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Mediators of Inflammation 2020In patients, an increase in the population of Th17-secreting cells negatively correlated with the abundance of both IFN--producing and T regulatory as well as suppressor...
Imbalance in PB IL-17-Secreting and Regulatory Cells in Pars Planitis Is Associated with Dysregulation of IFN--Secreting Cells, Especially in Patients with Clinical Complications.
RESULTS
In patients, an increase in the population of Th17-secreting cells negatively correlated with the abundance of both IFN--producing and T regulatory as well as suppressor cells, regarding all the phenotypes studied. Although a strong dependence of the PB Th1 cell compartment on the duration of the disease was observed, it was limited to the subgroup of patients with macular edema only. The frequency of B regulatory cells was unchanged compared to controls.
CONCLUSIONS
In pars planitis, the alterations in lymphocyte cell distribution affect primarily the T cell repertoire. The imbalance in PB Th1/Th17/Treg cells creates proinflammatory conditions, strengthening the suggestion that the immune background may play a role in pars planitis pathogenesis. Also, circulating Th1 level may be of potential clinical relevance in terms of prediction of a more severe course of the disease.
Topics: Adolescent; Adult; Aged; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Female; Flow Cytometry; Humans; Interferon-gamma; Interleukin-17; Male; Middle Aged; Pars Planitis; T-Lymphocytes, Regulatory; Th1 Cells; Th17 Cells; Young Adult
PubMed: 32801998
DOI: 10.1155/2020/9175083 -
Ocular Immunology and Inflammation Nov 2021: To analyze the demographic characteristics, clinical features, ocular complications, and visual outcome of pediatric patients with uveitis.: Retrospective evaluation...
: To analyze the demographic characteristics, clinical features, ocular complications, and visual outcome of pediatric patients with uveitis.: Retrospective evaluation of medical records.: The study included 156 eyes of 93 patients. Fifty-three patients were female and 40 were male. Mean age at onset of the uveitis was 9.54 ± 4.29 years. The mean follow-up period was 29.88 ± 28.97 months. Anterior uveitis (49.5%) was the most common anatomic type followed by panuveitis (21.5%), intermediate uveitis (18.3%), and posterior uveitis (10.7%). Juvenile idiopathic arthritis (JIA) was the most common leading systemic disease (18.3%) followed by Behçet disease (11.8%). It was detected at least one complication in 53 (34.0%) eyes at presentation. Mean LogMAR visual acuity was found <0.3 in 136 (87.2%) eyes at final examination.: The most common localization was the anterior segment and the most common etiologic relationship was JIA. Visual outcome could be satisfactory with early and appropriate treatment.
Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Infant; Male; Retrospective Studies; Tertiary Care Centers; Turkey; Uveitis; Visual Acuity
PubMed: 32463707
DOI: 10.1080/09273948.2020.1758158 -
Graefe's Archive For Clinical and... Aug 2020Pars planitis is a commonly observed type of pediatric uveitis. The aim of this study was to evaluate the implications of pars planitis-associated cystoid macular edema...
PURPOSE
Pars planitis is a commonly observed type of pediatric uveitis. The aim of this study was to evaluate the implications of pars planitis-associated cystoid macular edema (CME) on visual outcome and treatment modalities.
METHODS
A retrospective review of medical records in a single center with academic practice.
RESULTS
Included were 33 children (mean age 8 years, 58 eyes). Eighteen eyes developed CME (31%): in 67% of them, CME was diagnosed at presentation and in 33%, it developed at a mean of 57 months after presentation. Anterior and posterior segment complications were more prevalent in eyes with CME. Papillitis was significantly associated with the development of CME (OR 12.4, 95% CI 2.3 to 65.6, p = 0.003). Patients with CME were 1.7 times more likely to be treated with systemic therapy. By the last follow-up, 50% of patients who never developed CME were without systemic therapy compared with 13% of patients who developed CME (p = 0.034). LogMAR visual acuity improvement between presentation and month 36 was 0.41 for eyes with CME compared with 0.14 for eyes that never developed CME (p = 0.009).
