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BMC Ophthalmology Apr 2024To determine the prevalence, clinical characteristics, and independent predictors of uveitic macular edema (UME) in patients with intermediate, posterior and panuveitis.
BACKGROUND
To determine the prevalence, clinical characteristics, and independent predictors of uveitic macular edema (UME) in patients with intermediate, posterior and panuveitis.
METHODS
We retrospectively reviewed the records of patients with intermediate, posterior, and panuveitis who underwent macular assessment using optical coherence tomography between January 2015 and February 2020. The prevalence of UME and clinical characteristics of the patients were described. Predictors of UME were identified using multivariate regression analysis.
RESULTS
A total of 349 patients were included. The mean age was 41 years, female: male ratio was 1.3:1. The prevalence of UME was 51.9%. UME was found in 33.9%, 56.9%, and 54.1% of the intermediate, posterior, and panuveitis cases, respectively. Among patients with UME, 47% had infectious uveitis, 32.6% had idiopathic uveitis, and 20.4% had immune-mediated uveitis. Diffuse macular edema was the most frequently observed pattern (36.5%). Multivariate analysis showed that factors independently associated with UME included age at uveitis onset (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00-1.03, P = 0.036), PU and panuveitis compared with intermediate uveitis (aOR 2.09, 95% CI 1.14-3.86, P = 0.018), and infectious uveitis compared with noninfectious uveitis (aOR 2.13, 95% CI 1.34-3.37, P = 0.001).
CONCLUSIONS
Increasing age at uveitis onset, posterior/panuveitis, and infectious etiology are predictive factors for UME in patients with intermediate, posterior and panuveitis.
Topics: Humans; Retrospective Studies; Male; Female; Macular Edema; Adult; Prevalence; Tomography, Optical Coherence; Middle Aged; Uveitis; Visual Acuity; Risk Factors; Young Adult; Singapore
PubMed: 38649909
DOI: 10.1186/s12886-024-03447-0 -
Cardiovascular Pathology : the Official... 2024This case report presents a 20-year-old male patient initially diagnosed with infective endocarditis, later correctly identified as Behçet's syndrome. The patient's...
This case report presents a 20-year-old male patient initially diagnosed with infective endocarditis, later correctly identified as Behçet's syndrome. The patient's complex clinical presentation, including chest pain, aortic dilation, severe aortic regurgitation, and aortic root abscess, posed significant diagnostic and therapeutic challenges. Despite initial misdiagnosis and treatment difficulties, the patient's condition significantly improved with appropriate immunosuppressive therapy, underscoring the potential for successful management of this complex condition. This case serves as a valuable reminder of the diagnostic challenges posed by Behçet's syndrome and the importance of considering this condition in patients presenting with symptoms suggestive of infective endocarditis.
Topics: Humans; Behcet Syndrome; Male; Young Adult; Immunosuppressive Agents; Diagnostic Errors; Endocarditis; Treatment Outcome; Diagnosis, Differential; Aortic Valve Insufficiency; Predictive Value of Tests
PubMed: 38649123
DOI: 10.1016/j.carpath.2024.107648 -
Indian Journal of Ophthalmology May 2024Behçet's disease (BD) is an autoimmune chronic systemic inflammatory disease characterized by a versatile clinical spectrum. Growth arrest specific protein 6...
PURPOSE
Behçet's disease (BD) is an autoimmune chronic systemic inflammatory disease characterized by a versatile clinical spectrum. Growth arrest specific protein 6 (GAS6)/soluble AXL (sAXL) signaling pathway draws attention in the resolution of inflammation, and its deficiency is associated with chronic inflammatory, autoimmune diseases, as well as clearance of apoptotic cells by phagocytes - efferocytosis. In this study, it was aimed to investigate whether GAS6/sAXL, interleukin (IL)-10, nitric oxide (NO), and BCL-2 levels were associated with inflammation and efferocytosis contributes to the pathogenesis of BD.
METHODS
A total of 37 Behçet patients with ocular involvement and 30 healthy control subjects were included in this study. GAS6, sAXL, IL-10, NO, and BCL-2 levels were quantified using enzyme-linked immunosorbent assay (ELISA) method.
RESULTS
Serum GAS6, sAXL, IL-10, NO, and BCL-2 levels were significantly lower in patients with BD compared to the controls (P < 0.005, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). In correlation analysis, research parameters decreased in patients with BD was significantly correlated with each other: GAS6-IL-10 (r = 0.585, P < 0.001), GAS6-BCL-2 (r = 0.541, P < 0.001), sAXL-BCL-2 (r = 0.696, P < 0.001), IL-10-NO (r = 0.717, P < 0.001), IL-10-BCL-2 (r = 0.759, P < 0.001), and NO-BCL-2 (r = 0.541, P < 0.001).
CONCLUSION
In conclusion, decreased serum BCL-2 level may be an indicator of increased apoptosis in these patients and decreased levels of GAS6/sAXL, IL-10, and NO may indicate insufficient clearance of apoptotic bodies released as a result of increased apoptosis in BD patients.
