% had negative polymerase chain reaction results. Detection of herpes simplex virus or varicella zoster virus on polymerase chain reaction of the aqueous was associated with paucifocal lesions (82%, P = 0.021) and lesions involving the peripheral retina (91%, P = 0.023), consistent with the diagnosis of acute retinal necrosis.
CONCLUSION
These data suggest that the diagnosis of acute retinal necrosis can be reasonably inferred on clinical examination, providing a guide for initial empiric therapy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Uveitis, Posterior; Vitreous Body; Young Adult
PubMed: 30601389
DOI: 10.1097/IAE.0000000000002423