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Journal of Clinical Medicine Feb 2023This study retrospectively determined the relationship between vitreous IL-6 levels and clinical and laboratory data collected from uveitis patients. We examined an...
This study retrospectively determined the relationship between vitreous IL-6 levels and clinical and laboratory data collected from uveitis patients. We examined an unknown cause of posterior uveitis, collecting vitreous fluid to investigate vitreous IL-6 levels. The samples were analyzed in consideration of clinical and laboratory factors, such as the male/female ratio. The present study included 82 eyes from 77 patients with a mean age of 66.20 ± 15.41 years. The IL-6 concentrations of the vitreous specimens were 6255.0 ± 14,108.3 pg/mL in males and 277.6 ± 746.3 pg/mL in females, which was found to be a statistically significant difference ( = 0.048) (n = 82). There was also a statistically significant correlation between vitreous IL-6 concentrations, serum C-reactive protein (CRP) value and white blood cell counts (WBCs) (n = 82). In multivariate analysis, vitreous IL-6 levels were significantly correlated with gender and CRP in all cases ( = 0.048 and < 0.01, respectively) and were also significantly correlated with CRP in non-infectious uveitis ( < 0.01). In infectious uveitis, there were no significant differences between IL-6 level and several variables. Vitreous IL-6 concentrations were higher in males than in females in all cases. In non-infectious uveitis, vitreous IL-6 levels were correlated with serum CRP. These results might suggest that intraocular IL-6 levels depend on gender differences in posterior uveitis, and intraocular IL-6 levels in non-infectious uveitis may reflect systemic inflammations, including increased serum CRP.
PubMed: 36902507
DOI: 10.3390/jcm12051720 -
Eye (London, England) Feb 2012Visual loss in infectious posterior uveitis or panuveitis can occur if proper therapy is delayed because of diagnostic uncertainty. Some disorders, such as acute retinal... (Review)
Review
Visual loss in infectious posterior uveitis or panuveitis can occur if proper therapy is delayed because of diagnostic uncertainty. Some disorders, such as acute retinal necrosis and bacterial endophthalmitis, can be rapidly progressive, and therefore require prompt and accurate diagnosis to guide initial therapy. Other more slowly evolving infections, such as toxoplasmic chorioretinitis or fungal endophthalmitis, can be worsened by empiric use of corticosteroids without specific antimicrobial coverage. Key ocular diagnostic features are helpful but highly variable with overlap with both non-infectious uveitis and neoplastic masquerades, even for key signs such as hypopyon. Close examination of the fundus with attention to color, location, size, border, and opacity of lesions and associated arteriolitis or frosted branch angiitis is helpful in the diagnosis of chorioretinitis. Ultrasonography is an important tool in the evaluation of eyes with suspected endophthalmitis, especially those with intracapsular infection or focal infected deposits. Testing of intraocular fluid can be extremely useful but suffers from inaccessibility, poor sensitivity, and test selections dependent on a presumptive diagnosis, which may be wrong. The dilemma for clinician is to make the correct diagnosis of a rare, blinding, variegated disease quickly enough to intercede with specific therapy or to apply empiric therapy in a sufficiently skilled manner to avert disaster and confirm the diagnosis by response to treatment. When non-infectious uveitis is in the differential, empiric corticosteroids must sometimes be used, at great risk, if clinical examination, ancillary testing, and any available intraocular diagnostic tests have failed to confirm a diagnosis.
Topics: Chorioretinitis; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Endophthalmitis; Humans; Polymerase Chain Reaction; Retinitis; Tomography, Optical Coherence; Ultrasonography; Uveitis
PubMed: 22116459
DOI: 10.1038/eye.2011.299 -
Medicina (Kaunas, Lithuania) Jan 2022Primary inflammatory choriocapillaropathies (PICCPs) belong to a group of intraocular inflammatory diseases with the common characteristic of inflammatory... (Review)
Review
PURPOSE
Primary inflammatory choriocapillaropathies (PICCPs) belong to a group of intraocular inflammatory diseases with the common characteristic of inflammatory choriocapillaris hypo- or non-perfusion as the main clinicopathological mechanism. The purpose of our article is to describe clinical characteristics and multimodal imaging, that can help the diagnosis and treatment of PICCPs.
