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Survey of Ophthalmology 2013Serpiginous choroiditis (SC) is a posterior uveitis displaying a geographic pattern of choroiditis, extending from the juxtapapillary choroid and intermittently... (Review)
Review
Serpiginous choroiditis (SC) is a posterior uveitis displaying a geographic pattern of choroiditis, extending from the juxtapapillary choroid and intermittently spreading centrifugally. The choroiditis involves the overlying retinal pigment epithelium, and the outer retina. This intraocular inflammation typically involves both eyes in otherwise healthy, middle-aged individuals with no familial or ethnic predilection. Pathogenesis is unclear; based on limited histopathologic studies, however, favorable response to immunosuppressive agents, and the absence of association with systemic or local infectious or noninfectious diseases, an organ-specific autoimmune inflammation seems likely to be the underlying process. Patients, particularly from tuberculosis-endemic regions, may present with fundus changes simulating SC, but show evidence of active tuberculosis and/or the presence of mycobacterial DNA in the aqueous humor. This has been referred to as serpiginous-like choroiditis, but we prefer the description multifocal serpiginoid choroiditis (MSC). We present the distinguishing features of SC and infectious multifocal serpiginoid choroiditis simulating SC. The distinction is crucial to avoid unnecessarily treating SC with antimicrobial agents. Advances in diagnostic and imaging modalities can help differentiate SC from MSC. Novel local and systemic treatment approaches improve the outcome and preserve vision in SC.
Topics: Choroiditis; Diagnosis, Differential; Fluorescein Angiography; Glucocorticoids; Humans; Immunosuppressive Agents; Multifocal Choroiditis; Tomography, Optical Coherence; Tuberculosis, Ocular; Visual Field Tests
PubMed: 23541041
DOI: 10.1016/j.survophthal.2012.08.008 -
Canadian Medical Association Journal Feb 1967Endogenous uveitis in 117 children aged 15 years or under was investigated at The Hospital for Sick Children, Toronto, in a 12-year period from 1953 to 1964. This group...
Endogenous uveitis in 117 children aged 15 years or under was investigated at The Hospital for Sick Children, Toronto, in a 12-year period from 1953 to 1964. This group included 55 children with anterior uveitis, 59 with posterior uveitis, and three with diffuse uveitis. An etiologic diagnosis could be made or the uveitis recognized as part of a definite clinical syndrome in approximately 47% of the 117 children. The commonest cause of posterior uveitis was toxoplasmosis and the commonest associated finding in anterior uveitis was juvenile rheumatoid arthritis. Chronic cyclitis of unknown etiology was a relatively common disease.
Topics: Adolescent; Adrenal Cortex Hormones; Arthritis, Juvenile; Child; Child, Preschool; Ciliary Body; Female; Humans; Male; Toxoplasmosis, Congenital; Uveitis; Uveitis, Anterior
PubMed: 6066889
DOI: No ID Found -
Indian Journal of Ophthalmology May 2023To report the clinical profile of Behcet's disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in... (Observational Study)
Observational Study
PURPOSE
To report the clinical profile of Behcet's disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in South India.
METHODS
This was a retrospective, observational study. Records of 45 eyes of 25 patients between January 2016 and December 2021 were retrieved from the hospital database. Complete ophthalmic evaluation and systemic examination by the rheumatologist with appropriate investigations had been done. Results were analyzed using Statistical Package for the Social Sciences (SPSS) software.
RESULTS
Males (19, 76%) were found to be more affected than females (6, 24%). Mean age of presentation was 27.68 ± 11.08 years. Twenty patients had bilateral involvement (80%), and unilateral involvement was seen in five patients (20%). Seven eyes of four patients (16%) had isolated anterior uveitis, out of which one patient had unilateral and three patients had bilateral involvement. Twenty-six eyes of 16 patients (64%) had posterior uveitis, out of which six patients had unilateral and 10 had bilateral involvement. Twelve eyes of seven patients (28%) had panuveitis, out of which two patients had unilateral and five had bilateral involvement. Hypopyon was seen in five eyes (11.1%) and posterior synechiae in seven eyes (15.55%). Posterior segment findings included vitritis (24.44%), vasculitis (17.78%), retinitis (17.78%), disc hyperemia (11.11%), and disc pallor (8.89%). Steroids alone were given in five patients (20%) and intravenous methylprednisolone (IVMP) was given in four patients (16%). Immunosuppressive agents along with steroids were given in 20 patients (80%), of which azathioprine alone was given in seven patients (28%), cyclosporin alone was given in two patients (8%), mycophenolate mofetil alone was given in three patients (12%), combination of azathioprine and cyclosporin was given in six patients (24%), and combination of methotrexate and mycophenolate mofetil was given in one patient (4%). Biologics were given in 10 patients (40%) - adalimumab in seven patients (28%) and infliximab in three patients (12%).
