RESUMO
Th17/Treg cell balance is essential for immune homeostasis and when disrupted, is associated with the occurrence and development of inflammation in numerous autoimmune diseases. However, its contribution in pathophysiology of uveitis remains unexplored. In this study, we deciphered the role of Th17/Treg cell balance in autoimmune uveitis subjects. Using flow cytometry, we detected the frequencies and absolute count of both Th17 and Treg cells in the aqueous humor and peripheral blood of patients and healthy controls. Our results for the first time reveal a significant increase (p < 0.01 and p < 0.005) in Th17 population alongside a significant decrease (p < 0.001 and p < 0.003) in Treg cell population in both the aqueous humor and PBMCs of uveitis patients. Further we analyzed the expression of Th17-Treg associated genes and cytokines via qPCR and ELISA respectively. These findings align with our flow cytometry results, as evident by a significant (p < 0.002) up-regulation of IL-17 and a concurrent down regulation of IL-10 at transcriptional levels. Moreover, IL-17A cytokine was found to be substantially high (p < 0.001) and IL-10 (p < 0.02) down regulated in serum. Interestingly, we demonstrated a significant correlation of Th17/Treg cells in aqueous humor with those in peripheral blood. Conclusively, our results suggest the pivotal role of Th17/Treg cell axis in the immuno-pathophysiology of human uveitis. Further we propose the therapeutic potential of targeting this novel axis for ameliorating the disease burden associated with uveitis.
Assuntos
Humor Aquoso , Linfócitos T Reguladores , Células Th17 , Uveíte Intermediária , Humanos , Células Th17/imunologia , Células Th17/metabolismo , Linfócitos T Reguladores/imunologia , Linfócitos T Reguladores/metabolismo , Feminino , Masculino , Adulto , Humor Aquoso/imunologia , Humor Aquoso/metabolismo , Uveíte Intermediária/imunologia , Uveíte Intermediária/diagnóstico , Citocinas/metabolismo , Pessoa de Meia-Idade , Adulto JovemRESUMO
We report the visual and clinical outcomes of a middle-aged woman who presented with exudative retinal detachment (ERD) secondary to a vasoproliferative tumor (VPT) in an eye with sarcoidosis-associated intermediate uveitis. A 55-year-old woman previously diagnosed with sarcoidosis presented with decreased vision in the left eye (LE). Visual acuity in the LE was counting fingers. She had active vitritis, and a peripheral retinal vascular mass was noted in the superotemporal periphery. The mass was associated with ERD involving the posterior pole. The patient was managed with systemic and intravitreal steroids, and cyclosporine was subsequently added as a steroid-sparing agent. Because of recurrence of ERD, the patient underwent pars plana vitrectomy, and cryotherapy and laser photocoagulation were applied to the VPT. Two months postoperatively, visual acuity in the LE improved to 6/10. There was marked regression of the VPT and total resolution of the ERD. In conclusion, we report a favorable visual and clinical outcome in a patient with VPT-associated ERD who responded to a combination of medical therapy and surgical intervention. VPT may lead to different remote complications, so timely diagnosis of these tumors and proper management of their complications is warranted.
Assuntos
Angiofluoresceinografia , Neoplasias da Retina , Sarcoidose , Uveíte Intermediária , Acuidade Visual , Humanos , Feminino , Pessoa de Meia-Idade , Sarcoidose/complicações , Sarcoidose/diagnóstico , Angiofluoresceinografia/métodos , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/complicações , Neoplasias da Retina/terapia , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/complicações , Tomografia de Coerência Óptica/métodos , Fundo de Olho , Vitrectomia/métodos , Glucocorticoides/uso terapêutico , Descolamento Retiniano/etiologia , Descolamento Retiniano/diagnósticoRESUMO
PURPOSE: To evaluate the microvasculature during remission in patients with pars planitis (PP-IU) and multiple sclerosis-associated intermediate uveitis (MS-IU) using optical coherence tomography angiography (OCT-A). METHODS: Single-center, descriptive, case-control study was conducted. Adult patients (≥16 years) with IU in remission (PP-IU and MS-IU) and healthy age-sex matched healthy controls (HC) were enrolled to the study. Demographic/clinical features, best-corrected visual acuity (BCVA), ocular findings, neurological symptoms and preferred treatments were recorded. The presence of cystoid macular edema (CME) during follow-up was recorded. All IU patients in remission and HC subjects were scanned with OCT-A. Foveal avascular zone (FAZ) areas of superficial and deep capillary plexus (SCP/DCP) and vascular densities of SCP, DCP and choriocapillaris were obtained from OCT-A and compared between the groups. RESULTS: Sixty-nine eyes of 37 IU patients in remission and 20 HC were included (44 eyes/23 patients in PP-IU, 25/14 in MS-IU, 40/20 in HC). No statistically significant differences were observed in terms of demographic or clinical characteristics of the patients. The vascular density in the SCP was significantly reduced in the PP-IU and MS-IU groups compared to the HC group (p < .05). Nevertheless, there were no significant changes in any of the OCTA parameters between the IU groups. Uveitis duration was found to be correlated with enlargement of the FAZ area in PP-IU (p = .039). CONCLUSION: OCTA may not be useful in differentiating between PP-IU and MS-IU. Nevertheless, the primary implication in SCP potentially elucidates the pathogenesis of these two subtypes of IU, which are characterized by a shared pathogenesis. The monitoring of the FAZ area in the PP-IU group is valuable in terms of chronicity.
