RESUMO
Importance: Monitoring for and reporting potential cases of intraocular inflammation (IOI) in clinical practice despite limited occurrences in clinical trials, including experiences with relatively new intravitreal agents, such as brolucizumab, pegcetacoplan, or faricimab, helps balance potential benefits and risks of these agents. Objective: To provide descriptions of 3 initially culture-negative cases of acute, severe, posterior-segment IOI events occurring within the same month following intravitreal faricimab injections at a single institution. Design, Setting, and Participants: In this case series, 3 patients manifesting acute, severe IOI following intravitreal injection of faricimab were identified between September 20, 2023, and October 20, 2023. Exposure: Faricimab, 6 mg (0.05 mL of 120 mg/mL solution), for neovascular age-related macular degeneration among patients previously treated with aflibercept; 1 patient also had prior exposure to bevacizumab. Main Outcomes and Measures: Visual acuity, vitreous taps for bacterial or fungal cultures, and retinal imaging. Results: All 3 patients received intravitreal faricimab injections between September 20 and October 20, 2023, from 2 different lot numbers (expiration dates, July 2025) at 3 locations of 1 institution among 3 of 19 retina physicians. Visual acuities with correction were 20/63 OS for patient 1, 20/40 OD for patient 2, and 20/20 OS for patient 3 prior to injection. All 3 patients developed acute, severe inflammation involving the anterior and posterior segment within 3 to 4 days after injection, with visual acuities of hand motion OS, counting fingers OD, and hand motion OS, respectively. Two patients were continuing faricimab treatment while 1 patient was initiating faricimab treatment. All received intravitreal ceftazidime, 2.2 mg/0.1 mL, and vancomycin, 1 mg/0.1 mL, immediately following vitreous taps. All vitreous tap culture results were negative. One patient underwent vitrectomy 1 day following presentation. Intraoperative vitreous culture grew 1 colony of Staphylococcus epidermidis, judged a likely contaminant by infectious disease specialists. All symptoms resolved within 1 month; visual acuities with correction were 20/100 OS for patient 1, 20/50 OD for patient 2, and 20/30 OS for patient 3. Conclusions and Relevance: In this case series, 3 patients with acute, severe IOI within 1 month at 3 different locations among 3 ophthalmologists of 1 institution following intravitreal faricimab could represent some unknown storage or handling problem. However, this cluster suggests such inflammatory events may be more common than anticipated from faricimab trial reports, emphasizing the continued need for vigilance to detect and report such cases following regulatory approval.
Assuntos
Anticorpos Biespecíficos , Doenças da Úvea , Uveíte , Humanos , Bevacizumab/uso terapêutico , Uveíte/tratamento farmacológico , Inflamação/tratamento farmacológico , Injeções Intravítreas , Doenças da Úvea/tratamento farmacológico , Inibidores da Angiogênese/uso terapêuticoRESUMO
Uveal effusion can lead to anterior swelling of the choroid up to angle-closure glaucoma. This article reports the case of a 57-year-old male patient who presented with headache, vertigo and bilaterally reduced visual acuity. The examination showed a myopic shift and angle-closure glaucoma caused by uveal effusion. The medical history revealed that 3 days before the appearance of the symptoms, treatment with chlorthalidone was added to the antihypertensive medication. After discontinuation of the chlorthalidone intake the uveal effusion and its concomitant symptoms disappeared without residues.