Topics: Adult; Female; Humans; Male; Middle Aged; Young Adult; Axl Receptor Tyrosine Kinase; Behcet Syndrome; Biomarkers; Enzyme-Linked Immunosorbent Assay; Intercellular Signaling Peptides and Proteins; Interleukin-10; Nitric Oxide; Proto-Oncogene Proteins; Proto-Oncogene Proteins c-bcl-2; Receptor Protein-Tyrosine Kinases
PubMed: 38648454
DOI: 10.4103/IJO.IJO_2829_23 -
Ocular Immunology and Inflammation Apr 2024In 15 patients with idiopathic uveitis associated with retinal vasculitis, HLA DRB1 gene testing was performed to detect a possible association. 11 patients tested...
PURPOSE
In 15 patients with idiopathic uveitis associated with retinal vasculitis, HLA DRB1 gene testing was performed to detect a possible association. 11 patients tested positive and 4 negative for the HLA DRB1 × 15 allele. The presence of the HLA DRB1 × 15 haplotype might be associated with a higher susceptibility to develop Multiple Sclerosis (MS).
METHODS
In this case series, we describe the ophthalmological and neurological findings in 10 HLA DR15-positive patients and 4 HLA DR15-negative patients that had neurological workup, including Magnetic Resonance Imaging (MRI) of the brain.
RESULTS
All patients had granulomatous ocular inflammation with either panuveitis or intermediate uveitis. MRI of the brain showed white matter lesions in 13 patients (9/10 and 4/4 respectively) of which 4 patients were eventually diagnosed with MS (3/10 and 1/4 respectively).
CONCLUSION
Although the majority of tested patients was carrying at least one HLA DRB1-15 allele, there was no difference in ophthalmological and neurological findings in both groups.
PubMed: 38648262
DOI: 10.1080/09273948.2024.2316759 -
Journal of Clinical Tuberculosis and... May 2024Intraocular tuberculosis (IOTB) is a common site of extrapulmonary tuberculosis and a main cause of infectious uveitis. It can result in severe visual morbidity if not...
INTRODUCTION
Intraocular tuberculosis (IOTB) is a common site of extrapulmonary tuberculosis and a main cause of infectious uveitis. It can result in severe visual morbidity if not recognized and treated properly. The clinical manifestations of IOTB are varied, and the duration of treatment is unclear. This study describes the clinical characteristics and outcomes of patients with IOTB and compares the duration of antituberculosis therapy (ATT) and steroid use.
METHOD
An 8-year retrospective study of IOTB patients in an endemic area of a tertiary hospital in Thailand. All patients had a complete treatment of ATT at least for 6 months.
RESULTS
Forty-three patients with 57 eyes and a mean age of 43.72 years were included. Panuveitis (38.6 %), retinal phlebitis (31.6 %), and posterior uveitis (15.8 %) were common clinical characteristics. A significant difference between initial and final best corrected visual acuity (BCVA) after ATT in 6 months for therapy and at least 9 months for therapy was observed ( = 0.004, 0.003, respectively). Ninety point nine percent of patients who received ATT for 9 months achieved a successful treatment outcome, while 66.7 % of patients who received ATT for 6 months did = 0.056). Patients who received systemic and/or regional corticosteroids therapy during treatment had a higher rate of treatment failure ( < 0.001).
CONCLUSION
IOTB had a variety of clinical manifestations, including nongranulomatous inflammation. Patients who completed treatment with ATT for at least 6 months improved their final BCVA. There was no difference in treatment outcomes regarding the duration of treatment. Combined treatment with systemic and/or regional corticosteroids was significantly associated with failed treatment outcomes.
PubMed: 38646417
DOI: 10.1016/j.jctube.2024.100439 -
Clinica Chimica Acta; International... Jun 2024Demyelination and immunocyte-infiltrated lesions have been found in neuro-Behçet's disease (NBD) pathology. Lacking satisfying laboratory biomarkers in NBD impedes...
OBJECTIVES
Demyelination and immunocyte-infiltrated lesions have been found in neuro-Behçet's disease (NBD) pathology. Lacking satisfying laboratory biomarkers in NBD impedes standard clinical diagnostics. We aim to explore the ancillary indicators for NBD diagnosis unveiling its potential etiology.
METHODS
28 NBD with defined diagnosis, 29 patients with neuropsychiatric lupus erythematosus, 30 central nervous system idiopathic inflammatory demyelination diseases (CNS-IIDD), 30 CNS infections, 30 cerebrovascular diseases, and 30 noninflammatory neurological diseases (NIND) were retrospectively enrolled. Immunoglobulins (Ig) in serum and cerebral spinal fluid (CSF) were detected by immunonephelometry and myelin basic protein (MBP) by quantitative enzyme-linked immunosorbent assay.
RESULTS
IgA index is almost twice enhanced in NBD than NIND with an accuracy of 0.8488 in differential diagnosis, the sensitivity and specificity of which were 75.00 % and 90.00 % when the cutoff was > 0.6814. The accuracy of CSF Ig and quotient of Ig all exceed 0.90 in discerning NBD with damaged and intact blood-brain barrier (BBB). Clustering analyses divided NBD into two different phenotypes: one with BBB damage has lower Ig synthesis, the other with extra-synthesis in parenchymal sites but with intact BBB. MBP index is significantly correlated with kappa (KAP) index and lambda (LAM) index (r = 0.358, 0.575, P < 0.001), hinting the NBD pathogenesis of CNS demyelination in triggering excessive intrathecal Ig productions and humoral responses.