CONCLUSION
Behcet's disease is an uncommon uveitis in India. Addition of immunosuppressants and biologics to conventional steroid therapy gives better visual outcomes.
Topics: Male; Female; Humans; Adolescent; Young Adult; Adult; Behcet Syndrome; Immunosuppressive Agents; Biological Products; Azathioprine; Mycophenolic Acid; Uveitis; Steroids; Cyclosporins; Retrospective Studies
PubMed: 37203067
DOI: 10.4103/ijo.IJO_1439_22 -
Acta Ophthalmologica Sep 2013To investigate the prognosis and complications in patients with peripheral multifocal chorioretinitis (PMC). PMC is a posterior or panuveitis characterized by chronic... (Review)
Review
PURPOSE
To investigate the prognosis and complications in patients with peripheral multifocal chorioretinitis (PMC). PMC is a posterior or panuveitis characterized by chronic bilateral vitritis and punched-out lesions in the peripheral retina which occurs commonly in elderly white women and is associated with sarcoidosis. Prognosis and complications are largely unknown.
METHODS
A structured literature search in PubMed, Embase and Cochrane was performed to identify relevant articles. Articles were screened, and the remaining articles were critically appraised based on relevance and validity.
RESULTS
The search yielded 267 articles. Eight relevant articles were retrieved. All studies reported on moderate visual impairment. Macular oedema occurred in 60% of the patients with PMC (range, 0-71%), glaucoma in 27% (range, 25-43%) and an epiretinal membrane in 21% (range, 0-28%). In total, 47% had proven or presumed sarcoidosis. Treatment usually comprised topical corticosteroids, periocular steroid injections and systemic corticosteroids regularly in combination with methotrexate.
CONCLUSION
The prognosis of patients with PMC is characterized by a rather poor visual outcome and the relatively high prevalence of complications. PMC is strongly associated with sarcoidosis. Solid proof for the treatment efficacy of PMC is lacking.
Topics: Chorioretinitis; Drug Therapy, Combination; Epiretinal Membrane; Glaucoma; Glucocorticoids; Humans; Immunosuppressive Agents; Macular Edema; Methotrexate; Prognosis; Sarcoidosis
PubMed: 22863241
DOI: 10.1111/j.1755-3768.2012.02483.x -
Therapeutic Delivery Oct 2019Uveitis is a major cause of ocular morbidity, potentially leading to significant visual impairment. The recent adoption of alternative drug delivery options has led to... (Review)
Review
Uveitis is a major cause of ocular morbidity, potentially leading to significant visual impairment. The recent adoption of alternative drug delivery options has led to the development of new sustained-delivery corticosteroid systems, able to manage successfully chronic noninfectious posterior uveitis. The treatment goal is to target the site of inflammation with low dose of corticosteroids, delivered over an extended period of time, to minimize the cumulative damage resulting from repeated recurrences, reducing both injections frequency and ocular side effects. This article will review the pharmacology and preliminary clinical data of the 0.18 mg fluocinolone acetonide intravitreal implant (YUTIQ™), to show its efficacy and safety in the treatment of noninfectious posterior uveitis.
Topics: Chronic Disease; Clinical Trials, Phase III as Topic; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug Implants; Drug Liberation; Fluocinolone Acetonide; Glucocorticoids; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Uveitis, Posterior
PubMed: 31663454
DOI: 10.4155/tde-2019-0051 -
Ophthalmology Oct 2020To evaluate the efficacy and safety of intravitreal sirolimus in the management of noninfectious uveitis of the posterior segment (NIU-PS). (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy and Safety of Intravitreal Sirolimus for Noninfectious Uveitis of the Posterior Segment: Results from the Sirolimus Study Assessing Double-Masked Uveitis Treatment (SAKURA) Program.
PURPOSE
To evaluate the efficacy and safety of intravitreal sirolimus in the management of noninfectious uveitis of the posterior segment (NIU-PS).