CONCLUSION
Pars planitis-associated CME entailed higher prevalence of ocular complications, more frequent use of immunomodulatory therapy, and a lower rate of remission.
Topics: Adolescent; Child; Child, Preschool; Disease Management; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Macular Edema; Male; Pars Planitis; Prognosis; Retrospective Studies; Visual Acuity
PubMed: 32346784
DOI: 10.1007/s00417-020-04696-7 -
Ophthalmology and Therapy Jun 2020To determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of...
INTRODUCTION
To determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of intraocular lenses.
METHODS
Uveitis ophthalmologists and pediatric ophthalmologists were surveyed via an online poll regarding their therapeutic management of pediatric uveitic cataract and intraocular lens (IOL) placement.
RESULTS
Sixty-two responses from uveitis ophthalmologists and 47 responses from pediatric ophthalmologists were recorded. According to 79% of all responses, uveitis was not a contraindication for primary IOL implantation in patients with controlled intraocular inflammation. Pediatric ophthalmologists were more likely to respond that the presence of chronic juvenile idiopathic arthritis-associated iridocyclitis, pars planitis, or recurrent acute anterior uveitis is a contraindication for primary IOL implantation in pediatric cases with full control of intraocular inflammation. There was no consensus within either specialty with regard to the preferred IOL material for lens implantation. Uveitis ophthalmologists were more likely to report the use of intravenous and intravitreal steroids for perioperative treatment. In cataract surgery for a child with recurrent acute anterior uveitis, a higher percentage of uveitis ophthalmologists (71%) than pediatric ophthalmologists (50%) responded that the posterior capsule should be primarily opened. A higher percentage of uveitis ophthalmologists also stated that anterior vitrectomy should be performed at the time of cataract surgery in all three uveitis types.
CONCLUSIONS
Pediatric ophthalmologists and uveitis ophthalmologists have similar approaches to the management of pediatric uveitic cataract removal and IOL insertion, but several differences remain between these subspecialties. Continued collaboration between the subspecialties would be helpful to better develop consistent criteria to improve patient care.
PubMed: 32157612
DOI: 10.1007/s40123-020-00245-x -
Journal of Ophthalmic Inflammation and... Jan 2020In previous studies, authors use ultrasound biomicroscopy (UBM) to analyze the characteristics of cyclitic membranes and the associated complications in patients with...
BACKGROUND
In previous studies, authors use ultrasound biomicroscopy (UBM) to analyze the characteristics of cyclitic membranes and the associated complications in patients with pars planitis. However, there are no reports regarding the prevalence of cyclitic membranes or complications at diagnosis and during follow-up.
PURPOSE
To describe the characteristics and complications of cyclitic membranes, as determined by UBM in patients with pars planitis using AVISO-S™ (Quantel Medical) equipment with a 50-MHz linear probe with a focus at the pars plana.
DESIGN
This retrospective study reviewed UBM images of patients diagnosed with pars planitis, from the Inflammatory Eye Disease Clinic in Mexico City from January 2010 to June 2016.
RESULTS
Cyclitic membranes were observed in the first UBM image in 67 eyes (56.7%) and during follow-up in 81 eyes (68.62%). In 67 eyes (82.71%), the cyclitic membranes extended through one or two quadrants. Extension toward the posterior lens capsule was recognized in 15 eyes (18.52%) and extension toward the peripheral retina in 12 eyes (14.81%). Complications included ciliary body detachments in 10 eyes (12.35%) and peripheral retinal traction in 8 eyes (9.88%).
CONCLUSIONS
UBM is a valuable tool for the diagnosis of cyclitic membranes at admittance and during follow-up of patients with pars planitis; it helps the clinician to detect this complication early.
PubMed: 31997032
DOI: 10.1186/s12348-020-0194-7 -
Medical Science Monitor : International... Dec 2019BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye....
Comparison of Methods of Endotamponade Used During 23-Gauge Pars Plana Vitrectomy and the Risk of Raised Intraocular Pressure During 24-Month Follow-Up: A Retrospective Study of 196 Patients.
