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1.
Ocul Immunol Inflamm ; 32(3): 351-354, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38330153

RESUMO

PURPOSE: The objective of this study is to report a case of unilateral acute retinal necrosis (ARN) with contralateral eye presenting as non-necrotizing herpetic uveitis. CASE REPORTS: Case 1: A 48-year-old female presented at our clinic with blurred vision in the right eye for 7 days. She was diagnosed with ARN in the left eye 2 weeks ago. Ophthalmic examination revealed reduced visual acuity in the right eye (20/33) with the presence of optic disc swelling and macular exudation without peripheral necrotic lesions. With systemic antiviral therapy, optic disc swelling of the right eye vanished gradually, and the visual acuity improved to 20/20. Loss of retinal nerve fiber layer (RNFL) and decreased retinal thickness in the corresponding area occurred during follow-up. CONCLUSION: Non-necrotizing herpetic uveitis may occur in the contralateral eye of unilateral ARN under rare conditions. Structure abnormities, including loss of RNFL and focal decreased retinal thickness, are irretrievable.


Assuntos
Herpes Simples , Herpes Zoster Oftálmico , Síndrome de Necrose Retiniana Aguda , Uveíte , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome de Necrose Retiniana Aguda/diagnóstico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Herpes Simples/complicações , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Retina , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/tratamento farmacológico
2.
Photodiagnosis Photodyn Ther ; 45: 104009, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38346467

RESUMO

PURPOSE: To evaluate the changes in posterior segment after uncomplicated cataract surgery in uveitic patients. METHODS: Retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), central macular thickness (CMT), and choroidal thickness (CT) of 38 eyes of 28 patients were measured pre- and postoperatively on day 1, week 1, and month 1, 3, 6, 9, and 12. RESULTS: The RNFLT increased after surgery. Although the measurements taken were higher than the baseline CMT at all postoperative times, no significant difference was detected between the paired comparisons. The GCLT was found to be higher than the baseline value in all quadrants at the 12th month. A decrease in CT was observed at 5 measured points on the 1st day compared to the baseline. CONCLUSION: During the 1-year follow-up, the effect of cataract surgery on the retina and choroid in uveitic eyes was most evident at the postoperative month 1.


Assuntos
Catarata , Fotoquimioterapia , Uveíte , Humanos , Estudos Prospectivos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Uveíte/complicações , Retina , Catarata/complicações
3.
Neuropediatrics ; 55(2): 117-123, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38181817

RESUMO

INTRODUCTION: We report a case study of two male pediatric patients presenting with anterior uveitis and elevated renal function parameters. Both were diagnosed with tubulointerstitial nephritis and uveitis syndrome and subsequently developed diffuse cerebral symptoms such as headache, fatigue, and diziness. METHODS: Magnetic resonance images (MRIs) of the brain showed T2-hyperintense lesions with and without gadolinium enhancement leading to brain biopsy and diagnosis of small-vessel central nervous system (CNS) vasculitis in both cases. Both patients were treated according to BrainWorks small-vessel vasculitis protocol and symptoms vanished over the course of treatment. Follow-up MRIs up to 12 months after initiation of therapy showed no signs of recurrence indicating a monophasic disease. CONCLUSION: Small-vessel CNS vasculitis can occur simultaneously to other autoimmune diseases (ADs) in the scope of polyautoimmunity. As clinical findings of CNS vasculitis are often unspecific, neurological symptoms in nonneurological ADs should be adressed thoroughly. Under suspicion of small-vessel CNS vasculitis brain biopsy is still the gold standard and only secure way of definitive diagnosis.