Assuntos
Glaucoma de Ângulo Fechado , Miopia , Doenças da Úvea , Anti-Hipertensivos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Úvea/tratamento farmacológico , Acuidade VisualAssuntos
Corpo Ciliar/patologia , Infecções Oculares Bacterianas/diagnóstico , Doenças da Íris/diagnóstico , Melanoma/diagnóstico , Tuberculoma/diagnóstico , Tuberculose Ocular/diagnóstico , Doenças da Úvea/diagnóstico , Neoplasias Uveais/diagnóstico , Acetilcolinesterase/sangue , Adulto , Antígenos de Bactérias/genética , Antituberculosos/uso terapêutico , Humor Aquoso/metabolismo , Proteínas de Bactérias/genética , Sedimentação Sanguínea , Corpo Ciliar/efeitos dos fármacos , Diagnóstico Diferencial , Infecções Oculares Bacterianas/tratamento farmacológico , Expressão Gênica/fisiologia , Humanos , Doenças da Íris/tratamento farmacológico , Masculino , Microscopia Acústica , Reação em Cadeia da Polimerase , Tuberculoma/tratamento farmacológico , Tuberculose Ocular/tratamento farmacológico , Doenças da Úvea/tratamento farmacológicoAssuntos
Exantema/diagnóstico , Infecções Oculares Bacterianas/diagnóstico por imagem , Neurossífilis/diagnóstico por imagem , Doenças da Úvea/diagnóstico por imagem , Antibacterianos/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Exantema/tratamento farmacológico , Infecções Oculares Bacterianas/líquido cefalorraquidiano , Infecções Oculares Bacterianas/tratamento farmacológico , Dor Ocular/diagnóstico , Feminino , Humanos , Microscopia Acústica , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Punção Espinal , Treponema pallidum/isolamento & purificação , Doenças da Úvea/líquido cefalorraquidiano , Doenças da Úvea/tratamento farmacológicoAssuntos
Acetazolamida/uso terapêutico , Doenças da Coroide/tratamento farmacológico , Corpo Ciliar/patologia , Latanoprosta/uso terapêutico , Microftalmia/diagnóstico , Descolamento Retiniano/tratamento farmacológico , Doenças da Úvea/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Benzofenonas/uso terapêutico , Bromobenzenos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Corioide/patologia , Quimioterapia Combinada , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Retina/patologia , Descolamento Retiniano/diagnóstico , Síndrome , Tomografia de Coerência Óptica , Doenças da Úvea/diagnósticoRESUMO
PURPOSE: The purpose of the study was to investigate the corticosteroids for uveal effusion syndrome (UES). METHODS: Retrospective series of 104 eyes with UES treated with oral corticosteroids (OCS), periocular corticosteroids (PCS), topical corticosteroids (TCS), or observation (OBS). Main outcome measure was UES resolution. RESULTS: Of 104 eyes, treatment included OCS (n = 27), PCS (n = 12), TCS (n = 11), and OBS (n = 54). A comparison of the four groups (OCS vs. PCS vs. TCS vs. OBS) revealed differences in those managed with OCS versus OBS as younger (66 vs. 72 years, P = 0.049), PCS versus OBS as male (100% vs. 54%, P = 0.002), PCS versus OBS with decreased visual acuity (VA)/visual field (91% vs. 51%, P = 0.018), and OBS versus OCS as asymptomatic (28% vs. 0%, P = 0.001). Of the 59 with follow-up information, management included OCS (n = 21), PCS (n = 12), TCS (n = 6), and OBS (n = 20). There were differences in initial VA <20/400 in PCS versus OBS (42% vs. 5%, P = 0.018), effusion thickness in TCS versus OCS (7 vs. 3 mm, P = 0.004), and serous retinal detachment in PCS versus OBS (100% vs. 30%, P < 0.001) and PCS versus OCS (100% vs. 57%, P = 0.012). Regarding outcomes, VA showed less worsening in OCS versus OBS (0% vs. 30%, P = 0.008) and OCS versus PCS (0% vs. 33%, P = 0.012). There was no difference in rate of effusion resolution or effusion recurrence. Overall, using combination of corticosteroid therapies, effusion resolution was achieved in 56/59 (95%) cases and the need for surgical management with scleral windows was necessary in only 3/59 (5%) cases. Complications included cataract (n = 9) and no instance of steroid-induced glaucoma. CONCLUSION: Management of UES is complex and depends on disease severity. Using various corticosteroid delivery routes, UES control was achieved in 95%, and scleral window surgery was required in only 5%. A trial of corticosteroids can benefit patients with UES.