BACKGROUND Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye. Complications following PPV include raised intraocular pressure (IOP). This retrospective study aimed to compare methods of endotamponade used during 23-gauge PPV and the risk of raised IOP during 24-month follow-up at a single center. MATERIAL AND METHODS The study included 196 patients (age, 15-86 years; mean, 63.5 years) (196 eyeballs). There were 93 patients (47.45%) with a preoperative history of type 2 diabetes mellitus and 14 patients (7.14%) with a history of myopia. IOP was measured with Goldmann applanation tonometry at one-, three-, six-, 12-, and 24-month follow-up. The outcome was compared following endotamponade with silicone oil, sulfur hexafluoride (SF6), and balanced salt solution (BSS). RESULTS Mean IOP at one-month follow-up was 17.2 mmHg (±3.61 mmHg; range, 9-45 mmHg), and at 24-month follow-up was 17.3 mmHg (±3.23 mmHg; range, 7-30 mmHg). IOP following PPV was significantly associated with the indication for PPV (P=0.023), and the type of endotamponade used (P=0.049). In patients with silicone oil endotamponade, the risk of IOP at 24 months was increased by 2.3 times compared with SF6 or BSS endotamponade. Patients with SF6 endotamponade had a risk of IOP that was 3.3 times lower than for silicone oil tamponade or BSS tamponade. CONCLUSIONS Silicone oil endotamponade in PPV was associated with an increased risk of IOP at 24-month follow-up.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Endotamponade; Female; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Pars Planitis; Poland; Prospective Studies; Retinal Detachment; Retinal Diseases; Retrospective Studies; Risk Factors; Silicone Oils; Tonometry, Ocular; Vitrectomy; Vitreous Body
PubMed: 31811816
DOI: 10.12659/MSM.918114 -
Ocular Immunology and Inflammation Feb 2021: To report the manifestations, patterns of disease, treatment strategies and outcomes in pediatric patients with noninfectious uveitis.: Demographic information of 76...
: To report the manifestations, patterns of disease, treatment strategies and outcomes in pediatric patients with noninfectious uveitis.: Demographic information of 76 cases was recorded. Symptoms, anatomic location, laterality, visual acuity (VA), intraocular pressure, associated systemic diseases, therapeutic strategies, side effects, complications were reviewed.: Thirty-one patients were diagnosed as uveitis on routine surveillance because of underlying systemic disease. The most common anatomic location was intermediate uveitis (34.2%). Juvenile idiopathic arthritis (JIA) was the most common underlying systemic disease (25%). Glaucoma was the most common complication (7.7%). The patients with refractory uveitis received adalimumab (26.5%), infliximab (4.6%) and tocilizumab (3.1%). The mean first-year VA was between 20/32 and 20/20 in 116/140 eyes.: Most pediatric noninfectious uveitis cases have bilateral intermediate uveitis. JIA was the most common systemic association. The first-year VA was good in most eyes which may be due to early use of corticosteroid-sparing agents.
Topics: Child; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Incidence; Male; Retrospective Studies; Tertiary Care Centers; Time Factors; Tomography, Optical Coherence; Turkey; Uvea; Uveitis; Visual Acuity
PubMed: 31687865
DOI: 10.1080/09273948.2019.1674890 -
Ocular Immunology and Inflammation Jul 2020To describe the finding of inferior corneal haze secondary to presumed inflammatory endothelio-10 pathy in a series of patients with pars planitis.
PURPOSE
To describe the finding of inferior corneal haze secondary to presumed inflammatory endothelio-10 pathy in a series of patients with pars planitis.
METHODS
Single-center retrospective observational consecutive case-series.