Assuntos
Angiofluoresceinografia , Esclerose Múltipla , Pars Planite , Vasos Retinianos , Tomografia de Coerência Óptica , Uveíte Intermediária , Acuidade Visual , Humanos , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Adulto , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/fisiopatologia , Uveíte Intermediária/tratamento farmacológico , Angiofluoresceinografia/métodos , Acuidade Visual/fisiologia , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico por imagem , Vasos Retinianos/patologia , Vasos Retinianos/diagnóstico por imagem , Pars Planite/diagnóstico , Adulto Jovem , Pessoa de Meia-Idade , Seguimentos , Estudos de Casos e Controles , Fundo de Olho , AdolescenteRESUMO
PURPOSE: To report the clinical and fluorescein angiographic (FA) features of demyelinating plaque-associated uveitis (DPU), a subset of uveitis in which patients have demyelinating plaques on the brain/cervical magnetic resonance image (MRI) but do not meet the criteria for multiple sclerosis (MS). METHODS: In this retrospective observational study, Persian Patients were diagnosed with DPU and included if (1) they never satisfied the MS criteria, (2) all other possible etiologies were excluded, and (3) they were followed for at least 2 years. RESULTS: After a median follow-up of 3 years (interquartile range, 2.0-5.3), 8 out of 40 (20%) patients diagnosed with DPU were excluded as they subsequently met the MS criteria. Of remaining 32 patients studied, the mean age was 36.3±9.9 (range 20-56 years), and 30 (93.8%) were female. Twenty-four (75.0%) showed bilateral involvement and 27 (84.4%) had insidious-chronic course. Uveitis was classified as intermediate (with or without anterior uveitis) in 29 (90.6%) and isolated anterior in 3 (9.4%) patients. Nine (28.1%) patients had at least one systemic neurological complaint. Ocular findings were: granulomatous keratic precipitates in 43/44 (97.7%) eyes; snowballs in 25/52 (48.1%) eyes; snowbanks in 4/52 (7.7%) eyes; cystoid macular edema in 20/56 (35.7%) eyes; and optic neuritis in 5/56 (8.9%) eyes. Visual acuity was ≥ 20/40 in 39 eyes (69.6%) at presentation which improved to 46 eyes (81.2%) at 2-year follow up. The two most frequent findings in FA were optic disc leakage/staining in 44/52 (81.5%) eyes, and peripheral retinal perivascular leakage in 39/52 (76.9%) eyes, which in 14/52 (26.9%) eyes extended beyond the equator. CONCLUSION: DPU usually presents as a bilateral chronic granulomatous intermediate and, less often, isolated anterior uveitis, especially in females. Most are neurologically asymptomatic. Visual outcome is generally favorable. In FA, peripheral retinal perivascular leakage is common. DPU patients have an increased tendency to develop MS and should be prohibited from anti-TNF treatment.
Assuntos
Placa Aterosclerótica , Uveíte Anterior , Uveíte Intermediária , Uveíte , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Uveíte/diagnóstico , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/etiologia , Retina , Angiofluoresceinografia , Estudos Retrospectivos , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológicoRESUMO
Intermediate and posterior uveitis can have multiple infectious and noninfectious causes, and posterior uveitis in particular is clinically multifaceted. Some entities require prompt initiation of therapy to ensure visual prognosis. This article presents typical characteristics of intermediate and posterior uveitides and explains special features of their treatment.
