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International Ophthalmology Jan 2022This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly... (Review)
Review
PURPOSE
This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease.
METHODS
A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items.
RESULTS
Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used.
CONCLUSION
Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
Topics: Chorioretinitis; Eye; Humans; Toxoplasma; Toxoplasmosis, Ocular; Uveitis, Posterior
PubMed: 34370174
DOI: 10.1007/s10792-021-01994-9 -
International Ophthalmology Clinics 1992
Review
Topics: Amblyopia; Antineoplastic Agents; Autoimmune Diseases; Child; Diagnosis, Differential; Eye Foreign Bodies; Eye Infections; Eye Injuries, Penetrating; Eye Neoplasms; Fundus Oculi; Glucocorticoids; Humans; Uveitis, Posterior
PubMed: 1537655
DOI: 10.1097/00004397-199203210-00012 -
Scientific Reports Aug 2022Clinical discrimination of posterior uveitis entities remains a challenge. This exploratory, cross-sectional study investigated the green (GEFC) and red emission...
Clinical discrimination of posterior uveitis entities remains a challenge. This exploratory, cross-sectional study investigated the green (GEFC) and red emission fluorescent components (REFC) of retinal and choroidal lesions in posterior uveitis to facilitate discrimination of the different entities. Eyes were imaged by color fundus photography, spectrally resolved fundus autofluorescence (Color-FAF) and optical coherence tomography. Retinal/choroidal lesions' intensities of GEFC (500-560 nm) and REFC (560-700 nm) were determined, and intensity-normalized Color-FAF images were compared for birdshot chorioretinopathy, ocular sarcoidosis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), and punctate inner choroidopathy (PIC). Multivariable regression analyses were performed to reveal possible confounders. 76 eyes of 45 patients were included with a total of 845 lesions. Mean GEFC/REFC ratios were 0.82 ± 0.10, 0.92 ± 0.11, 0.86 ± 0.10, and 1.09 ± 0.19 for birdshot chorioretinopathy, sarcoidosis, APMPPE, and PIC lesions, respectively, and were significantly different in repeated measures ANOVA (p < 0.0001). Non-pigmented retinal/choroidal lesions, macular neovascularizations, and fundus areas of choroidal thinning featured predominantly GEFC, and pigmented retinal lesions predominantly REFC. Color-FAF imaging revealed involvement of both, short- and long-wavelength emission fluorophores in posterior uveitis. The GEFC/REFC ratio of retinal and choroidal lesions was significantly different between distinct subgroups. Hence, this novel imaging biomarker could aid diagnosis and differentiation of posterior uveitis entities.
Topics: Birdshot Chorioretinopathy; Coloring Agents; Cross-Sectional Studies; Fluorescein Angiography; Humans; Optical Imaging; Sarcoidosis; Tomography, Optical Coherence; Uveitis, Posterior
PubMed: 36038591
DOI: 10.1038/s41598-022-18048-4 -
Klinische Monatsblatter Fur... May 2022Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture,...
Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture, diagnostic and treatment strategies of these diseases are presented.
Topics: Eye Infections; Humans; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Ocular; Treponema; Tuberculosis; Uveitis; Uveitis, Posterior
PubMed: 35320874
DOI: 10.1055/a-1727-1951 -
Ocular Immunology and Inflammation 2022To report a case of acute unilateral posterior uveitis as a rare manifestation of giant cell arteritis (GCA).
PURPOSE
To report a case of acute unilateral posterior uveitis as a rare manifestation of giant cell arteritis (GCA).
OBSERVATION
A 62-year-old male presented to the clinic for evaluation of decreased vision in the right eye (OD). BCVA in OD was 20/60, and fundus examination revealed 3+ vitreous cells along with several inflammatory precipitates located in posterior vitreous and on surface of retina. Although TAB was inconclusive for GCA, the clinical diagnosis of GCA was made according to the GCA diagnostic criteria. This diagnosis was further supported by FDG-PET scan. The patient was started on corticosteroids, and the symptoms improved significantly after first week of treatment. At follow-up visit one month and half later, BCVA improved to 20/40 in the right eye.
CONCLUSION
Although GCA is rarely present with uveitis, in case of unilateral posterior uveitis in elderly patient, it should be considered in the differential diagnosis.