RESULTS
Seven patients with an established diagnosis of pars planitis are described in this case series including four females and three males. The ages ranged from 5 to 31 years at presentation. Pars planitis was bilateral in six patients and unilateral in one patient. Fundus examinations revealed vitreous opacities and pars plana exudates in all seven patients, cystoid macular edema in four patients, and peripheral retinal vasculitis in two patients. Corneal examination revealed opacification of the posterior cornea in an inferior location in 10 of the 13 eyes with pars planitis. Only one of these eyes had keratic precipitates. For a given patient, corneal involvement was more commonly seen in the more inflamed eye. In one patient with active inflammation, microcystic corneal edema was noted to predate the formation of inferior corneal endothelial opacification, suggesting that physical proximity to the site of inflammation at the inferior pars plana is the cause of this notable physical finding.
CONCLUSIONS
Inferior posterior corneal haze related to inflammatory endotheliopathy may occur in eyes with pars planitis. As patients with pars planitis may be otherwise asymptomatic, this corneal finding shouldprompt a detailed funduscopic examination to rule out this form of uveitis.
Topics: Adolescent; Adult; Child; Child, Preschool; Corneal Opacity; Endothelium, Corneal; Female; Humans; Inflammation; Male; Pars Planitis; Retrospective Studies; Young Adult
PubMed: 31573365
DOI: 10.1080/09273948.2019.1629603 -
Arthritis Care & Research Nov 2020Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior...
OBJECTIVE
Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior uveitis is the most commonly encountered ocular manifestation of rheumatic disease, little is known about the clinical presentation, management, and long-term outcome of more complex eye conditions such as pars planitis (PP), panuveitis (PU), and Vogt-Koyanagi-Harada disease (VKH). The present study was undertaken to comprehensively assess the long-term safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologics for the treatment of pediatric and adolescent patients with PP, PU, and VKH.
METHODS
We retrospectively reviewed a cohort of 75 children and adolescents with idiopathic PP (n = 50), PU (n = 12), and VKH (n = 14) followed by the Pediatric Rheumatology Core at Children's Hospital Los Angeles and evaluated referral patterns, clinical presentation, treatment response, and long-term clinical outcome.
RESULTS
Patients were followed for an average of 52 months. Their mean age at disease onset was 10 years. Bilateral eye involvement was seen in 87% of the patients. At first presentation to an ophthalmologist, glaucoma was noted in 21% of patients and vision loss (<20/40) in 87% of patients, while legal blindness (≤20/200 in the better-seeing eye) was diagnosed in 18 of 75 (24%) of patients (PP 22%, PU 36%, and VKH 21%). The average referral time to a pediatric rheumatologist was 13 months (range 1-96 months). Topical steroids were used in all patients, but 98% of patients required additional DMARDs, and 73% required therapy with biologics. After a mean of 52 months, 35% of patients across all disease groups had significant vision loss or were blind, and only 28% were in clinical remission without medications. The worst outcome was observed in children with PU. Regression analysis, young age at onset, delayed referral to a pediatric rheumatologist, and chronic disease were strong predictors for the risk of long-term blindness.
CONCLUSION
PP, PU, and VKH involve a high risk of permanent vision loss and should be managed by a skilled rheumatologist as early and as aggressively as possible.
Topics: Adolescent; Antirheumatic Agents; Biological Products; Child; Female; Humans; Male; Panuveitis; Pars Planitis; Regression Analysis; Retrospective Studies; Uveomeningoencephalitic Syndrome; Vision Disorders
PubMed: 31444859
DOI: 10.1002/acr.24056 -
Graefe's Archive For Clinical and... Sep 2019To describe the characteristics of de novo uveitis in patients ≥ 60 years old. (Comparative Study)
Comparative Study
PURPOSE
To describe the characteristics of de novo uveitis in patients ≥ 60 years old.
METHODS
Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared.
RESULTS
A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group.
CONCLUSION
In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.
Topics: Age Factors; Aged; Animals; Behcet Syndrome; Eye Neoplasms; Female; Fluorescein Angiography; France; Fundus Oculi; Humans; Incidence; Male; Middle Aged; Ophthalmoscopy; Retrospective Studies; Sarcoidosis; Tertiary Care Centers; Tomography, Optical Coherence; Uveitis
PubMed: 31312906
DOI: 10.1007/s00417-019-04411-1