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1.
Rev Med Liege ; 79(1): 48-53, 2024 Jan.
Artigo em Francês | MEDLINE | ID: mdl-38223970

RESUMO

Behçet disease is a chronic multisystemic inflammatory condition. The ocular disease mainly manifests as a bilateral, non-granulomatous, posterior uveitis or panuveitis, associated with occlusive retinal vasculitis. Uveitis is frequent in Behçet disease, it may be severe, and visually threatening. Early diagnosis and aggressive treatment are mandatory to preserve visual function. Therefore, the goal of this review is to describe the new diagnosis tools and therapeutic guidelines allowing for a significant improvement of the visual prognosis.


La maladie de Behçet est une pathologie inflammatoire chronique multisystémique. L'atteinte oculaire se caractérise le plus souvent par une panuvéite ou uvéite postérieure bilatérale récidivante, non granulomateuse, associée à une vascularite rétinienne occlusive. L'uvéite associée à la maladie de Behçet est fréquente, sévère et potentiellement cécitante en l'absence d'un diagnostic précoce et d'un traitement adapté. L'objectif de cette revue est de décrire les outils diagnostiques et thérapeutiques ayant permis une amélioration significative du pronostic visuel.


Assuntos
Síndrome de Behçet , Vasculite Retiniana , Uveíte , Humanos , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Uveíte/diagnóstico , Uveíte/etiologia , Uveíte/tratamento farmacológico , Vasculite Retiniana/complicações , Prognóstico
2.
Ocul Immunol Inflamm ; 32(2): 218-225, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36731516

RESUMO

OBJECTIVE: To analyze characteristics, etiology, and outcome of retinal vasculitis in Central Thailand. METHODS: A retrospective cohort study. RESULTS: Retinal vasculitis was found in 10% of uveitis, 74 from 741 uveitis, noninfectious (64.9%) and infectious group (35.1%). The most common cause was Behcet's disease (48.6%). Behcet's disease was the most common cause of all types of vascular leakage on angiography, including capillary (80.4%), venous (56.3%), and arterial leakage (56%). Final visual acuity was 0.86 ± 0.97 logMAR. Cataract was the most frequent complication (42.5%). Acute clinical course (p = .025) and retinal neovascularization (p = .031) were associated with infectious group. Forty-three percent of vasculitis complicated by ischemia required photocoagulation (33%) and anti-VEGF injection (17%). Furthermore, 17% of vasculitis underwent vitrectomy. CONCLUSION: One-half of the retinal vasculitis in Central Thailand were Behcet's disease. Acute onset and retinal neovascularization may suggest infectious etiology. Retinal ischemia should be cautious and undergo early interventions to prevent sight-threatening complications.


Assuntos
Síndrome de Behçet , Neovascularização Retiniana , Vasculite Retiniana , Uveíte , Humanos , Vasculite Retiniana/etiologia , Vasculite Retiniana/complicações , Síndrome de Behçet/complicações , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/etiologia , Centros de Atenção Terciária , Tailândia/epidemiologia , Estudos Retrospectivos , Angiofluoresceinografia , Uveíte/complicações , Isquemia
3.
Eur J Ophthalmol ; 34(1): NP70-NP74, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37186765

RESUMO

INTRODUCTION: Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare clinical entity affecting young healthy individuals. Treatment primarily involves pan retinal photocoagulation (PRP) to capillary non perfusion areas. Intravitreal anti-VEGF or steroids are given in the presence of macula edema. Oral steroids do not alter the course of the disease. Arterial occlusions have been reported in IRVAN. METHODS: Retrospective case review. RESULT: A twenty seven year old male presented to us with mild blurring of vision for one week. His BCVA was OU 20/20. Anterior segment examination was normal. Fundus examination showed bilateral disc aneurysm with OS arterial aneurysm along the inferior arcade. Fundhus fluorescein angiography and OCT angiography were confirmatory of the disc and retinal aneurysm. Capillary non perfusion (CNP) areas were noted in the periphery. Two days later he presented with paracentral scotoma in his left eye which was confirmed by Amsler chart. Fundus, OCT and OCTA were confirmatory of Paracentral Acute Middle Maculopathy (PAMM). The retinal aneurysm had increased in size from 333 micron diameter to 566 micron diameter. Panretinal photocoagulation to the CNP areas was done and intravitreal antiVEGF was given. At 6 months follow up, retinal aneurysm had disappeared. DISCUSSION: Our case describes a unique event with sudden increase in size of the aneurysm leading to acute blockage in the deep capillary plexus thus being the first report of PAMM in IRVAN. The patient was treated with PRP and intravitreal anti-VEGF for the enlarging aneurysm which reduced in size within a week.