Assuntos
Nefrite Intersticial , Uveíte , Vasculite do Sistema Nervoso Central , Humanos , Masculino , Criança , Meios de Contraste/uso terapêutico , Gadolínio/uso terapêutico , Uveíte/complicações , Uveíte/diagnóstico , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/diagnóstico
4.
BMC Ophthalmol ; 24(1): 27, 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38243196

RESUMO

BACKGROUND/AIMS: To simultaneously evaluate iris area (IA) and subfoveal choroidal thickness (SFCT) in eyes with Fuchs Uveitis Syndrome (FUS). METHODS: We prospectively recruited a case series of patients with FUS at our institution, simultaneously measuring IA with anterior segment spectral domain optical coherence tomography (SD-OCT) and SFCT with enhanced depth imaging optical coherence tomography (EDI-OCT). Iris images were analyzed by ImageJ software. We tested the differences in intereye IA and SFCT with the healthy eye (HE) using the Wilcoxon test, and clinical interpretation was controlled by intraclass correlation coefficient (ICC) between two masked specialists. RESULTS: Sixteen patients with unilateral FUS were included. Six were female, and the age range was 37 to 67 (median age 48 years, IQR 41-60). ICC of 98.9%, with a lower confidence interval of 97%. Eyes with FUS had a significant thinning of the total iris median area (p < 0.002), restricted to the temporal and nasal areas compared to the HE (p < 0.01 and < 0.001, respectively). SFCT was also significantly thinner compared to the HE (p < 0.0001). A low correlation was found between iris and choroidal thinning in FUS eyes (rs = 0.21; p = 0.4). CONCLUSIONS: This study found reduced iris area and subfoveal choroidal thickness in eyes with FUS compared to the normal fellow eye.


Assuntos
Corioide , Uveíte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Iris/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Uveíte/complicações , Uveíte/diagnóstico , Adulto , Idoso
5.
Cornea ; 43(5): 644-647, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38265274

RESUMO

PURPOSE: This study aimed to report a case of persistent keratouveitis associated with mpox virus infection in an immunocompetent patient with a history of laser-assisted in situ keratomileusis (LASIK), leading to the need for flap removal. METHODS: A comprehensive literature review was conducted, and a detailed case report was presented. RESULTS: A 44-year-old immunocompetent male patient with a history of LASIK and HIV infection presented with conjunctival and corneal lesions indicative of mpox infection. Despite initial topical treatment, the condition worsened, leading to severe epithelial and stromal keratitis with anterior chamber inflammation. Polymerase chain reaction testing confirmed the presence of mpox virus in conjunctival, corneal, and aqueous humor samples. The patient underwent various treatments, including tecovirimat, oral and topical corticosteroids, and topical trifluridine, and eventually flap removal with amniotic membrane application. Subsequent polymerase chain reaction testing of the aqueous humor yielded negative results, and the cornea gradually reepithelialized without inflammation. After 8 months, the patient's eye remained stable, with a central stromal scar. CONCLUSIONS: This case highlights the rare occurrence of mpox-associated keratouveitis and emphasizes the challenges faced in its management. The successful outcome achieved through a combination of antiviral therapy, antiinflammatories, and surgical intervention underscores the importance of a multidisciplinary approach in managing such cases.


Assuntos
Infecções por HIV , Ceratite , Ceratomileuse Assistida por Excimer Laser In Situ , Varíola dos Macacos , Uveíte , Masculino , Humanos , Adulto , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Córnea , Ceratite/induzido quimicamente , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Uveíte/complicações , Inflamação
6.
BMC Ophthalmol ; 24(1): 21, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-38225542