Assuntos
Uveíte Intermediária , Uveíte Posterior , Uveíte , Humanos , Uveíte Posterior/diagnóstico , Uveíte Posterior/terapia , Uveíte/diagnóstico , Uveíte/terapia , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/terapiaRESUMO
PURPOSE: To analyse the clinical characteristics of adult patients with pars planitis (PP-IU), non-pars planitis (NPP-IU) and multiple sclerosis-associated intermediate uveitis (MS-IU) and distinguish between groups. METHODS: Seventy-three adult patients with intermediate uveitis (IU) reviewed retrospectively and divided as PP-IU, NPP-IU and MS-IU according to 'The standardization of uveitis nomenclature working group classification criteria.' Demographic and clinical characteristics, OCT and fluorescein angiography (FA) findings, complications and treatments were recorded. RESULTS: A total of 134 eyes of 73 patients were included, and 42 of the patients were classified as PP-IU, 12 as NPP-IU, and 19 as MS-IU. If a patient presenting with blurred vision, or tent-shaped vitreous band/snowballs/snowbank on examination, or vascular leakage on FA and accompanying neurological symptoms, the frequency of demyelinating plaque detection on cranial MRI and the risk of MS-IU increased. Mean BCVA was increased from 0.22 ± 0.30 logMAR to 0.19 ± 0.31 logMAR (p = 0.021). Gender, initial BCVA, snowbank formation, disc oedema and periphlebitis on examination, and disc leakage/occlusion on FA were found predictive of decreased BCVA at final visit (p < 0.05). CONCLUSIONS: The clinical features of these three groups are similar, some features that can guide the differential diagnosis. It may be recommended to periodically evaluate "suspicious" patients with MRI for MS.
Assuntos
Pars Planite , Uveíte Intermediária , Uveíte , Humanos , Adulto , Estudos Retrospectivos , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/etiologia , Uveíte/complicações , Pars Planite/complicações , Transtornos da VisãoRESUMO
Purpose: To evaluate the macular microvascular changes in patients with intermediate uveitis (IU) using optical coherence tomography angiography (OCT-A) and to determine the relationship of OCT-A measurements with disease duration and activity. Methods: This cross-sectional study was performed at the uvea department of a tertiary hospital. Patients with IU (8 women, 8 men; mean age: 28.80 ± 12.80 years) were included in the study. The macular thickness measurements obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) and macular superficial and deep vessel density (VD) parameters obtained by OCT-A (Avanti RTVue-XR; Optovue, Fremont, CA, USA) were compared with healthy subjects (12 men, 22 women; mean age: 28.40 ± 8.32 years). Eyes with pathology including marked obvious edema in the macula were not included in the study. Results: The macular thickness was found to be higher in the patient group (p < 0.001). The deep and superficial VD measurements in almost all quadrants in both superficial and deep layers were significantly lower in the IU patient group (p < 0.05). Macular thickness was increased in the active state of IU (p = 0.03), however, none of the OCT-A parameters showed a significant difference between active and inactive IU patients (p > 0.05). No correlation was observed between OCT-A parameters and total IU disease duration. Conclusion: Quantitative analyses of macular vascular structures demonstrate significantly reduced VD in both superficial and deep retinal layers in IU patients. Considering the importance of the macula in visual prognosis, OCT-A can provide crucial data for the monitoring and follow-up of IU patients.
Assuntos
Vasos Retinianos , Uveíte Intermediária , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Vasos Retinianos/patologia , Angiofluoresceinografia/métodos , Tomografia de Coerência Óptica/métodos , Estudos Transversais , Uveíte Intermediária/diagnósticoRESUMO
PURPOSE: This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU). METHODS: Narrative literature review. RESULTS: IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice. CONCLUSIONS: IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.