CONCLUSIONS
IgA index acts as a potential diagnostic indicator in differentiating NBD from NIND and CNS-IIDD. Excessive immunoglobulin production induced by CNS inflammation and demyelination might be latent immunopathogenesis of NBD.
Topics: Humans; Behcet Syndrome; Male; Female; Adult; Retrospective Studies; Middle Aged; Immunoglobulins; Central Nervous System; Young Adult; Central Nervous System Diseases; Adolescent
PubMed: 38643816
DOI: 10.1016/j.cca.2024.119681 -
Ocular Immunology and Inflammation Apr 2024To report two patients with herpetic zoster panuveitis and chorioretinopathy with choroidal hypopigmentation.
PURPOSE
To report two patients with herpetic zoster panuveitis and chorioretinopathy with choroidal hypopigmentation.
METHODS
Retrospective chart review of two patients.
RESULTS
We report a series of two patients with a history of HZO with orbital inflammation and panuveitis, who developed patchy choroidal depigmentation consistent with a choroidopathy. The lesions were extensive and involved the posterior pole and mid-periphery in both cases. Both cases demonstrated scattered areas of ellipsoid zone loss, and fluorescein angiography showed corresponding late hyperfluorescence. OCTA in one case demonstrated flow voids at the level of choriocapillaris.
CONCLUSIONS
Our series suggests that herpetic chorioretinopathy may be a relatively benign process that presents late and may involve large areas of the posterior choroid.
PubMed: 38639557
DOI: 10.1080/09273948.2024.2338271 -
Anales de Pediatria May 2024
Topics: Humans; Uveitis, Anterior; Primary Health Care; Ultrasonography; Child; Female; Male
PubMed: 38637204
DOI: 10.1016/j.anpede.2024.04.003 -
American Journal of Ophthalmology Case... Jun 2024To describe a case of bilateral panuveitis in a patient with Stimulator of Interferon Genes (STING)-Associated Vasculitis with Onset in Infancy (SAVI).
PURPOSE
To describe a case of bilateral panuveitis in a patient with Stimulator of Interferon Genes (STING)-Associated Vasculitis with Onset in Infancy (SAVI).
OBSERVATIONS
A 45-year-old patient diagnosed with SAVI presented bilateral panuveitis and uncontrolled secondary intraocular hypertension due to structural complications from uveitis. Multimodal imaging revealed the presence of intraretinal fluid and bilateral vasculitis. The patient was started with systemic methotrexate.
CONCLUSIONS AND IMPORTANCE
This case is essential to characterize ocular involvement in patients with SAVI. Awareness of these ocular manifestations is crucial for timely management and improvement of visual prognosis.
PubMed: 38633003
DOI: 10.1016/j.ajoc.2024.102046 -
Cytokine Jul 2024Remitting-Relapsing Multiple Sclerosis (RRMS) and Neuro-Behçet Disease (NBD) are two chronic neuro-inflammatory disorders leading to brain damage and disability in...
Remitting-Relapsing Multiple Sclerosis (RRMS) and Neuro-Behçet Disease (NBD) are two chronic neuro-inflammatory disorders leading to brain damage and disability in young adults. Herein, we investigated in these patients the cytokine response by beads-based multiplex assays during the early stages of these disorders. Cytokine investigations were carried out on treatment-naive patients suffering from RRMS and NBD recruited at the first episode of clinical relapse. Our findings demonstrate that Cerebrospinal Fluid (CSF) cells from NBD patients, but not RRMS, secrete significant high levels of IL-22 which is associated with elevated IL-22 mRNA expression. We also observed an increase in IL-22 levels in the definite NBD subgroup as compared to the probable NBD one, indicating a clear relationship between elevated IL-22 levels and diagnostic certainty. Interestingly, we found no correlation of IL-22 secretion between CSF and serum arguing about intrathecal release of IL-22 in the CNS of NBD patients. Moreover, we showed by correlogram analysis that this cytokine doesn't correlate with IL-17A, IL-17F and IL-21 suggesting that this cytokine is secreted by Th22 cells and not by Th17 cells in the CSF of NBD patients. Finally, we found elevated levels of IL-6 and a positive correlation between IL and 6 and IL-22 in the CSF of NBD. In conclusion, these results suggest that IL-6 contributes to the production of IL-22 by T cells leading to the exacerbation of inflammation and damage within the CNS of NBD patients.
Topics: Humans; Behcet Syndrome; Interleukin-22; Interleukins; Adult; Male; Female; Multiple Sclerosis, Relapsing-Remitting; Middle Aged; Interleukin-17; Interleukin-6; Th17 Cells; Young Adult; RNA, Messenger
PubMed: 38631183
DOI: 10.1016/j.cyto.2024.156617