RESUMO

PURPOSE: To examine the 6-month visual outcomes and complications following cataract surgery in patients with persumed trematode induced granulomatous anterior uveitis. SETTING: Assiut university hospital, Assiut, Egypt. DESIGN: This is a retrospective non comparative case series study. METHODS: Patients presenting with significant cataract secondary to uveitis caused by trematode induced anterior chamber granuloma were included in this study. Cases with active anterior uveitis, within the last 3 months preceding surgery, and those with a history of trauma, were excluded from this study. Data collected included demographic characteristics, history of the condition including when uveitis started, treatment received and history of other health conditions that may be relevant to uveitis.Complete opthalmologic examination including assessment of best corrected visual acuity (BCVA) and OCT macula, if possible, were done. These was repeated 1 week, 1 month, 3 months and 6 months after surgery. Specular microscopy was performed preoperatively and 3 months after surgery. Patients underwent cataract surgery with posterior chamber intra ocular lens and statistical analysis was performed to compare preoperative and postoperative BCVA and corneal endothelial cell counts. Postoperative complications were recorded. RESULTS: Five eyes of 5 patients were included in the study. All study eyes showed improvement in the post-operative visual acuity. A statistically significant improvement was observed in VA in the sixth postoperative month compared to the baseline measurements (p = 0.004). No statistically significant difference was observed between the preoperative and postoperative endothelial cell counts (p = 0.696). Cystoid macular edema did not occur as a postoperative complication. CONCLUSION: Visual outcomes of cataract surgery in eyes with persumed trematode induced granulametous anterior uveitis are favorable. No sight threatening complication was observed in our series.


Assuntos
Catarata , Facoemulsificação , Trematódeos , Uveíte Anterior , Uveíte , Criança , Animais , Humanos , Estudos Retrospectivos , Uveíte/complicações , Uveíte Anterior/complicações , Uveíte Anterior/cirurgia , Catarata/complicações , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento , Facoemulsificação/efeitos adversos
7.
Ocul Immunol Inflamm ; 32(2): 154-160, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36749910

RESUMO

BACKGROUND/PURPOSE: To assess the efficacy and tolerance of hydroxychloroquine in sarcoidosis-associated uveitis. METHODS: Retrospective study on all patients with sarcoidosis-associated uveitis who were treated with hydroxychloroquine between 2003 and 2019 in a French university hospital. RESULTS: Twenty-seven patients with sarcoidosis-associated uveitis received hydroxychloroquine. The mean duration of treatment was 20.0 ± 10.9 months. At the end of the follow-up, hydroxychloroquine success was achieved in 15 (55.6%) patients. Four of them were also on oral corticosteroids, with a prednisone dose ≤5 mg/day. Under treatment, the median prednisone dose decreased from 20.0 (interquartile range (IQR), 7-25) to 5.0 (IQR, 3-6.5) mg/day (p = .02). The incidence rate of flare decreased from 204.6 to 63.8 per 100 person-years (p = .02). Hydroxychloroquine was discontinued in 12 (44.4%) patients during follow-up, including 8 (29.6%) for ineffectiveness, and three who experienced side effects. CONCLUSION: Hydroxychloroquine appears as an interesting option in sarcoidosis-associated uveitis.Abbreviations: AZA: Azathioprine; BAL: Bronchoalveolar Lavage; BCVA: Best-Corrected Visual Acuity; ENT: Ears, Nose and Throat; HCQ: Hydroxychloroquine; IOP: Intra-Ocular Pressure; IQR: interquartile range; MHC: Major Histocompatibility Complex; MMF: Mycophenolate Mofetil; MTX: Methotrexate; PMSI: Programme de Médicalisation du Système d'Information; SAU: Sarcoidosis-Associated Uveitis; SD: Standard Deviation; SUN: Standard Uveitis Nomenclature.


Assuntos
Sarcoidose , Uveíte , Humanos , Imunossupressores/uso terapêutico , Prednisona/uso terapêutico , Hidroxicloroquina/uso terapêutico , Estudos Retrospectivos , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Metotrexato/uso terapêutico , Ácido Micofenólico/uso terapêutico , Ácido Micofenólico/efeitos adversos , Sarcoidose/complicações , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Resultado do Tratamento
8.
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
9.
Eur J Ophthalmol ; 34(2): NP92-NP97, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37723890