Assuntos
Pars Planite , Uveíte Intermediária , Uveíte , Humanos , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológico , Uveíte Intermediária/complicações , Pars Planite/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Transtornos da Visão , Linfócitos TRESUMO
PURPOSE: To report a case of multiple sclerosis (MS) development in a patient with Juvenile Idiopathic Arthritis (JIA) and bilateral intermediate uveitis (IU) treated with Adalimumab. CASE REPORT: A 21-year-old Colombian woman diagnosed with JIA and bilateral refractory IU treated with methotrexate and Adalimumab with difficult control of the disease and multiple ocular complications. Eight years after starting Adalimumab, the patient presented paresthesia in the left upper limb. Radiologic findings in the brain and cervical spine MRI confirmed the diagnosis of MS. CONCLUSIONS: We reported the first case of MS development in a patient with JIA treated with Adalimumab and the third in a patient with noninfectious uveitis treated with anti-TNFα. It remains uncertain whether MS is secondary to anti-TNFα therapy or is linked to a polyautoimmunity phenomenon.
Assuntos
Antirreumáticos , Artrite Juvenil , Esclerose Múltipla , Uveíte Intermediária , Uveíte , Feminino , Humanos , Adulto Jovem , Adulto , Adalimumab/efeitos adversos , Artrite Juvenil/complicações , Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Antirreumáticos/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Uveíte/etiologia , Uveíte Intermediária/complicações , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológicoRESUMO
AIM: To study the long-term efficacy and safety of Ozurdex as anti-inflammatory monotherapy in the management of tuberculosis-associated intermediate uveitis (TBIU). METHODS: Retrospective analysis of eyes with TBIU that received Ozurdex as anti-inflammatory monotherapy with a follow-up of at least 1 year. RESULTS: 13 eyes (2 pseudophakic) of 11 patients were included. Mean BCVA improved from 0.65 to 0.11 at 3 months (p = .0005) and remained 0.11 at 1 year. Mean central foveal thickness improved from 452.87µ to 187.25µ at 3 months (p = .0009) and 184.62µ at 1 year in 8 eyes with CME. Mean vitreous haze improved from 2.38 to 0.11 at 3 months with no recurrences at 1 year. Mean IOP increased from 13.15mmHg to 15.53mmHg (p = .013) at 2 months and reduced to 12.46mmHg by 1 year. None required antiglaucoma medication. One eye underwent cataract surgery. The mean follow-up was 18.4 months. CONCLUSION: Ozurdex is safe and efficacious in TBIU as anti-inflammatory monotherapy in conjunction with antitubercular therapy.
Assuntos
Edema Macular , Tuberculose , Uveíte Intermediária , Uveíte , Humanos , Glucocorticoides/uso terapêutico , Estudos Retrospectivos , Edema Macular/tratamento farmacológico , Implantes de Medicamento , Anti-Inflamatórios/uso terapêutico , Dexametasona , Injeções Intravítreas , Uveíte Intermediária/complicações , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológico , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológicoRESUMO
Purpose: To report the prevalence, clinical profile, investigations, and visual outcomes of sarcoid intermediate uveitis in a tertiary eye care center in South India. Methods: Retrospective, observational case series. Records of 29 patients with sarcoid intermediate uveitis were retrieved. Complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done. Results were analyzed using SPSS software. Results: Mean age group was 42.14 ± 11.31 years. The bilateral presentation was more common and females were more affected than males. Anterior chamber cells and flares in 22.4% of cases (N = 11 eyes), posterior synechiae in 20.4% (N = 10 eyes), and both small and mutton fat keratic precipitates in 14.2% of cases (N = 7 eyes) were noted; only one eye had Busacca nodules similar to other granulomatous uveitis. Cystoid macular edemas were present in three eyes. Treatment with oral steroids and systemic immunosuppression resulted in good visual recovery. The mean presenting visual acuity in right and left eye were 0.2 and 0.3, respectively. The mean final visual acuity in right and left eye was 0.1 and 0.3, respectively. Conclusion: Sarcoid intermediate uveitis is quite common in a tuberculosis endemic country like India. A complete review of systems with appropriate investigations is essential to prevent visual complications.