Assuntos
Aneurisma , Coriorretinite , Degeneração Macular , Vasculite Retiniana , Retinite , Masculino , Humanos , Adulto , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Estudos Retrospectivos , Retinite/diagnóstico , Angiofluoresceinografia , Aneurisma/complicações , Aneurisma/diagnóstico , Aneurisma/cirurgia , Esteroides/uso terapêutico , Vasos Retinianos
6.
Ocul Immunol Inflamm ; 32(1): 89-97, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36625549

RESUMO

PURPOSE: To examine the long-term efficacy and safety of adalimumab (ADA) in patients with Behçet uveitis (BU). METHODS: A systematic review and meta-analysis of observational studies was performed. Pooled results are presented as mean difference or standardized mean difference (std diff) and 95% confidence intervals (CI). Visual acuity (VA), intraocular inflammation grade, central macular thickness, corticosteroid (CS) sparing effect and adverse events were evaluated. RESULTS: Ten studies were included finally for quantitative and qualitative synthesis. ADA therapy resulted in 0.124 (95%CI: 0.084, 0.165) logMAR improvement in VA. In addition, ADA therapy resulted in decreased grade of intraocular inflammation [std diff, -1.187 (95%CI: -1.508, -0.866)] and macular thickness [std diff, -0.564 (95%CI: -0.843, -0.286)] and caused a decrease in CS dosage [std diff, -1.809 (95%CI: -2.420, -1.198)]. The pooled rate of overall adverse events for ADA in 301 patients was 8.5% (95%CI: 0.039, 0.177). CONCLUSION: ADA is an efficient therapy that improves VA and controls intraocular inflammation, macular edema and retinal vasculitis. As the disease exposure time increased, improvement in VA was less. The safety and CS-sparing effect of ADA were demonstrated with few adverse effects. The results provided evidence that ADA can be used safely and efficiently as the first-line drug in patients with BU.


Assuntos
Síndrome de Behçet , Vasculite Retiniana , Uveíte , Humanos , Adalimumab , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Uveíte/etiologia , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/complicações , Inflamação/tratamento farmacológico , Vasculite Retiniana/tratamento farmacológico
8.
Retin Cases Brief Rep ; 18(1): 106-111, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36067444

RESUMO

PURPOSE: To report the clinicopathological findings of retinal vasoproliferative tumor/reactive retinal astrocytic tumor (VPT/RRAT) with retinal vasculitis, treated by tumor resection. METHODS: A retrospective single case report. PATIENT: A 29-year-old Japanese woman was referred with cystoid macular edema and retinal vasculitis in the right eye. Best-corrected visual acuity was 0.9. Results of fundus examination, optical coherence tomography, and fluorescein angiography demonstrated VPT/RRATs in the temporal retina surrounded by a subretinal exudate, serous retinal detachment and macular edema, and retinal vasculitis. Despite 3 months of oral prednisolone treatment, a full-thickness macular hole developed. Pars plana vitrectomy and endoresection of the VPT/RRATs were performed. Pathologic and immunohistochemical analyses with anti-CD34 antibody, antiglial fibrillary acidic protein antibody, anti-Ki67 antibody, and anti-vascular endothelial growth factor antibody were performed on the excised tissue. Inflammation was evaluated by immunohistological staining with leukocyte common antigen (LCA), anti-CD3 antibody, and anti-CD20 antibody. RESULTS: After surgery, the macular hole closed, best-corrected visual acuity improved to 1.2, retinal vasculitis was ameliorated, and retinal exudate disappeared. There was no recurrence of VPT/RRAT or retinal vasculitis. Pathologic examination showed that antiglial fibrillary acidic protein and anti-vascular endothelial growth factor were widely expressed, irrespective of the distribution of blood vessels. Ki67-positive proliferating cells were detected in the perivascular area. Leukocyte common antigen-positive leukocytes and CD3-positive T cells were detected throughout the samples, whereas CD20-positive B cells were rarely detected. CONCLUSION: Endoresection of VPT/RRAT could be a good treatment option for secondary VPT/RRAT accompanied by retinal vasculitis. Pathologic findings revealed for the first time that inflammatory cells infiltrate the tissue in secondary VPT/RRAT.