Assuntos
Glucocorticoides/uso terapêutico , Doenças da Úvea/tratamento farmacológico , Administração Oral , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Coroide/diagnóstico , Diagnóstico Diferencial , Exsudatos e Transudatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/diagnóstico , Estudos Retrospectivos , Doenças da Úvea/diagnósticoAssuntos
Câmara Anterior/patologia , Descolamento Retiniano/diagnóstico , Doenças da Úvea/diagnóstico , Transtornos da Visão/diagnóstico , Doença Aguda , Administração Oral , Idoso , Neoplasias da Coroide/diagnóstico , Diagnóstico Diferencial , Exsudatos e Transudatos , Glucocorticoides/uso terapêutico , Humanos , Masculino , Microscopia Acústica , Prednisona/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Descolamento Retiniano/fisiopatologia , Doenças da Úvea/tratamento farmacológico , Doenças da Úvea/fisiopatologia , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/fisiopatologia , Acuidade VisualRESUMO
PURPOSE: To report a case of choroidal neovascularization (CNV) in a patient with ocular sarcoidosis treated by intravitreal aflibercept. METHODS: A 27-year old man was referred to our department because of sudden visual acuity decrease (best-corrected visual acuity (BCVA) was 20/80 LE). Fundus examination showed bilateral optic disk swelling, retinal pigment epithelium changes at the posterior pole, yellowish chorioretinal lesions in the periphery, and the presence of a prominent peripapillary neovascular complex. RESULTS: The clinical diagnosis was most compatible with ocular sarcoidosis, later confirmed by mediastinal lymph node biopsy. Fluorescein and indocyanine green angiography confirmed the presence of active peripapillary type 2 (classic) CNV in both eyes. Given that the exudation of the peripapillary CNV harmed the fovea, the patient underwent a single intravitreal aflibercept injection LE. One month after the treatment, LE BCVA decreased to 20/125. Spectral-domain optical coherence tomography (SD-OCT) showed complete resolution of subretinal fluid but revealed outer retinal atrophy with complete loss of the ellipsoid zone (EZ) in the macula (possibly responsible for visual acuity worsening). Six months later, LE BCVA slightly increased to 20/100, and SD-OCT showed partial recovery of the EZ in the macula. No adverse events related to the treatment were recorded during follow-up. CONCLUSIONS: We report a case of CNV in a patient with ocular sarcoidosis treated with intravitreal aflibercept. In our experience, intravitreal aflibercept injection achieved morphologic resolution for sarcoid-related peripapillary CNV.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Sarcoidose/tratamento farmacológico , Doenças da Úvea/tratamento farmacológico , Adulto , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/etiologia , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Masculino , Sarcoidose/complicações , Sarcoidose/diagnóstico , Biópsia de Linfonodo Sentinela , Líquido Sub-Retiniano , Tomografia de Coerência Óptica , Doenças da Úvea/complicações , Doenças da Úvea/diagnóstico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologiaRESUMO
CASE REPORT: A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DISCUSSION: The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.