METHODS
Narrative review with multimodal imaging analysis.
RESULTS
Choriocapillaris non-perfusion can affect the end-choriocappilaries, at the benign end of the PICCP spectrum (MEWDS), to larger choriocapillaris vessels or precapillary vessels at the origin of more severe forms such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), idiopathic multifocal choroiditis (MFC) and Serpiginous Choroiditis (SC). Diagnosis is mostly based on multimodal imaging and especially on indocyanine green angiography (ICGA), fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT)/OCT-angiography (OCT-A). ICGA shows the typical pattern of patchy lobular hypofluorescence reflecting hypo- or non-perfusion of the choriocapillaris that can also take the aspect of geographic areas in the more severe forms. Treatment depends on the severity of the disease and goes from observation in MEWDS and some mild cases of APMPPE, to oral corticosteroid and/or immunomodulator agents in the more severe conditions of APMPPE and MFC and SC cases. Close multimodal monitoring is crucial in order to introduce or adjust treatment.
CONCLUSION
PICCPs are resulting from one common clinicopathological mechanism, inflammatory choriocapillaris hypo- or non-perfusion. ICGA findings are essential for the diagnosis and follow-up of PICCPs, but non-invasive methods such as FAF and SD-OCT/OCT-A also have their role especially in follow-up of the diseases. Treatment should be individualized according to the pathology and the evolution of lesions.
Topics: Choroid; Choroiditis; Fluorescein Angiography; Humans; Multifocal Choroiditis; Tomography, Optical Coherence
PubMed: 35208488
DOI: 10.3390/medicina58020165 -
Clinical and Experimental Immunology Sep 2008Toxoplasma infection accounts for up to 50% of all cases of posterior uveitis worldwide. In this review the control of Toxoplasma infection generally, and specific in... (Review)
Review
Toxoplasma infection accounts for up to 50% of all cases of posterior uveitis worldwide. In this review the control of Toxoplasma infection generally, and specific in the eye, by the immune system is discussed.
Topics: Animals; Cattle; Chorioretinitis; Cytokines; Humans; Immunity; Metabolic Networks and Pathways; Mice; Nitric Oxide; Toxoplasma; Toxoplasmosis, Ocular
PubMed: 18549442
DOI: 10.1111/j.1365-2249.2008.03692.x -
American Journal of Ophthalmology Aug 2021To determine classification criteria for pars planitis.
PURPOSE
To determine classification criteria for pars planitis.
DESIGN
Machine learning of cases with pars planitis and 4 other intermediate uveitides.
METHODS
Cases of intermediate uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the intermediate uveitides. The resulting criteria were evaluated on the validation set.
RESULTS
Five hundred eighty-nine cases of intermediate uveitides, including 226 cases of pars planitis, were evaluated by machine learning. The overall accuracy for intermediate uveitides was 99.8% in the training set and 99.3% in the validation set (95% confidence interval 96.1, 99.9). Key criteria for pars planitis included unilateral or bilateral intermediate uveitis with either 1) snowballs in the vitreous or 2) snowbanks on the pars plana. Key exclusions included: 1) multiple sclerosis, 2) sarcoidosis, and 3) syphilis. The misclassification rates for pars planitis were 0% in the training set and 1.7% in the validation set, respectively.
CONCLUSIONS
The criteria for pars planitis had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
Topics: Adolescent; Adult; Child; Female; Humans; Machine Learning; Male; Pars Planitis; Visual Acuity; Young Adult
PubMed: 33845006
DOI: 10.1016/j.ajo.2021.03.045 -
American Journal of Ophthalmology Jan 2021To elucidate molecular risk factors for posterior segment uveitis using a functional genomics approach.
OBJECTIVE
To elucidate molecular risk factors for posterior segment uveitis using a functional genomics approach.
DESIGN
Genetic association cohort study.
METHODS
Setting: Single-center study at an academic referral center.
STUDY POPULATION
164 patients with clinically diagnosed uveitis of the posterior segment.
MAIN OUTCOME MEASURES
Exome sequencing was used to detect variants identified in 164 patients with posterior segment uveitis. A phenotype-driven analysis, protein structural modeling, and in silico calculations were then used to rank and predict the functional consequences of key variants.