RESUMO

INTRODUCTION: Panuveitis is a serious inflammatory disease. Setae are fibers produced by many insects and plants. Many case reports have described caterpillar and spider fibers entering the eye. These hairs are covered with tiny barbs that help them enter and migrate into the eye tissue, leading to severe inflammation. Normally, they are buried mainly in the conjunctiva and cornea. However, in the present case, they entered the posterior segment of the eye, which is very rare. CASE DESCRIPTION: A female patient presented with a complaint of repeated foreign body sensation, redness, pain, and photophobia in the left eye for 9 years following initial exposure to caterpillars. She visited the doctor in January after aggravation of symptoms. Slit-lamp examination, ultrasound biomicroscopy, ultrasound B-scan, fluorescein angiography, and indocyanine green angiography revealed the presence of a foreign body in the vitreous, which caused discomfort in the patient's left eye and subsequently, panuveitis of the left eye. The symptoms improved significantly after foreign body removal using vitrectomy. Microscopic examination revealed that the foreign body was caterpillar setae. CONCLUSION: Clinicians should be more vigilant about history of contact with caterpillars while examining uveitis that has recurred for many years. Identification of the root cause of the disease can ensure better treatment.


Assuntos
Corpos Estranhos no Olho , Lepidópteros , Pan-Uveíte , Uveíte , Animais , Feminino , Humanos , Sensilas , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/etiologia , Corpos Estranhos no Olho/cirurgia , Pan-Uveíte/diagnóstico , Pan-Uveíte/etiologia , Uveíte/complicações , Córnea
10.
Eye (Lond) ; 38(2): 386-392, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37598261

RESUMO

BACKGROUND: Autoimmunity and deficiency of the transcription factor autoimmune regulator protein (AIRE) are known associations with Down syndrome (DS). Lack of AIRE abrogates thymic tolerance. The autoimmune eye disease associated with DS has not been characterized. We identified a series of subjects with DS (n = 8) and uveitis. In three consecutive subjects, we tested the hypothesis that autoimmunity to retinal antigens might be a contributing factor. SUBJECTS/METHODS: This was a multicentred, retrospective case series. Deidentified clinical data of subjects with both DS and uveitis were collected via questionnaire by uveitis-trained ophthalmologists. Anti-retinal autoantibodies (AAbs) were detected using an Autoimmune Retinopathy Panel tested in the OHSU Ocular Immunology Laboratory. RESULTS: We characterized eight subjects (mean age 29 [range, 19-37] years). The mean age of detected uveitis onset was 23.5 [range, 11-33] years. All eight subjects had bilateral uveitis (p < 0.001 based on comparison to published university referral patterns), with anterior and intermediate uveitis found in six and five subjects respectively. Each of three subjects tested for anti-retinal AAbs was positive. Detected AAbs included anti-carbonic anhydrase II, anti-enolase, anti-arrestin, and anti-aldolase. DISCUSSION: A partial deficiency in the AIRE on chromosome 21 has been described in DS. The similarities in the uveitis presentations within this patient group, the known autoimmune disease predisposition in DS, the recognized association of DS and AIRE deficiency, the reported detection of anti-retinal antibodies in patients with DS in general, and the presence of anti-retinal AAbs in three subjects in our series supports a causal association between DS and autoimmune eye disease.


Assuntos
Doenças Autoimunes , Síndrome de Down , Doenças Retinianas , Uveíte , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Doenças Autoimunes/complicações , Síndrome de Down/complicações , Estudos Retrospectivos , Autoanticorpos , Uveíte/complicações
11.
J Cataract Refract Surg ; 50(3): 257-263, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-37885121