DESIGN
Combined analysis of 2 phase 3, randomized, double-masked, multinational, 6-month studies.
PARTICIPANTS
Adults with active NIU-PS (intermediate uveitis, posterior uveitis, or panuveitis; defined as vitreous haze [VH] ≥1.5+ on modified Standardization of Uveitis Nomenclature scale).
METHODS
Patients were randomized 1:1:1 to receive intravitreal sirolimus 44 μg (n = 208), 440 μg (n = 208), or 880 μg (n = 177) on days 1, 60, and 120. Patients discontinued medications for NIU-PS except for systemic corticosteroids, which were tapered according to protocol. Enrollment in the 880-μg group was terminated after interim results found no significant difference in efficacy compared with the 440-μg dose.
MAIN OUTCOME MEASURES
The primary efficacy end point was the percentage of patients with VH of 0 at month 5 in the study eye without the use of rescue therapy. Secondary efficacy end points included VH of 0 or 0.5+, corticosteroid-tapering success, and changes in best-corrected visual acuity (BCVA). Safety measures included ocular and nonocular adverse events.
RESULTS
A total of 592 patients were randomized. Significantly higher proportions of patients treated with 440 μg compared with 44 μg intravitreal sirolimus achieved VH of 0 (21.2% vs. 13.5%; P = 0.038) and VH of 0 or 0.5+ (50.0% vs. 40.4%; P = 0.049) at month 5. Best-corrected visual acuity was stable (absolute change <5 ETDRS letters) or improved >5 letters in 80.1% and 80.2% of patients in the 440-μg and 44-μg groups, respectively. At month 5, corticosteroids were tapered successfully in 69.6% and 68.8% of patients in the 440-μg and 44-μg groups, and among these patients, VH of 0 or 0.5+ was achieved by 43.5% and 28.1% in the 440-μg and 44-μg groups. Both doses were generally well tolerated. Mean changes from baseline intraocular pressure (IOP) in the study eye at each analysis visit were minimal in all treatment groups.
CONCLUSIONS
Intravitreal sirolimus 440 μg improved ocular inflammation, as measured by VH, compared with the 44-μg dose, with minimal impact on IOP, while preserving BCVA.
Topics: Aged; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Intraocular Pressure; Intravitreal Injections; Male; Posterior Eye Segment; Sirolimus; Tomography, Optical Coherence; Uveitis, Posterior
PubMed: 32564920
DOI: 10.1016/j.ophtha.2020.03.033 -
Medical Hypothesis, Discovery &... 2019Optical coherence tomography angiography (OCTA) is an innovative imaging technology enabling clinicians to learn more about the pathophysiology of disease processes as... (Review)
Review
Optical coherence tomography angiography (OCTA) is an innovative imaging technology enabling clinicians to learn more about the pathophysiology of disease processes as it facilitates visualization of the retinal and choroidal circulation without injection of a dye. Also it provides ample qualitative and quantitative data on the vascular supply. OCTA has become an important tool nowadays in the diagnosis and follow-up of patients with age-related macular degeneration, inherited chorioretinal diseases, diabetic retinopathy, retinal vascular occlusive diseases and optic nerve disorders. However, its place is relatively less known in non-infectious posterior uveitis (NIPU). OCTA may help mainly in assessing macular and peripheric retinal perfusion status, detection of retinal and/or disc neovascularization, diagnose of inflammatory choroidal neovascularization and visualizing the uveitic white-dot lesions. This mini-review describes the use of OCTA in patients with NIPU and summarizes some practical points in several uveitic entities.
PubMed: 31788494
DOI: No ID Found -
Indian Journal of Ophthalmology Aug 2022To analyze the structural features of subretinal hyper-reflective material (SHRM) in posterior uveitis using swept-source optical coherence tomography (SS-OCT) and... (Observational Study)
Observational Study
Morphological characterization of subretinal hyper-reflective material in posterior uveitis using swept-source optical coherence tomography and optical coherence tomography angiography.
PURPOSE
To analyze the structural features of subretinal hyper-reflective material (SHRM) in posterior uveitis using swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (SS-OCTA).
METHODS
In this observational study, subjects with quiescent posterior uveitis and the presence of SHRM on SS-OCT were subjected to SS-OCTA to identify the presence of an intrinsic choroidal neovascular (CNV) network. OCT features were compared for SHRM harboring CNV (vascular SHRM) with those without CNV network (avascular SHRM) to identify clinical signs pointing toward the presence of CNVM inside SHRM.