Assuntos
Anormalidades do Olho , Sarcoidose , Uveíte Intermediária , Uveíte , Adulto , Anormalidades do Olho/complicações , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sarcoidose/complicações , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Uveíte/epidemiologia , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológico , Uveíte Intermediária/epidemiologiaAssuntos
COVID-19/complicações , Síndrome de Resposta Inflamatória Sistêmica/complicações , Uveíte Intermediária/etiologia , Adolescente , COVID-19/diagnóstico , COVID-19/terapia , Dexametasona/uso terapêutico , Humanos , Masculino , SARS-CoV-2/isolamento & purificação , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Resultado do Tratamento , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológicoRESUMO
PURPOSE: To describe the course of childhood-onset intermediate uveitis without associated systemic disease, and investigate determinants of outcomes. DESIGN: A retrospective clinical cohort study METHODS: This study was conducted in an institutional setting. A total of 125 children (221 eyes) aged 16 years and less participated. Outcomes of interest were visual acuity, severity of inflammation, and the occurrence of sight-threatening complications. Variables examined included age and clinical findings at presentation, treatment, and duration of follow-up. Multivariable analysis was undertaken to investigate potential predictors of outcomes. RESULTS: The median follow-up duration was 57 months. At presentation, best-corrected visual acuity worse than 20/160 was recorded in 11 (4.4%) eyes and significant vitreous haze (≥2+Standardisation of Uveitis Nomenclature (SUN)) in 35 (14%) eyes. Corticosteroid-sparing agents were used in 41 children (33%), with methotrexate most commonly used (27 children, 21.6%). The most frequent complications were raised intraocular pressure (n = 65; 29.4%), cataract (n = 41; 18.5%), and cystoid macular edema (n = 29; 13.1%). At the last visit, 116 (92.8%) patients achieved best-corrected vision of 20/40 or better with quiescent uveitis. The absence of the use of a steroid-sparing immunomodulatory agent was the strongest predictive factor for the development of new macular edema (odds ratio = 6.3, 95% CI = 2.3-16.9, P < .001) or glaucoma (odds ratio = 6.6, 95% CI = 2.5-17.9, P < .001) over the period of observation. CONCLUSIONS: The visual outcomes of childhood-onset idiopathic intermediate uveitis are favorable. The frequency of sight-threatening sequelae of inflammation, which confer a lifelong risk of further visual loss, is high. The use of immunomodulatory therapy is associated with a lower risk of developing macular edema and ocular hypertension.
Assuntos
Glaucoma , Edema Macular , Uveíte Intermediária , Uveíte , Criança , Glaucoma/complicações , Humanos , Inflamação/complicações , Edema Macular/tratamento farmacológico , Estudos Retrospectivos , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Uveíte Intermediária/complicações , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológicoRESUMO
The manifestation of intermediate uveitis (IU) in patients with retinitis pigmentosa (RP) is uncommon and poses diagnostic and management challenges. In this case, we describe the clinical features and management outcomes in an RP patient with a novel homozygous splice site mutation in PRPF8. A 21-year-old male presented with unilateral decrease of vision in the right eye for 1 week. Retinal dystrophy features were present in the left eye. After 2 weeks of topical steroid therapy, near-total resolution of IU was achieved and vision improved to 20/30. Signs of (RP) were present bilaterally, with the right eye more affected than the left. Genetic testing indicated a novel homozygous c. 3061-6_3061-3del mutation in the PRPF8 gene. IU in young patients with RP can be effectively treated with a short course of topical steroids, sparing the need for systemic immunosuppressives. After the improvement in IU, the right eye showed more advanced RP changes.
Assuntos
Retinose Pigmentar , Uveíte Intermediária , Adulto , Humanos , Masculino , Adulto Jovem , Mutação , Linhagem , Retinose Pigmentar/complicações , Retinose Pigmentar/genética , Proteínas de Ligação a RNA/genética , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/etiologiaRESUMO
PURPOSE: To evaluate the efficacy of Ozurdex implant by analyzing macular morphology and function in pediatric uveitis and related cystoid macular edema (CMO). METHODS: Main outcomes were visual acuity, mfERG and photopic ERG response, and central macular thickness. Mean values recorded at each time-point were compared to baseline and correlations between functional and anatomical parameters were evaluated. RESULTS: Resolution of intraocular inflammation and CMO was achieved in all eyes 1 month after implant without procedure or drug-related complications. Mean visual acuity and mfERG amplitude improved showing a statistically significant difference to baseline values for the first 4 months. Mean central macular thickness showed a statistically significant reduction for all follow-up time. Photopic ERG did not vary significantly. Statistically significant correlation was found between trends of visual acuity, central macular thickness, and mfERG responses. CONCLUSION: Correlation found between macular morphology and function confirms the efficacy of Ozurdex in pediatric uveitis.
