-
Ocular Immunology and Inflammation Aug 2006
Topics: Glucocorticoids; Humans; Injections; Triamcinolone Acetonide; Uveitis, Posterior; Vitreous Body
PubMed: 16911980
DOI: 10.1080/09273940600940926 -
International Ophthalmology Clinics 1995
Review
Topics: Base Sequence; Genetic Techniques; Humans; Molecular Biology; Molecular Probes; Molecular Sequence Data; Mycoses; Parasitic Diseases; Uveitis, Posterior; Virus Diseases
PubMed: 8964667
DOI: 10.1097/00004397-199503530-00007 -
Current Eye Research 1992Posterior uveitis is thought to be a T-cell mediated disease since active foci of inflammation, identified in eyes enucleated for the complications of intraocular... (Review)
Review
Posterior uveitis is thought to be a T-cell mediated disease since active foci of inflammation, identified in eyes enucleated for the complications of intraocular inflammation, are found to be predominantly composed of CD4+ T-cells. Few B-cells and little immunoglobulin are found suggesting that antibody and immune complex deposition do not play a major role in perpetuating the inflammatory process. As ocular biopsy is not a feasible method for monitoring disease activity and response to treatment, parameters of T-cell activation and retinal damage have been studied in the peripheral blood. These have included antibody and T-cell sensitisation to retinal S-antigen, serum soluble IL-2 receptors and IL-2 receptors on activated T-cells. none of these parameters, however, have been found to be useful in the monitoring of ocular disease activity alone or in the prediction of disease relapse.
Topics: Antigen-Antibody Complex; Antigens; Arrestin; Autoantigens; B-Lymphocytes; CD4-Positive T-Lymphocytes; Eye Proteins; Humans; Immunity; Lymphocyte Activation; Uveitis, Posterior
PubMed: 1358554
DOI: 10.3109/02713689208999506 -
The Kaohsiung Journal of Medical... Feb 2022
Topics: Acute Disease; Adult; Diagnosis, Differential; Humans; Male; Retinal Telangiectasis; Uveitis, Posterior
PubMed: 34528375
DOI: 10.1002/kjm2.12451 -
Indian Journal of Ophthalmology May 2022To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population...
PURPOSE
To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt.
METHODS
In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture.
RESULTS
The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis.
CONCLUSION
Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.
Topics: Adult; Female; Humans; India; Male; Middle Aged; Panuveitis; Retrospective Studies; Uveitis; Uveitis, Posterior; Young Adult
PubMed: 35502042
DOI: 10.4103/ijo.IJO_2159_21 -
International Ophthalmology May 2020To review the multimodal imaging patterns of posterior syphilitic uveitis.
PURPOSE
To review the multimodal imaging patterns of posterior syphilitic uveitis.
METHODS
A systematic review.
RESULTS
The percentage of syphilis has started to increase again: The World Health Organization has reported 12 million new cases of syphilis each year. In addition, syphilis was responsible for 0.3% of deaths globally in 2002. Eye manifestations happen prevalently in secondary and tertiary stages of syphilis, even though ocular involvement can occur in all stages. Syphilis has the nickname: "the great imitator" since it has no unique clinical presentation, even though posterior uveitis is considered the most common form. Syphilis is known as "the great imitator," making its diagnosis in the presence of posterior uveitis particularly challenging as it presents similarly to other ocular conditions such as acute retinal necrosis. However, with the advent of multimodal imaging some particular patterns of pre-retinal, retinal, retinochoroidal and optic nerve involvement from syphilis can be identified to guide the diagnosis and the laboratory workup.
CONCLUSION
This review highlights the various patterns of pre-retinal precipitates, multifocal retinitis, retinochoroiditis (confluent and placoid) and optic neuritis caused by syphilis, the appropriate laboratory work to be obtained and the treatment to be initiated.
Topics: Anti-Bacterial Agents; Eye Infections, Bacterial; Humans; Multimodal Imaging; Prognosis; Syphilis; Uvea; Uveitis, Posterior; Visual Acuity
PubMed: 31927680
DOI: 10.1007/s10792-020-01285-9 -
American Journal of Ophthalmology Nov 2021To validate a custom algorithm for automated identification and quantification of clinically relevant inflammatory choriocapillaris (CC) lesions from en face... (Observational Study)
Observational Study
PURPOSE
To validate a custom algorithm for automated identification and quantification of clinically relevant inflammatory choriocapillaris (CC) lesions from en face swept-source optical coherence tomography (SS-OCTA) images.
