A Rare Case of Didanosine-Induced Mid-Peripheral Chorioretinal Atrophy Identified Incidentally 11 Years after the Drug Cessation.

Objective: This article aims to describe a unique case of didanosine-induced retinal degeneration that was discovered 11 years after the drug withdrawal. Case report: The patient is a 42-year-old woman with a medical history of HIV and hepatitis C virus since 2004. She has been prescribed antiretroviral therapy since then. For the first seven years (2004-2011), the patient was prescribed a combination therapy consisting of didanosine, efavirenz, and lamivudine. The protocol was changed to atripla (efavirenz, emtricitabine, and tenofovir) from 2011 to 2021. Recently (October 2021-January 2021), the patient was prescribed eviplera (rilpivirin, emtricitabine, and tenofovir). In addition, her past medical history revealed Gougerot-Sjogren syndrome and rheumatoid arthritis. She was prescribed hydroxychloroquine (HCQ) (2009-2021) at a dose of 400 mg daily. She had no vision complaint. Results: During her routine HCQ screening at the eye clinic, University Hospital Bretonneau, Tours, France, the widefield colour fundus photograph showed well-defined symmetric mid-peripheral areas of chorioretinal atrophy sparing the posterior pole of both eyes. Furthermore, the widefield fundus autofluorescence illustrated mid-peripheral round well-demarcation hypoautofluorescent areas of chorioretinal atrophy of both eyes. Conversely, the macular optical coherence tomography (OCT) was normal. Many of her drugs are known to be associated with retinopathy such as HCQ, tenofovir, efavirenz, and didanosine. Because our data corroborate peripheral retinal damage rather than posterior pole damage, this case report is compatible with didanosine-induced retinopathy rather than HCQ, efavirenz, or tenofovir retinal toxicity. Conclusions: All HIV patients who are presently or were previously on didanosine therapy should have their fundus examined utilising widefield fundus autofluorescence and photography.

Age, gender, and interracial variability of normal lacrimal gland volume using MRI.

PURPOSE: Aimed to evaluate normal volume of the lacrimal gland in patients of different age groups and race. METHODS: All MRI studies of the brain that were done between June 2012 and April 2013 were examined. Lacrimal glands were identified using fat-saturated fluid-attenuated inversion recovery (FLAIR) images, and the volumes were calculated using TeraRecon iNtuition viewer. Volumes for the right and left lacrimal glands were recorded for persons of different age groups and race, and the results were compared with those of a randomly selected group of patients who had undergone the same calculation method using CT of the brain, orbit, or paranasal sinuses. RESULTS: The authors included 998 lacrimal glands of 499 patients. The mean volumes for the right and left lacrimal glands were 0.770 and 0.684 cm, respectively. Lacrimal glands were larger in women; the largest volumes were observed during the second decade of life. Mean volumes also varied with race: 0.840 cm in Asians, 0.790 cm in Africans, 0.760 cm in Indians, and 0.710 cm in Middle Easterners. The consultant neuroradiologist and the intern showed excellent agreement for measurements of lacrimal gland volume. No significant difference was observed between lacrimal gland measurements method on MRI and CT. CONCLUSION: Lacrimal gland volume varies according to age, gender, race, and laterality. Measurements with MRI using fat-saturated FLAIR images and TeraRecon iNtuition viewer software are reliable, accurate, and can be used by junior staff with less radiation exposure to patients.

The association of human leukocyte antigen B27 with anterior uveitis in patients from the western region of Saudi Arabia: a retrospective study.

BACKGROUND: The association of human leukocyte antigen B27 (HLA-B27) with anterior uveitis is well known. The prevalence of HLA-B27 and its relation to anterior uveitis is related to race and geographic location. The association is strongest in Western countries and weakest in Eastern countries. Data regarding this association from Middle Eastern countries are limited. Thus, we undertook the study reported here to evaluate the association of HLA-B27 with anterior uveitis in patients in a tertiary center in the western region of the Saudi Arabia. METHODS: The study involved a retrospective analysis of the records of patients with anterior uveitis, referred to the uveitis clinic in Magrabi Eye and Ear Hospital, Jeddah, Saudi Arabia, from 1999 to 2010. The cost-effectiveness of HLA-B27 testing was analyzed. RESULTS: Among the 587 cases of uveitis, 335 (57.1%; mean age 37.56±12.82 years; 203 male and 132 female) cases were of anterior uveitis. All patients with anterior uveitis were investigated for HLA-B27 positivity. Idiopathic anterior uveitis was the most common (80%), followed by Fuchs heterochromic cyclitis (7.45%) and ankylosing spondylitis (3.8%). Only two patients were HLA-B27 positive. The cost-effectiveness of HLA-B27 testing was found to be 165,000 Saudi riyals (44,594 US dollars) per positive case. CONCLUSION: HLA-B27-related uveitis appears to be very rare in our part of the world. Idiopathic uveitis is the most common type of anterior uveitis. The cost-effectiveness of HLA-B27 testing is low for patients with anterior uveitis in the western region of Saudi Arabia.