RESULTS
A total of 203 single nucleotide variants, in 23 genes across 164 patients, were included in this study. Both known and novel variants were identified in genes previously implicated in specific types of syndromic uveitis-such as NOD2 (Blau syndrome) and CAPN5 NIV (neovascular inflammatory vitreoretinopathy)-as well as variants in genes not previously linked to posterior segment uveitis. Based on a ranked list and protein-protein-interaction network, missense variants in NOD-like receptor family genes (NOD2, NLRC4, NLRP3, and NLRP1), CAPN5, and TYK2 were characterized via structural modeling and in silico calculations to predict how specific variants might alter protein structure and function. The majority of analyzed variants were notably different from wild type.
CONCLUSIONS
This study implicates new pathways and immune signaling proteins that may be associated with posterior segment uveitis susceptibility. A larger cohort and functional studies will help validate the pathogenicity of the mutations identified. In specific cases, whole-exome sequencing can help diagnose nonsyndromic uveitis in patients harboring known variants for syndromic inflammatory diseases.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calpain; Child; Child, Preschool; Female; Genetic Association Studies; Humans; Inflammasomes; Male; Middle Aged; Mutation, Missense; NLR Proteins; Proteomics; TYK2 Kinase; Uveitis, Posterior; Exome Sequencing
PubMed: 32707200
DOI: 10.1016/j.ajo.2020.07.021 -
International Ophthalmology Feb 2023Using optical coherence tomography angiography (OCTA) to evaluate retinal microvascular changes in sarcoid and tuberculous (TB) posterior uveitis. (Observational Study)
Observational Study
PURPOSE
Using optical coherence tomography angiography (OCTA) to evaluate retinal microvascular changes in sarcoid and tuberculous (TB) posterior uveitis.
METHODS
Cross-sectional observational study includes 30 eyes. FFA and OCTA images were acquired. OCTA images were analyzed for areas of capillary hypo-perfusion, disorganization of the superficial and deep capillary plexuses (SCP and DCP) and intraretinal cystoid spaces and for measuring the size of the foveal avascular zone and vessel density (VD) in the SCP and DCP.
RESULTS
A total of 11 eyes were associated with TB and 19 with sarcoidosis. By OCTA, 100% had areas of capillary non-perfusion, 36.7% choroidal voids, 30% disorganization of the SCP and DCP and 26.6% intraretinal cystoid spaces. The VD of the DCP was significantly lower in the TB group. On comparing OCTA and FFA, parafoveal ischemia was detected more frequently on OCTA and macular edema more frequently on FFA (P = < 0.001). The BCVA was not significantly correlated with the VD of the SCP or DCP.
CONCLUSION
OCTA can be used in detection of early microvascular changes, segmenting retinal layers and localizing abnormalities. The presence of these changes may aid in the diagnosis of TB and sarcoid uveitis, for prognosis, follow-up and may be the only choice when FFA is contraindicated.
Topics: Humans; Retinal Vessels; Fluorescein Angiography; Tomography, Optical Coherence; Cross-Sectional Studies; Capillaries; Sarcoidosis; Uveitis, Posterior; Tuberculosis
PubMed: 36029353
DOI: 10.1007/s10792-022-02464-6 -
Journal of Ophthalmic & Vision Research 2022To investigate the pattern of ocular involvement in Behcet's disease (BD) with predictors of patients' final state of vision.
PURPOSE
To investigate the pattern of ocular involvement in Behcet's disease (BD) with predictors of patients' final state of vision.
METHODS
This historical cohort encompassed the clinical records of 200 patients diagnosed according to the International Criteria for BD (ICBD), over a period of 17 years between 2004 and 2021.