DESIGN
Observational case series.
METHODS
Twenty eyes of 14 patients with posterior uveitis were imaged. The machine-generated en face OCTA CC slabs were exported to a computing platform, where a custom algorithm performed unsupervised lesion boundary delineation and area quantification. Lesions identified by the algorithm (AG) were compared to those identified by 2 masked human graders (HG1 and HG2), using the Sørensen-Dice coefficient (DSC) and intraclass correlation coefficient (ICC). Intragrader and intravisit reliability were determined by coefficient of variation (CV) and DSC.
RESULTS
The AG demonstrated excellent agreement with both HGs in determination of lesion area (HG1 vs AG ICC 0.92, 95% CI 0.81-0.97, HG2 vs AG ICC 0.91, 95% CI 0.78-0.97). The AG demonstrated good spatial overlap (DSC ≥0.70) with both HGs in 14 of 20 (70%) eyes and at least 1 HG in 16 of 20 (80%) eyes. Poor spatial overlap (DSC between 0.31 and 0.69) was associated with the presence of a choroidal neovascular membrane and low-contrast lesion boundaries. Intravisit repeatability for the AG was superior to both HGs (CV 2.6% vs >5%).
CONCLUSION
This custom algorithm demonstrated a high degree of agreement with HGs in identification of inflammatory CC lesions and outperformed HGs in reproducibility. Automated CC lesion delineation will support the development of objective and quantitative biomarker of disease activity in patients with posterior uveitis.
Topics: Choroid; Fluorescein Angiography; Humans; Reproducibility of Results; Tomography, Optical Coherence; Uveitis, Posterior
PubMed: 34107308
DOI: 10.1016/j.ajo.2021.06.004 -
Current Opinion in Ophthalmology May 2021Given the heterogeneity of uveitis, markers of inflammation vary from patient to patient. Multimodal imaging has proven itself to be critical for accurate evaluation for... (Review)
Review
PURPOSE OF REVIEW
Given the heterogeneity of uveitis, markers of inflammation vary from patient to patient. Multimodal imaging has proven itself to be critical for accurate evaluation for disease activity and treatment response in uveitis.
RECENT FINDINGS
Ultra-widefield (UWF) fluorescein angiography and autofluorescence (AF) as well as optical coherence tomography angiography (OCTA) have provided insights into disease pathogenesis and monitoring not previously appreciated. In addition to structural retinal imaging, OCT can be used to assess the choroid, the posterior cortical vitreous and the retinal vasculature in eyes with uveitis.
SUMMARY
Multimodal ocular imaging in eyes with uveitis is critical for disease diagnosis and assessing response to treatment. UWF fluorescein angiography can detect retinal vasculitis even in the absence of overt vascular sheathing. UWF AF can help detect more chorioretinal lesions than clinically visible. OCT can be used to assess the posterior cortical vitreous, retina, large retinal vessels and choroid in uveitis. The use of multimodal imaging will likely be needed to determine clinical trial endpoints in studies evaluating therapeutics for uveitis.
Topics: Choroid; Fluorescein Angiography; Humans; Multimodal Imaging; Optical Imaging; Panuveitis; Retina; Retinal Vessels; Tomography, Optical Coherence; Uveitis, Intermediate; Uveitis, Posterior; Vitreous Body
PubMed: 33710009
DOI: 10.1097/ICU.0000000000000762 -
Ophthalmology Aug 2021To develop an agreed upon set of outcomes known as a "core outcome set" (COS) for noninfectious uveitis of the posterior segment (NIU-PS) clinical trials.
PURPOSE
To develop an agreed upon set of outcomes known as a "core outcome set" (COS) for noninfectious uveitis of the posterior segment (NIU-PS) clinical trials.
DESIGN
Mixed-methods study design comprising a systematic review and qualitative study followed by a 2-round Delphi exercise and face-to-face consensus meeting.
PARTICIPANTS
Key stakeholders including patients diagnosed with NIU-PS, their caregivers, and healthcare professionals involved in decision-making for patients with NIU-PS, including ophthalmologists, nurse practitioners, and policymakers/commissioners.