RESUMO

PURPOSE: To examine the visual outcomes and risk factors of uveitis cataract eyes after phacoemulsification and manual small-incision cataract surgery (MSICS). SETTING: Tertiary-care eye hospital in southern India. DESIGN: Retrospective interventional case series. METHODS: Of the uveitis eyes operated for cataract surgery between 2017 and 2020, eyes with a minimum of 6 months postoperative follow-up were included. Eyes with ocular trauma, lens subluxation, lens-induced uveitis, or retinal detachment-induced uveitis were excluded. Demography, visual acuity, intraoperative and postoperative records, and surgical outcomes were analyzed. RESULTS: 191 eyes of 191 patients with a mean age of 51.7 ± 14.4 years were included. Phacoemulsification was performed in 134 eyes, and 57 eyes underwent MSICS. Synechiolysis and pupil-expanding maneuvers were required in 74 eyes (38.7%). No differences were noted in the rates of complications between phacoemulsification and MSICS eyes, except at 1 year, where higher rates of posterior capsular opacification and vitritis were noted in MSICS eyes ( P = .018). The visual outcomes of eyes that underwent MSICS and phacoemulsification were comparable ( P = .463). In 12 eyes (13.5%), improvement in vision was not significant. CONCLUSIONS: This study shows phacoemulsification may be a preferred technique in uveitis cataracts, given the lesser incidence of postoperative complications. Patients should be counseled for realistic expectations.


Assuntos
Opacificação da Cápsula , Extração de Catarata , Catarata , Facoemulsificação , Uveíte , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Facoemulsificação/efeitos adversos , Facoemulsificação/métodos , Estudos Retrospectivos , Implante de Lente Intraocular/métodos , Extração de Catarata/efeitos adversos , Extração de Catarata/métodos , Catarata/complicações , Opacificação da Cápsula/etiologia , Uveíte/complicações , Complicações Pós-Operatórias/etiologia , Fatores de Risco
12.
Clin Rheumatol ; 43(2): 799-808, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37845415

RESUMO

Scleritis is an inflammation of the episcleral and scleral tissues, characterized by injection in both superficial and deep episcleral vessels. When only episcleral tissue is involved, it is referred to as episcleritis. Episcleritis is mainly idiopathic but may be secondary to an underlying rheumatologic disease. Despite being rare, drug-associated episcleritis and scleritis should also be included in the differential diagnosis. Tumor necrosis factor-alpha (TNF-α) inhibitors are generally well-tolerated, but etanercept, in particular, has the potential to cause paradoxical adverse reactions including ocular inflammations, such as uveitis, scleritis, and ocular myositis. Etanercept differs in its mechanism of action from other TNF-α inhibitors as it acts as a decoy receptor, and this may partly explain the more frequently reported etanercept-associated ocular inflammation. Etanercept may also be ineffective in preventing ocular inflammation. However, the dechallenge and rechallenge phenomena have proven there is a causative link between etanercept and new-onset ocular inflammation. We report a case of a 15-year-old boy with enthesitis-related arthritis and familial Mediterranean fever who presented with episcleritis and blepharitis while receiving etanercept treatment and subsequently showed dechallenge and rechallenge reactions. Therefore, physicians should also be aware that episcleritis should be considered a paradoxical adverse reaction to etanercept and can occur in pediatric patients. We also reviewed the English literature to provide an overview and evaluate intervention options.


Assuntos
Esclerite , Uveíte , Masculino , Humanos , Criança , Adolescente , Etanercepte/efeitos adversos , Esclerite/induzido quimicamente , Fator de Necrose Tumoral alfa , Uveíte/complicações , Inflamação/complicações
13.
Eur J Ophthalmol ; 34(1): NP133-NP137, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37438949