Assuntos
Edema Macular , Neoplasias da Retina , Perfurações Retinianas , Vasculite Retiniana , Feminino , Humanos , Adulto , Antígenos Comuns de Leucócito , Perfurações Retinianas/cirurgia , Vasculite Retiniana/complicações , Estudos Retrospectivos , Fatores de Crescimento Endotelial , Retina/patologia , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/cirurgia , Neoplasias da Retina/complicações , Edema Macular/complicações , Tomografia de Coerência Óptica , Angiofluoresceinografia
9.
BMC Ophthalmol ; 23(1): 464, 2023 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-37974099

RESUMO

BACKGROUND: Intraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis. CASE PRESENTATION: A 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200. RESULTS: The retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved. CONCLUSION: This report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.


Assuntos
Descolamento Retiniano , Vasculite Retiniana , Cirurgia Vitreorretiniana , Masculino , Humanos , Pessoa de Meia-Idade , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/etiologia , Vasculite Retiniana/cirurgia , Óleos de Silicone , Fibra de Algodão , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Vitrectomia/efeitos adversos , Prednisolona , Inflamação , Estudos Retrospectivos
10.
Am J Case Rep ; 24: e942085, 2023 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-38013402

RESUMO

BACKGROUND Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease of undefined etiology with a relapsing and remitting course. Lupus retinopathy is reported in around 10% of patients with SLE; however, it is rarely the initial presenting feature of the disease. We report a unique case of bilateral retinal vasculitis as the initial presentation of SLE with secondary antiphospholipid syndrome (APS). CASE REPORT A 34-year-old man, previously healthy, presented to the eye clinic for the first time with painless reduced vision for 3 weeks. A review of systems revealed generalized fatigue, myalgia, arthralgias, and weight loss of around 10 kg in the last 3 months. On ophthalmic examination, his visual acuity was reduced bilaterally, more in the right eye. A fundus exam revealed bilateral diffuse multiple cotton-wool spots, dot and blot hemorrhage covering the posterior pole, and venous congestion and beading. In addition, there was cystoid macular edema (CME) in the fovea of both eyes, and fundus fluorescein angiography (FFA) showed bilateral areas of peripheral and macular hypo-fluorescence, multiple hyper-fluorescent knob-like aneurysmal dilatations, and vascular leaking and staining. He was diagnosed with SLE by the rheumatology team based on the clinical presentations and laboratory investigations. The patient was managed with intravenous methylprednisolone and discharged on oral prednisone with a tapering regimen. Eighteen months after, he reported significant improvement in his vision with regular follow-ups. CONCLUSIONS Ocular manifestations can be the initial presentation of SLE and can lead to serious ocular complications. Early diagnosis and proper management are essential and require cooperation between rheumatologists and ophthalmologists.