Assuntos
Citalopram/efeitos adversos , Glaucoma de Ângulo Fechado/induzido quimicamente , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Líquido Sub-Retiniano , Doenças da Úvea/induzido quimicamente , Doença Aguda , Idoso , Atropina/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Doenças da Coroide/induzido quimicamente , Doenças da Coroide/tratamento farmacológico , Corpo Ciliar/patologia , Overdose de Drogas , Emergências , Feminino , Glaucoma de Ângulo Fechado/tratamento farmacológico , Humanos , Miopia/induzido quimicamente , Prednisona/uso terapêutico , Receptores de Serotonina/efeitos dos fármacos , Receptores de Serotonina/fisiologia , Líquido Sub-Retiniano/diagnóstico por imagem , Timolol/uso terapêutico , Doenças da Úvea/tratamento farmacológico , Doenças da Úvea/fisiopatologiaAssuntos
Acetazolamida/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Doenças da Coroide/tratamento farmacológico , Prostaglandinas F Sintéticas/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Doenças da Úvea/tratamento farmacológico , Feminino , Humanos , MasculinoAssuntos
Acetazolamida/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Doenças da Coroide/tratamento farmacológico , Prostaglandinas F Sintéticas/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Doenças da Úvea/tratamento farmacológico , Feminino , Humanos , MasculinoRESUMO
PURPOSE: To report a novel case of acute bilateral uveal effusions, angle closure, and acute myopia induced by administration of chlorthalidone. METHODS: Case report. RESULTS: Bilateral shallow anterior chambers, high intraocular pressure, and a myopic shift were encountered in a patient 1 week after initiation of chlorthalidone. Ultrasound evaluation revealed bilateral ciliochoroidal effusions, appositional angle closure, and suspected ciliary body edema. Cessation of chlorthalidone, in addition to administration of cycloplegics and ocular antihypertensives, resulted in prompt resolution of this idiosyncratic reaction. CONCLUSIONS: The antihypertensive medication chlorthalidone may cause bilateral uveal effusions inducing acute angle-closure glaucoma and acute myopia.
Assuntos
Anti-Hipertensivos/efeitos adversos , Clortalidona/efeitos adversos , Glaucoma de Ângulo Fechado/induzido quimicamente , Miopia/induzido quimicamente , Doenças da Úvea/induzido quimicamente , Doença Aguda , Administração Oral , Adulto , Anti-Hipertensivos/uso terapêutico , Diuréticos/uso terapêutico , Feminino , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/tratamento farmacológico , Humanos , Hipertensão/tratamento farmacológico , Microscopia Acústica , Midriáticos/administração & dosagem , Miopia/diagnóstico , Miopia/tratamento farmacológico , Doenças da Úvea/diagnóstico , Doenças da Úvea/tratamento farmacológico , Acuidade Visual/efeitos dos fármacosAssuntos
Doenças da Úvea/diagnóstico , Uveíte/diagnóstico , Xantomatose/diagnóstico , Terapia Combinada , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Facoemulsificação , Doenças da Úvea/tratamento farmacológico , Doenças da Úvea/cirurgia , Acuidade Visual , Xantomatose/tratamento farmacológico , Xantomatose/cirurgiaRESUMO
This case describes the use of intravitreal triamcinolone in the treatment of unilateral choroidal granulomas secondary to systemic sarcoidosis complicated by choroidal neovascular membrane. A single injection of 2â mg intravitreal triamcinolone was administered as treatment for rapidly progressing choroidal granulomas and associated choroidal neovascular membrane with subretinal fluid. Visual acuity had dropped from 6/5 to 6/48 with the progressing lesions. The patient was a 52-year-old woman with type 2 diabetes mellitus who was reluctant to consider oral steroids in view of their side effect profile. Ten days after injection, visual acuity improved to 6/24 and to 6/6 at 3â months follow-up with resolution of the subretinal fluid. There was no rise in intraocular pressure. There has been no recurrence at 5â months follow-up.
Assuntos
Corioide/patologia , Neovascularização de Coroide , Glucocorticoides/administração & dosagem , Granuloma/tratamento farmacológico , Sarcoidose/complicações , Triancinolona/administração & dosagem , Doenças da Úvea/tratamento farmacológico , Feminino , Granuloma/etiologia , Granuloma/patologia , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Doenças da Úvea/etiologia , Doenças da Úvea/patologia , Acuidade VisualRESUMO
PURPOSE: To report a case series of three patients with bilateral uveal effusion syndrome (UES), treated conservatively with oral carbonic anhydrase inhibitors and topical prostaglandin analogues (PAs). METHODS: Three patients with bilateral UES were treated with the same initial therapy. Topical PA latanoprost 0.005% and acetazolamide 250 mg were administered in order to reduce intraocular pressure, improve uveoscleral outflow, and facilitate resolution of uveal effusion. RESULTS: The chorioretinal detachment resolved within 3 months in two reported patients while the third one underwent surgery on his left eye. After clinical improvement, further oral therapy with acetazolamide was stopped, while topical prostaglandins were continued for at least the next 3 months. All patients were free from recurrence during the follow-up period. CONCLUSION: Although the usually recommended UES therapy is partial or full-thickness sclerectomy, our case series showed apparent resolution of chorioretinal detachment in two patients on medical therapy alone. Conservative therapy may be the first step before the standard recommended surgical approach, but further studies are needed to verify the effectiveness of reported therapy.