RESUMO

INTRODUCTION: Granulomatous uveitis is mainly defined by the nature of keratic precipitates and iris nodules. Anterior chamber (AC) granulomas, also known as Berlin nodules (BN), are circumscribed granulomatous nodules that form in the iridocorneal angle (ICA) in response to intraocular inflammation. CASES DESCRIPTION: We present three representative cases of anterior uveitis with berlin nodules to insist on the clinical features of this entity. Case 1: A female adult was referred to our department for bilateral redness and gradual blurry vision. Slit-lamp examination of both eyes (OU) found a yellow-white nodular mass at 6 o'clock on the peripheral iris with irido-crystalline synechiae, vitreous haze and blurred fundus. Purified protein derivative skin test revealed an induration of 20 mm. A diagnosis of presumed ocular tuberculosis was made. The patient received antituberculosis drugs and steroids with good evolution. Case 2: An 11-year-old girl presented for redness and pain OU. Anterior segment examination showed circumciliary congestion, epithelial microcystic edema OU and pearly vascularized lesion against the cornea in the right eye. Fundus examination was unremarkable. A diagnosis of definite ocular sarcoidosis was made based on accessory salivary glands biopsy. The patient was treated with teroids and controlled twice a week. Case 3: A 26-year-old male presented with a redness and pain of the left eye. The slit-lamp examination showed fine keratic precipitates with pearly white nodules within the AC. Fundus examination showed a chorioretinal lesion and occlusive vasculitis. Chest CT was consistent with milliary tuberculosis. Adequate therapy was initiated with favorable outcome. CONCLUSION: BN can be associated with various ocular manifestations of several diseases. They may be the first manifestation of systemic conditions and seem to be well managed with topical steroids.


Assuntos
Endoftalmite , Sarcoidose , Uveíte Anterior , Uveíte , Masculino , Adulto , Humanos , Feminino , Criança , Uveíte/complicações , Uveíte Anterior/complicações , Sarcoidose/complicações , Sarcoidose/diagnóstico , Transtornos da Visão/complicações , Esteroides , Dor
14.
Ocul Immunol Inflamm ; 32(1): 127-130, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36622871

RESUMO

DESIGN: Case Report Case description: This report describes the case of a female patient diagnosed with oculo-cerebral toxocariasis manifesting initially in the form of isolated bilateral cystoid macular edema. Diagnosis was made by means of positive anterior chamber and lumbar puncture western blots. The unusual presentation, ancillary findings and treatment are discussed. The control of intraocular inflammation that was only partially responsive to steroids was eventually achieved with pegylated interferon alfa-2a. CONCLUSION: Isolated macular edema is a rare presentation of ocular toxocariasis. Interferon alfa-2a may prove useful in case of insufficient control of inflammation.


Assuntos
Edema Macular , Toxocaríase , Uveíte , Animais , Humanos , Feminino , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Toxocaríase/complicações , Toxocaríase/diagnóstico , Toxocaríase/tratamento farmacológico , Uveíte/complicações , Interferon alfa-2 , Inflamação/complicações
15.
Ocul Immunol Inflamm ; 32(2): 226-233, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36701640

RESUMO

BACKGROUND: Anterior uveitis is the most common anatomical type of uveitis. Patients with noninfectious anterior uveitis may develop various ocular complications and eventually visual impairment. Appropriately differentiating the etiologies can help clinicians to predict the outcome, arrange clinical follow-up, and decide the treatment or prevention strategy. Adequate treatment and effective prevention strategies can reduce the frequency of recurrence and the risk of developing complications. Human leukocyte antigen (HLA)-B27 is the most common positive finding in patients with noninfectious AAU in many countries including Taiwan. PURPOSE: To report a consensus from experienced uveitis specialists and rheumatologists was made in Taiwan. METHODS: A panel of nine ophthalmologists from nine different referral centers with expertise in the management of uveitis and an experienced rheumatologist was held on January 16, 2022. A comprehensive literature review was performed. Differential diagnoses for etiologies, general treatments, and prevention strategies were discussed. Each statement in the consensus was made only if more than 70% of the experts agreed. RESULTS: A flow chart and seven statements regarding the differential diagnoses for etiologies, treatments and preventions, and co-management with rheumatologists were included in the consensus. CONCLUSIONS: This article discusses the general diagnosis, treatment, and prevention of noninfectious acute anterior uveitis, with or without HLA-B27, in adults for general ophthalmologists to improve overall outcomes of these patients.