Assuntos
Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico , Edema Macular , Vasculite Retiniana , Masculino , Humanos , Adulto , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Vasculite Retiniana/etiologia , Vasculite Retiniana/complicações , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Edema Macular/tratamento farmacológico , Metilprednisolona/uso terapêutico
13.
Rom J Ophthalmol ; 67(2): 195-199, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37522015

RESUMO

Purpose: To report the case of a 26-year-old male with bilateral Eales' disease that led to total blindness in the left eye and legal blindness in the right eye in a short time. Methods: A total clinical systemic examination, computed tomography, magnetic resonance imaging, genetic testing, and optical coherence tomography were performed in the reported case. Results: The eye condition was managed by scatter laser treatment, Anti-VEGF injections, anterior chamber paracentesis and trabeculectomy. Non-steroidal eye drops, as well as prostaglandin analogues, beta-blockers, and carbonic anhydrase inhibitors, have been used as local treatment. Systemic treatment included an intravenous methylprednisolone course, oral corticosteroids, azathioprine, mycophenolate mofetil and a total amount of 12 Anti-VEGF injections. Conclusion: Despite the aggressive treatment with oral steroids, immunosuppressants, and anti-VEGF injections, there were many exacerbations, and remission was not achieved. As a result, aggressive neovascular glaucoma developed, which led to total blindness in the left eye and legal blindness in the right eye. Abbreviations: HLA = human leukocyte antigens, Anti-VEGF = vascular endothelial growth factor inhibitors, BCVA = best corrected visual acuity, FA = fundus angiography, HBsAg = hepatitis B surface antigen, Anti-HCV = hepatitis C antibodies, TPHA = Treponema Pallidum hemagglutination assay, PCR = polymerase chain reaction, HSV = Herpes simplex virus, VZV = Varicella zoster virus, CMV = cytomegalovirus, IOP = intraocular pressure.


Assuntos
Vasculite Retiniana , Fator A de Crescimento do Endotélio Vascular , Masculino , Humanos , Adulto , Vasculite Retiniana/diagnóstico , Neovascularização Patológica/diagnóstico , Cegueira
14.
J Med Case Rep ; 17(1): 309, 2023 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-37408048

RESUMO

BACKGROUND: Eales' disease is an idiopathic peripheral retinal vasculopathy characterized by retinal phlebitis, ischemia, retinal neovascularization, and recurrent vitreous hemorrhages. But CRAO is an unusual presentation. CASE PRESENTATION: A 27-year-old healthy female nurse of Indian descent presented with sudden vision loss in her right eye upon awakening. Central retinal artery occlusion (CRAO), combined with mild central retinal vein occlusion (CRVO), was diagnosed. During the second of three consecutive sessions of hyperbaric oxygen treatments, her vision rapidly improved. One week later, she developed peripheral phlebitis in the same eye. Infectious, inflammatory, and hematologic etiologies were excluded. The systemic evaluation was normal except for a positive Mantoux tuberculin skin test. Following systemic steroidal treatment, she experienced gradual improvement of her vasculitis. Two weeks later, mild retinal phlebitis appeared in her left eye. Eales' disease was diagnosed after the exclusion of other diseases. CONCLUSION: This is an unusual Eales' disease case, which presented as combined CRAO with mild CRVO. The association of CRAO and Eales' disease is reported here for the first time, to our best knowledge.


Assuntos
Flebite , Oclusão da Artéria Retiniana , Vasculite Retiniana , Humanos , Feminino , Adulto , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/etiologia , Neovascularização Patológica , Flebite/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia
15.
Retin Cases Brief Rep ; 17(4): 474-477, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37364212

RESUMO

PURPOSE: To present a case of frosted branch angiitis associated with an exacerbation of mixed connective tissue disease (MCTD). METHODS: Single case report. RESULTS: A 31-year-old woman presented with a flare of her long-standing MCTD after a change in her immunosuppressive medications. She developed blurred vision and floaters first in the left eye but eventually in both eyes. Fundoscopy showed patchy perivascular sheathing of tertiary branch venules surrounded by retinal hemorrhages characterized as frosted branch angiitis. The patient's MCTD symptoms and retinal vasculitis improved with continued immunosuppressive therapy. At 1-month follow-up, her visual acuity had improved to 20/20 bilaterally with complete resolution on fundoscopy. CONCLUSION: To the authors' knowledge, this is the first report of frosted branch angiitis seen in association with MCTD. The improvement in the patient's visual acuity and fundoscopic findings in this case supports the role of immunosuppressive therapy to treat secondary frosted branch angiitis associated with an autoimmune condition such as MCTD. However, it is recommended that a comprehensive medical workup is performed to exclude an infective cause, particularly in immunocompromised patients.