RESULTS
The prevalence of Behcet's uveitis (BU) was more common in females and patients in the fourth decade of life. Ninety-five patients (47.5%) had evidence of ocular involvement in the initial ophthalmologic evaluation, and 171 patients (85.5%) manifested evidence of BU during the follow-up visits of which bilateral non-granulomatous panuveitis was the most common anatomical pattern of involvement (32.9%) followed by posterior (27.6%), anterior (26.5%), and intermediate (13.8%) uveitis. The prevalent accompanying signs were oral aphthous (67%), skin lesions (29%), and genital ulcers (19.5%). Cystoid macular edema (CME) was the most frequent ocular complication (62%), followed by cataract (57.5%) and epiretinal membranes (ERM) (36.5%). Univariate analysis showed the following determinants: male gender, younger age at onset, panuveitis, posterior uveitis, retinal vasculitis, and longer duration of uveitis as poorer visual prognostic factors of the disease. Multivariate analysis demonstrated a higher chance of poor visual prognosis of BD in patients with panuveitis, posterior uveitis, retinal vasculitis, and longer duration of uveitis.
CONCLUSION
This cohort study demonstrated an overview on epidemiological patterns of BU along with the visual prognostic factors in Iranian patients.
PubMed: 35765637
DOI: 10.18502/jovr.v17i2.10796 -
Annals of Palliative Medicine Dec 2021Uveitis is a not uncommon potentially sight-threatening intraocular inflammatory disorder and a major cause of blindness worldwide. Early diagnosis and effective...
BACKGROUND
Uveitis is a not uncommon potentially sight-threatening intraocular inflammatory disorder and a major cause of blindness worldwide. Early diagnosis and effective treatment are very important to reduce complications and protect vision.
METHODS
In a retrospective series, we enrolled 263 (390 eyes) consecutive uveitis patients, comprising 126 males and 137 females. The clinical types of uveitis, treatment efficacy, complications and visual prognosis were evaluated by detailed clinical examination, laboratory tests and treatment observation.
RESULTS
There were 101 cases of panuveitis (38.4%), 85 cases of anterior uveitis (32.3%), 75 cases of posterior uveitis (28.5%), and 2 cases of intermediate uveitis (8%). There was a statistically significant difference in (I) visual acuity between the acute and recovery periods (F=13.12, P<0.05); (II) visual acuity between first-time and recurrent patients (F=9.26, P<0.05); (III) visual acuity in the affected and healthy eyes in the total, anterior and posterior uveitis groups (P<0.05); and (IV) the presence of ocular complications. There was also a statistically significant difference in the presence or absence of ocular complications between patients with initial disease and those with a recurrence of disease (F=59.51, P<0.05).
CONCLUSIONS
In all its varying presentations, uveitis has a great impact on visual acuity. A careful clinical history should be taken and specific laboratory tests should be performed in order to improve the diagnosis and determine the etiology, and practitioners should provide appropriate treatment to avoid ocular complications, which can further damage visual acuity.
Topics: Female; Humans; Male; Panuveitis; Retrospective Studies; Uveitis; Uveitis, Intermediate; Uveitis, Posterior
PubMed: 35016443
DOI: 10.21037/apm-21-3549 -
Biomedicines Apr 2023Choroidal caverns (CCs) have been described in association with age-related macular degeneration and pachychoroid disease. However, it is unknown if caverns are found in...
Choroidal caverns (CCs) have been described in association with age-related macular degeneration and pachychoroid disease. However, it is unknown if caverns are found in patients with chronic non-infectious uveitis (NIU). Herein, we evaluated patients with NIU who had optical coherence tomography and indocyanine green angiography for CCs. Clinical and demographic characteristics were extracted from the chart review. Univariate and multivariate mixed-effects logistical models were used to assess the association between clinical and demographic factors and the presence of CCs. One hundred thirty-five patients (251 eyes) met the inclusion criteria: 1 eye had anterior uveitis, 5 had intermediate uveitis, 194 had posterior uveitis, and 51 had panuveitis. The prevalence of CCs was 10%. CCs were only observed in patients with posterior and panuveitis, with a prevalence of 10.8% and 7.8%, respectively. Multifocal choroiditis (MFC) was the type of uveitis where CCs were most frequently observed, with 40% of eyes with MFC having CCs. In addition, male sex ( = 0.024) was associated with CCs. There was no significant difference in the degree of intraocular inflammation or mean subfoveal choroidal thickness between CC+ and CC- eyes. This is the first study to describe CCs in uveitis. Overall, these findings suggest that caverns may be a sequela of structural and/or vascular perturbations in the choroid from uveitis.
PubMed: 37238939
DOI: 10.3390/biomedicines11051268