Assuntos
Espondilite Anquilosante , Uveíte Anterior , Uveíte , Adulto , Humanos , Antígeno HLA-B27 , Consenso , Taiwan/epidemiologia , Uveíte Anterior/diagnóstico , Uveíte Anterior/prevenção & controle , Uveíte/complicações , Doença Aguda , Espondilite Anquilosante/complicações
16.
Ocul Immunol Inflamm ; 32(2): 178-180, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36637975

RESUMO

We read with great interest the article by Oyeniran E et al. on "Isolated optic disc granuloma as a presenting sign of sarcoidosis." We would like to share our experience with a similar optic nerve head granuloma secondary to sarcoidosis in the absence of any systemic symptoms and no evidence of signs of periocular/intraocular inflammation. However, our case was refractory to oral steroids and methotrexate and required intravitreal dexamethasone implants and mycophenolate mofetil.


Assuntos
Disco Óptico , Sarcoidose , Uveíte , Humanos , Sarcoidose/complicações , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Granuloma/complicações , Uveíte/complicações , Transtornos da Visão
17.
Br J Ophthalmol ; 108(3): 380-385, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-36810151

RESUMO

PURPOSE: To evaluate the long-term visual acuity (VA) outcome of cataract surgery in inflammatory eye disease. SETTING: Tertiary care academic centres. DESIGN: Multicentre retrospective cohort study. METHODS: A total of 1741 patients with non-infectious inflammatory eye disease (2382 eyes) who underwent cataract surgery while under tertiary uveitis management were included. Standardised chart review was used to gather clinical data. Multivariable logistic regression models with adjustment for intereye correlations were performed to evaluate the prognostic factors for VA outcomes. Main outcome measure was VA after cataract surgery. RESULTS: Uveitic eyes independent of anatomical location showed improved VA from baseline (mean 20/200) to within 3 months (mean 20/63) of cataract surgery and maintained through at least 5 years of follow-up (mean 20/63). Eyes that achieved 20/40 or better VA at 1 year were more likely to have scleritis (OR=1.34, p<0.0001) or anterior uveitis (OR=2.2, p<0.0001), VA 20/50 to 20/80 (OR 4.76 as compared with worse than 20/200, p<0.0001) preoperatively, inactive uveitis (OR=1.49, p=0.03), have undergone phacoemulsification (OR=1.45 as compared with extracapsular cataract extraction, p=0.04) or have had intraocular lens placement (OR=2.13, p=0.01). Adults had better VA immediately after surgery, with only 39% (57/146) paediatric eyes at 20/40 or better at 1 year. CONCLUSIONS: Our results suggest that adult and paediatric eyes with uveitis typically have improved VA following cataract surgery and remain stable thereafter for at least 5 years.


Assuntos
Extração de Catarata , Catarata , Doenças da Túnica Conjuntiva , Facoemulsificação , Uveíte , Adulto , Humanos , Criança , Estudos Retrospectivos , Catarata/complicações , Resultado do Tratamento , Extração de Catarata/métodos , Acuidade Visual , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/cirurgia , Transtornos da Visão
18.
Klin Monbl Augenheilkd ; 241(1): 84-87, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36781159

RESUMO

This is a unique case of retinoschisis as an ocular manifestation of brucellosis. A 38-year-old male presented with recurrent episodes of bilateral eye redness, predominately in his left eye. His visual acuity was not affected, and he did not report any other symptoms. On slit lamp examination, binocular Koeppe nodules of the iris and cells in the left anterior chamber were observed. Fundoscopy followed by meticulous multimodal imaging confirmed left inferior retinoschisis. The patient was diagnosed with panuveitis, and a series of laboratory examinations revealed positive anti-IgM Brucella antibodies. Ocular brucellosis can cause variable, atypical, and serious presentations, hence, early diagnosis is paramount to avoid complications.