Assuntos
Acetazolamida/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Doenças da Coroide/tratamento farmacológico , Prostaglandinas F Sintéticas/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Doenças da Úvea/tratamento farmacológico , Administração Oral , Administração Tópica , Adulto , Doenças da Coroide/patologia , Quimioterapia Combinada , Feminino , Humanos , Pressão Intraocular , Latanoprosta , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/patologia , Doenças da Úvea/patologiaAssuntos
Anticonvulsivantes/efeitos adversos , Doenças da Coroide/diagnóstico por imagem , Corpo Ciliar/diagnóstico por imagem , Frutose/análogos & derivados , Glaucoma de Ângulo Fechado/diagnóstico , Doenças da Úvea/diagnóstico por imagem , Doença Aguda , Adulto , Anti-Hipertensivos/uso terapêutico , Doenças da Coroide/induzido quimicamente , Doenças da Coroide/tratamento farmacológico , Quimioterapia Combinada , Feminino , Frutose/efeitos adversos , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glaucoma de Ângulo Fechado/etiologia , Glucocorticoides/uso terapêutico , Humanos , Pressão Intraocular/efeitos dos fármacos , Microscopia Acústica , Midriáticos/uso terapêutico , Tonometria Ocular , Topiramato , Doenças da Úvea/induzido quimicamente , Doenças da Úvea/tratamento farmacológicoRESUMO
PURPOSE: To report on severe HLA B27-associated anterior uveitis complicated by vitritis, hypotony, and serous retinal detachment. METHODS: Retrospective case series. RESULTS: Five patients with HLA B27-associated uveitis presented with an acute anterior uveitis complicated by vitritis, hypotony, serous retinal detachment, and ciliochoroidal effusion. Two patients had previously acute anterior uveitis and two suffered from HLA B27-associated systemic disease. Laboratory and imaging examinations did not reveal another cause of uveitis. Despite the aggressive treatment a prolonged and slow recovery followed. Four patients developed macular edema and one additional patient developed a macular pucker. Finally, 3 eyes improved, 2 eyes developed atrophy, and 1 was lost at 4-month follow-up with visual acuity of hand movements. CONCLUSIONS: The authors conclude that severe uveitis with a serous retinal detachment might develop in HLA B27-positive patients and may be complicated by protracted hypotony, macular edema, and poor visual outcome.
Assuntos
Antígeno HLA-B27/imunologia , Hipotensão Ocular/complicações , Descolamento Retiniano/complicações , Doenças da Úvea/complicações , Uveíte Anterior/complicações , Doença Aguda , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Exsudatos e Transudatos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Infliximab , Pressão Intraocular , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Hipotensão Ocular/diagnóstico , Hipotensão Ocular/tratamento farmacológico , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/tratamento farmacológico , Estudos Retrospectivos , Soro , Doenças da Úvea/diagnóstico , Doenças da Úvea/tratamento farmacológico , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/imunologia , Adulto JovemRESUMO
Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a paraneoplastic syndrome characterized by cataract, photoreceptor loss and subretinal fluid overlying patchy areas of retinal pigment epithelium atrophy, and a diffusely thickened choroid with focal nodules. We present the case of a 64-year-old woman with a history of endometrial adenocarcinoma who developed BDUMP with bilateral exudative retinal detachments with inferior peripheral retinal ischemia. This new finding of peripheral nonperfusion expands the spectrum of BDUMP.