Topics: Humans; Aged; Middle Aged; Giant Cell Arteritis; Uveitis, Posterior
PubMed: 34270381
DOI: 10.1080/09273948.2021.1952274 -
Retina (Philadelphia, Pa.) Jan 2005
Review
Topics: Glucocorticoids; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Uveitis, Posterior
PubMed: 15655435
DOI: 10.1097/00006982-200501000-00001 -
Expert Opinion on Biological Therapy Dec 2014Noninfectious posterior uveitis is a leading cause of visual impairment. Although conventional immunosuppressive agents have been successfully used, these are... (Review)
Review
INTRODUCTION
Noninfectious posterior uveitis is a leading cause of visual impairment. Although conventional immunosuppressive agents have been successfully used, these are nonspecific and their long-term use may induce significant adverse effects. The purpose of this article is to identify recent advances and future therapeutic options in noninfectious posterior uveitis.
AREAS COVERED
A MEDLINE database search was conducted through May 2014 using the terms: uveitis, treatment, intravitreal and corticosteroid, biological. To provide ongoing and future perspectives in treatment options, also clinical trials as registered at ClinicalTrials.gov were included.
EXPERT OPINION
For individuals who do not respond to conventional immunotherapy, two major lines of treatments can be identified as focus in recent years: i) the intraocular application of anti-inflammatory drugs and ii) the introduction of new agents, for example, biologicals and small-molecule inhibitors. Whereas intravitreal treatments have the beauty of avoiding systemic side effects, new agents are gaining increased importance because of their highly targeted molecular effects. Even when current treatment strategies are still hampered by the paucity of randomized controlled trials, promising progress and continuous efforts are undertaken to close this gap. Still, a critical evaluation of new agents has to be made because 'new' agents are almost exclusively based on experience in other autoimmune disorders.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Biological Products; Humans; Immunosuppressive Agents; Immunotherapy; Intravitreal Injections; Ophthalmic Solutions; Uveitis, Posterior
PubMed: 25243865
DOI: 10.1517/14712598.2014.956074 -
Current Opinion in Ophthalmology Dec 2004The goal of this review is to describe the more commonly used imaging techniques and their use to identify causes of vision loss, extent of disease, and distinctive... (Review)
Review
PURPOSE OF REVIEW
The goal of this review is to describe the more commonly used imaging techniques and their use to identify causes of vision loss, extent of disease, and distinctive patterns associated with various causes of posterior uveitis.
RECENT FINDINGS
Distinctive patterns seen with new imaging techniques and applications are being described. Ophthalmic CT, fluorescein angiography, indocyanine green angiography, and others are demonstrating inflammation and pathology in posterior uveitis. As our experience grows with these modalities, they are being used increasingly in the diagnosis and management of patients with posterior uveitis.
SUMMARY
This review familiarizes the ophthalmologist with imaging in patients with inflammatory disorders of the retina and choroid. These modalities can help with the diagnosis, treatment, and monitoring of patients with uveitis.
Topics: Angiography; Coloring Agents; Diagnostic Imaging; Fluorescein Angiography; Fundus Oculi; Humans; Organic Chemicals; Photography; Tomography, Optical Coherence; Ultrasonography; Uveitis, Posterior; Vision Disorders
PubMed: 15523198
DOI: 10.1097/01.icu.0000144386.05116.c5 -
JAMA Ophthalmology Apr 2015
Topics: Anti-Bacterial Agents; Eye Infections, Bacterial; Female; Fluorescein Angiography; Humans; Infusions, Intravenous; Middle Aged; Penicillin G; Syphilis; Tomography, Optical Coherence; Uveitis, Posterior
PubMed: 25856651
DOI: 10.1001/jamaophthalmol.2014.4630 -
Seminars in Ophthalmology 2012Although the phenomenon of fundus autofluorescence has been known for decades, it has only recently been recognized as a measure of retinal pigment epithelial function... (Review)
Review
Although the phenomenon of fundus autofluorescence has been known for decades, it has only recently been recognized as a measure of retinal pigment epithelial function and health. Characteristic fundus autofluorescence patterns have been described in eyes affected by inflammation of the posterior segment, and these patterns have provided insights into the pathogenesis of posterior uveitis entities. In addition, preliminary data indicate that fundus autofluorescence characteristics may serve as markers of disease activity, allow prediction of visual prognosis, and may help determine the adequacy of therapy. We provide an overview of the current state of fundus autofluorescence imaging technology and review our current knowledge of fundus autoflourescence findings and their clinical use in the posterior uveitis entities.
Topics: Fundus Oculi; Humans; Lipofuscin; Optical Imaging; Prognosis; Retinal Pigment Epithelium; Uveitis, Posterior
PubMed: 23163281
DOI: 10.3109/08820538.2012.711414