Assuntos
Brucella , Brucelose , Pan-Uveíte , Retinosquise , Uveíte , Humanos , Masculino , Adulto , Uveíte/diagnóstico , Uveíte/complicações , Brucelose/complicações , Brucelose/diagnóstico , Brucelose/tratamento farmacológico
19.
Ocul Immunol Inflamm ; 32(2): 181-183, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37467487

RESUMO

We report a case of intermediate uveitis in the setting of both systemic sarcoidosis and multiple sclerosis. A 68-year-old female was diagnosed with bilateral granulomatous intermediate uveitis and cystoid macular edema. Initial systemic work-up was unrevealing. The uveitis was treated successfully with local corticosteroid injections. Eighteen months after presentation, the patient developed new systemic symptoms. Additional testing revealed systemic lymphadenopathy, with biopsy showing non-caseating granulomas, leading to a diagnosis of sarcoidosis. However, MRI of the brain and spinal cord along with cerebrospinal fluid analysis was consistent with MS. The management of the uveitis and systemic inflammation was co-managed by ophthalmology, neurology, and rheumatology, and eventually controlled with leflunomide and rituximab. Patients can rarely have co-existing systemic sarcoidosis and multiple sclerosis. Although challenging to diagnose, radiographic findings and cerebrospinal fluid analysis can be helpful to differentiate multiple sclerosis and neurosarcoidosis. Management of these patients requires coordination between multiple specialties.


Assuntos
Esclerose Múltipla , Sarcoidose , Uveíte Intermediária , Uveíte , Feminino , Humanos , Idoso , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Sarcoidose/complicações , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Uveíte Intermediária/complicações , Granuloma/complicações
20.
Clin Rheumatol ; 43(3): 1053-1061, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38082206

RESUMO

OBJECTIVE: To assess the frequency of uveitis in patients with psoriatic arthritis (PsA) in the era of biologics and to identify risk factors associated with uveitis. METHODS: A retrospective matched cohort study was conducted within the database of a large healthcare provider. Newly diagnosed 6147 adult PsA patients between 2005 and 2020 were matched by the index date of PsA diagnosis, age, sex, and ethnicity to 23,999 randomly selected controls. This cohort was used to examine the association between PsA and uveitis. An additional analysis was conducted within the PsA group to identify uveitis risk factors, using two analytic approaches: a retrospective cohort study and a nested case-control study. RESULTS: Uveitis was diagnosed in 107 patients in the PsA group (1.7%) vs 187 (0.8%) patients in the control group (adjusted HR, 2.38, 95% CI 1.80-3.15, p<0.005) and was similar when the analysis was confined to patients without past uveitis. Uveitis was diagnosed more in females (2.1% vs 1.3%, HR 1.61, 95% CI 1.09-2.40, p<0.05), and was acute in all cases. Anterior uveitis was documented in 41.1% of the cases, 64.5% unilateral, and 9.3% bilateral. In the PsA group, using nested case control approach, only past uveitis [adjusted OR 136.4 (95% CI 27.38-679.88), p<0.005] and treatment with etanercept [adjusted OR 2.57 (95% CI 1.45-4.57), p=0.001] were independently associated with uveitis. Only one PsA patient with uveitis (out of 107) required systemic oral treatment with prednisone, while the rest of the patients were treated with topical glucocorticosteroids only. CONCLUSION: PsA is associated with increased risk of uveitis. Past uveitis and treatment with etanercept were associated with higher risk of uveitis. Key Points • Psoriatic arthritis (PsA) is a major risk factor for uveitis with hazard ratio of 2.38 compared to healthy individuals without PsA. • Among PsA patients, the past event of uveitis and treatment with etanercept are risk factors for uveitis. • Uveitis in patients treated with biologics for their PsA requires topical therapy only in most of the cases.


Assuntos
Artrite Psoriásica , Produtos Biológicos , Uveíte , Adulto , Feminino , Humanos , Masculino , Artrite Psoriásica/complicações , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Estudos Retrospectivos , Estudos de Coortes , Etanercepte/uso terapêutico , Estudos de Casos e Controles , Fatores de Risco , Uveíte/etiologia , Uveíte/complicações , Produtos Biológicos/uso terapêutico
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