Assuntos
Doença Mista do Tecido Conjuntivo , Vasculite Retiniana , Feminino , Humanos , Adulto , Doença Mista do Tecido Conjuntivo/complicações , Doença Mista do Tecido Conjuntivo/diagnóstico , Angiofluoresceinografia , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/etiologia , Vasculite Retiniana/tratamento farmacológico
16.
P R Health Sci J ; 42(2): 180-182, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37352543

RESUMO

A 62-year-old female patient was evaluated for gradual vision loss, floaters, and photopsia in her left eye. A left fundus examination revealed vitreous cells, hypopigmented lesions, and retinal vasculitis, and a workup revealed a positive HLA-A29 serology, all of which findings were consistent with birdshot chorioretinopathy. The patient was treated with oral prednisone and mycophenolate mofetil, which resulted in the adequate control of her uveitis. Even though unilateral cases are exceedingly rare and do not meet the established research criteria, this case highlights the importance of not minimizing the significance of birdshot lesions in the differential of patients with unilateral multifocal chorioretinitis.


Assuntos
Coriorretinite , Vasculite Retiniana , Humanos , Feminino , Pessoa de Meia-Idade , Coriorretinopatia de Birdshot , Angiofluoresceinografia/métodos , Coriorretinite/diagnóstico , Coriorretinite/tratamento farmacológico , Hispânico ou Latino
18.
J Pediatr Ophthalmol Strabismus ; 60(3): e26-e30, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37227991

RESUMO

An 8-year-old girl presented with a subretinal abscess after strabismus surgery. This was treated successfully with medial rectus suture removal, pars plana vitrectomy, intravitreal antibiotics, and intravenous antibiotics. Recovery was complicated by acute post-infectious retinal vasculitis after tapering high-dose corticosteroids, requiring an extended corticosteroid regimen over 2 months until resolution. [J Pediatr Ophthalmol Strabismus. 2023;60(3):e26-e30.].


Assuntos
Endoftalmite , Vasculite Retiniana , Estrabismo , Feminino , Humanos , Criança , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/etiologia , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/etiologia , Endoftalmite/etiologia , Antibacterianos/uso terapêutico , Vitrectomia , Estrabismo/cirurgia , Estrabismo/complicações
19.
Retina ; 43(9): 1534-1543, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37229721

RESUMO

PURPOSE: Wide-field fluorescein angiography is commonly used to assess retinal vasculitis (RV), which manifests as vascular leakage and occlusion. Currently, there is no standard grading scheme for RV severity. The authors propose a novel RV grading scheme and assess its reliability and reproducibility. METHODS: A grading scheme was developed to assess both leakage and occlusion in RV. Wide-field fluorescein angiography images from 50 patients with RV were graded by four graders, and one grader graded them twice. An intraclass correlation coefficient (ICC) was used to determine intraobserver-interobserver reliability. Generalized linear models were calculated to associate the scoring with visual acuity. RESULTS: Repeated grading by the same grader showed good intraobserver reliability for both leakage (ICC = 0.85, 95% CI 0.78-0.89) and occlusion (ICC = 0.82, 95% CI 0.75-0.88) scores. Interobserver reliability among four independent graders showed good agreement for both leakage (ICC = 0.66, 95% CI 0.49-0.77) and occlusion (ICC = 0.75, 95% CI 0.68-0.81) scores. An increasing leakage score was significantly associated with worse concurrent visual acuity (generalized linear models, ß = 0.090, P < 0.01) and at 1-year follow-up (generalized linear models, ß = 0.063, P < 0.01). CONCLUSION: The proposed grading scheme for RV has good to excellent intraobserver and interobserver reliability across a range of graders. The leakage score related to present and future visual acuity.


Assuntos
Vasculite Retiniana , Humanos , Vasculite Retiniana/diagnóstico , Reprodutibilidade dos Testes , Angiofluoresceinografia/métodos , Fluoresceínas , Variações Dependentes do Observador
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