RESULTS
Forty-two eyes of 33 subjects (18 males; mean age: 29.52 ± 12.56 years) were evaluated. Two-thirds (28/42) of eyes having SHRM on SS-OCT harbored intrinsic neovascular network (vascular SHRM). Increased reflectivity of SHRM (P < 0.001) and increased transmission of OCT signal underlying SHRM (P = 0.03) were suggestive of the absence of CNVM. The presence of intra/subretinal fluid (P = 0.08) and pitchfork sign (P = 0.017) were important markers of vascular SHRM.
CONCLUSION
SHRM is an important OCT finding in eyes with posterior uveitis. Meticulous assessment of SHRM characteristics on SS-OCT can aid in identifying the underlying intrinsic neovascular network.
Topics: Adolescent; Adult; Choroid; Choroidal Neovascularization; Fluorescein Angiography; Humans; Male; Subretinal Fluid; Tomography, Optical Coherence; Uveitis, Posterior; Young Adult
PubMed: 35918956
DOI: 10.4103/ijo.IJO_343_22 -
American Journal of Ophthalmology Aug 2021The purpose of this study was to determine classification criteria for multiple evanescent white dot syndrome (MEWDS).
PURPOSE
The purpose of this study was to determine classification criteria for multiple evanescent white dot syndrome (MEWDS).
DESIGN
Machine learning of cases with MEWDS and 8 other posterior uveitides.
METHODS
Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior, or panuveitides. The resulting criteria were evaluated in the validation set.
RESULTS
A total of 1,068 cases of posterior uveitides, including 51 cases of MEWDS, were evaluated by machine learning. Key criteria for MEWDS included: 1) multifocal gray-white chorioretinal spots with foveal granularity; 2) characteristic imaging on fluorescein angiography ("wreath-like" hyperfluorescent lesions) and/or optical coherence tomography (hyper-reflective lesions extending from retinal pigment epithelium through ellipsoid zone into the retinal outer nuclear layer); and 3) absent to mild anterior chamber and vitreous inflammation. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval: 94.3-99.3) in the validation set. Misclassification rates for MEWDS were 7% in the training set and 0% in the validation set.
CONCLUSIONS
The criteria for MEWDS had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
Topics: Adult; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Multimodal Imaging; Retinal Pigment Epithelium; Tomography, Optical Coherence; White Dot Syndromes; Young Adult
PubMed: 33845025
DOI: 10.1016/j.ajo.2021.03.050 -
Radiology and Oncology Apr 2022Immune checkpoint inhibitors (ICI) are becoming increasingly common in treating several cancer types. Durvalumab is a human IgG1 monoclonal antibody that blocks PD-L1... (Review)
Review
BACKGROUND
Immune checkpoint inhibitors (ICI) are becoming increasingly common in treating several cancer types. Durvalumab is a human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80 and has recently been approved for the treatment of extensive-stage small-cell lung cancer (ES-SCLC) and locally advanced unresectable (NSCLC). The present review aimed to analyse immune-mediated uveitis, secondary to durvalumab treatment, through a review of the literature and a presentation of two clinical cases.
PATIENTS AND METHODS
A literature review using PubMed search was conducted to identify cases of uveitis secondary to durvalumab and cases of uveitis with optic disc oedema secondary to ICI use that were reported prior to November 14, 2021. Additionally, we report two cases of uveitis consequent on durvalumab treatment.
RESULTS
Five cases of uveitis secondary to durvalumab use were identified in the literature. Anterior, posterior uveitis and vasculitis were reported. Additionally, we present a case of bilateral intermediate uveitis with bilateral optic disc oedema and a case of bilateral posterior uveitis. Our further search revealed 12 cases of uveitis with optic disc oedema secondary to ICI use, with the majority of cases reported secondary to PD-1 inhibitors.
CONCLUSIONS
Rarely reported, uveitis secondary to durvalumab can present various clinical pictures and requires a thorough diagnostic workup. Once the diagnosis is established, treatment, commonly with a local or systemic corticosteroid, should be adapted to the severity of the inflammation.
Topics: Antibodies, Monoclonal; Humans; Immune Checkpoint Inhibitors; Lung Neoplasms; Papilledema; Uveitis; Uveitis, Posterior
PubMed: 35412706
DOI: 10.2478/raon-2022-0007