METHODS
A long list of outcomes was developed based on the results of (1) a systematic review of clinical trials of NIU-PS and (2) a qualitative study of key stakeholders including focus groups and interviews. The long list was used to generate a 2-round Delphi exercise of stakeholders rating the importance of outcomes on a 9-point Likert scale. The proportion of respondents rating each item was calculated, leading to recommendations of "include," "exclude," or "for discussion" that were taken to a face-to-face consensus meeting of key stakeholders at which they agreed on the final COS.
MAIN OUTCOME MEASURE
Items recommended for inclusion in the COS for NIU-PS.
RESULTS
A total of 57 outcomes grouped in 11 outcome domains were presented for evaluation in the Delphi exercise, resulting in 9 outcomes directly qualifying for inclusion and 15 outcomes being carried forward to the consensus meeting, of which 7 of 15 were agreed on for inclusion. The final COS contained 16 outcomes organized into 4 outcome domains comprising visual function, health-related quality of life, treatment side effects, and disease control.
CONCLUSIONS
This study builds on international work across the clinical trials community and our qualitative research to construct the world's first COS for NIU-PS. The COS provides a list of outcomes that represent the priorities of key stakeholders and provides a minimum set of outcomes for use in all future NIU-PS clinical trials. Adoption of this COS can improve the value of future uveitis clinical trials and reduce noninformative research. Some of the outcomes identified do not yet have internationally agreed upon methods for measurement and should be the subject of future international consensus development.
Topics: Adult; Aged; Caregivers; Clinical Trials as Topic; Consensus; Delphi Technique; Endpoint Determination; Female; Humans; Male; Middle Aged; Ophthalmologists; Outcome Assessment, Health Care; Patients; Quality of Life; Research Design; Systematic Reviews as Topic; Uveitis, Posterior; Visual Acuity
PubMed: 33515595
DOI: 10.1016/j.ophtha.2021.01.022 -
Ophthalmology Apr 2019To assess the safety and efficacy of an intravitreal fluocinolone acetonide (FA) insert to manage inflammation associated with chronic noninfectious posterior uveitis. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To assess the safety and efficacy of an intravitreal fluocinolone acetonide (FA) insert to manage inflammation associated with chronic noninfectious posterior uveitis.
DESIGN
Multicenter, randomized, prospective, doubled-masked, sham-controlled, 3-year phase 3 clinical trial.
PARTICIPANTS
One hundred twenty-nine participants with recurrent noninfectious posterior uveitis were assigned randomly to FA insert (n = 87) or sham injection (n = 42). The more severely affected eye in participants with bilateral disease was designated as the study eye.
METHODS
The insert (FA, 0.18 mg) was injected into the vitreous cavity; sham injection mimicked the insert delivery procedure. Ophthalmic examinations, OCT, and ocular tolerability and discomfort assessments were conducted; study visits were on days 7 and 28 and months 2, 3, 6, 9, and 12. Uveitis recurrence was treated as needed. The 6-month recurrence rate was the primary outcome measure.
RESULTS
The 6-month (28% and 91%) and 12-month (38% and 98%) uveitis recurrence rates were significantly lower (P < 0.001) with FA insert vs. sham, respectively. Fewer recurrences per study eye (mean, 0.7 vs. 2.5), lower incidence of 15-letter or more decrease in best-corrected visual acuity (14% vs. 31%), and reduced systemic (19% vs. 40%) and local (7% vs. 62%) uveitis adjunctive treatments were observed with FA insert vs. sham, respectively. The FA insert group showed higher rates of cataract. Intraocular pressure-lowering treatment use was similar between groups. No deaths, treatment-related study discontinuations, or unanticipated safety signals were observed through 12 months.
CONCLUSIONS
Chronic noninfectious posterior uveitis was managed successfully in this study population; FA insert eyes experienced fewer uveitis recurrence episodes, required fewer adjunctive treatments, and demonstrated less visual acuity loss compared with sham eyes. The FA insert treatment group showed higher rates of cataract; delivery by injection was not associated with an increase in ocular adverse events or any other safety measures not typically associated with local steroid use, suggesting the procedure is appropriate for an office setting.
Topics: Chronic Disease; Double-Blind Method; Drug Implants; Fluocinolone Acetonide; Glucocorticoids; Humans; Intravitreal Injections; Prospective Studies; Recurrence; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Uveitis, Posterior; Visual Acuity
PubMed: 30367884
DOI: 10.1016/j.ophtha.2018.10.033