Assuntos
Edema Macular , Uveíte Intermediária , Uveíte , Criança , Dexametasona/uso terapêutico , Implantes de Medicamento , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Estudos Retrospectivos , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Uveíte Intermediária/complicações , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológicoAssuntos
Edema Macular , Uveíte Intermediária , Dexametasona/efeitos adversos , Implantes de Medicamento , Glucocorticoides/efeitos adversos , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/tratamento farmacológicoRESUMO
PURPOSE: The purpose of this study was to determine classification criteria for multiple sclerosis-associated intermediate uveitis. DESIGN: Machine learning of cases with multiple sclerosis-associated intermediate uveitis 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 in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the intermediate uveitides. The resulting criteria were evaluated in the validation set. RESULTS: A total of 589 cases of intermediate uveitides, including 112 cases of multiple sclerosis-associated intermediate uveitis, 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 multiple sclerosis-associated intermediate uveitis included unilateral or bilateral intermediate uveitis and multiple sclerosis diagnosed by the McDonald criteria. Key exclusions included syphilis and sarcoidosis. The misclassification rates for multiple sclerosis-associated intermediate uveitis were 0 % in the training set and 0% in the validation set. CONCLUSIONS: The criteria for multiple sclerosis-associated intermediate uveitis had a low misclassification rate and appeared to perform sufficiently well enough for use in clinical and translational research.
Assuntos
Aprendizado de Máquina , Esclerose Múltipla/classificação , Pesquisa Translacional Biomédica/métodos , Uveíte Intermediária/classificação , Acuidade Visual , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/etiologiaRESUMO
PURPOSE: To determine classification criteria for intermediate uveitis, non-pars planitis type (IU-NPP, also known as undifferentiated intermediate uveitis). DESIGN: Machine learning of cases with IU-NPP 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 of cases of intermediate uveitides, including 114 cases of IU-NPP, 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 IU-NPP included unilateral or bilateral intermediate uveitis with neither snowballs in the vitreous humor nor snowbanks on the pars plana. Other key exclusions included multiple sclerosis, sarcoidosis, and syphilis. The misclassification rates for IU-NPP were 0% in the training set and 0% in the validation set. CONCLUSIONS: The criteria for IU-NPP had a low misclassification rate and seemed to perform well enough for use in clinical and translational research.
Assuntos
Aprendizado de Máquina , Uveíte Intermediária/classificação , Acuidade Visual , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pars Planite/classificação , Pars Planite/diagnóstico , Uveíte Intermediária/diagnóstico , Adulto JovemRESUMO
ABSTRACT This report aims to describe the effectiveness of a unilateral intravitreal dexamethasone implant (Ozurdex®) used for the treatment of cystoid macular edema in a patient with recurrent intermediate uveitis. Bearing in mind the adverse effects of the prolonged use of systemic corticosteroids, the objective here was to provide a less damaging form of intervention, and also to demonstrate the safety of the dexamethasone implant for patients who fail to respond to conventional treatment. In the present case, there was bilateral improvement in retinal anatomy and function with use of the unilateral intravitreal dexamethasone implant (Ozurdex®).
RESUMO Neste estudo, o objetivo foi descrever, a partir de um relato de caso, a eficácia do uso de implante de dexametasona intravítrea (Ozurdex®) unilateral, para o tratamento de edema macular cistoide, em um paciente com quadro de uveíte intermediária recorrente, visando uma terapêutica menos lesiva, diante dos efeitos colaterais do uso prolongado de corticoesteroides sistêmicos, demonstrando também a segurança desse tratamento alternativo para aqueles pacientes que se apresentam refratários a terapêutica tradicional. No caso relatado, vale ressaltar a melhora bilateral da anatomia e função retiniana com o implante unilateral de dexametasona intravítrea (Ozurdex®).
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dexametasona/administração & dosagem , Uveíte Intermediária/complicações , Edema Macular/etiologia , Edema Macular/tratamento farmacológico , Acuidade Visual , Uveíte Intermediária/diagnóstico , Edema Macular/diagnóstico , Tomografia de Coerência Óptica , Implantes de Medicamento/administração & dosagem , Injeções IntravítreasRESUMO
PURPOSE: To determine the incidence of and predictive factors for cataract in intermediate uveitis. DESIGN: Retrospective cohort study. METHODS: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status. RESULTS: Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk. CONCLUSIONS: Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.