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1.
Orv Hetil ; 160(44): 1744-1750, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31657252

RESUMO

We present herewith cases of non-infectious uveitis with biological treatment where the ocular complaints were the initial symptoms indicating a multi-organ autoimmune disease. The first case was a patient with panuveitis and Vogt-Koyanagi-Harada disease, the second case was also a panuveitic patient with sarcoidosis and the third case was a patient with intermediate uveitis and inflammatory bowel disease. In all cases, emerging new, biological therapy (adalimumab) was necessary to achieve permanent inactive period of uveitis and the autoimmune disease. Introducing systemic biological treatment (adalimumab) in ophthalmology is crucial in the therapy of immune-mediated, non-infectious uveitis in order to preserve visual acuity. Orv Hetil. 2019; 160(44): 1744-1750.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Oftalmologia , Pan-Uveíte/tratamento farmacológico , Uveíte/tratamento farmacológico , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Pan-Uveíte/diagnóstico , Sarcoidose/diagnóstico , Resultado do Tratamento , Uveíte/diagnóstico , Síndrome Uveomeningoencefálica/diagnóstico , Acuidade Visual
2.
Isr Med Assoc J ; 21(7): 475-479, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507124

RESUMO

BACKGROUND: Uveitis is an inflammatory disorder of the uveal tract of the eye that can affect both adults and children. Non-infectious uveitis can be an expression of a systemic autoimmune condition, or it can be idiopathic. It is a serious disease, associated with possible severe complications leading to visual impairment and blindness. For this reason, a prompt diagnosis and assessment of an appropriate treatment, with the collaboration of specialists such as ophthalmologists and rheumatologists, are extremely important. Many treatment options may be associated to side effects; therefore, clinicians should follow a stepladder approach starting with the least aggressive treatments to induce remission of inflammation. In this review, we reported the current evidence-based treatments for non-infectious uveitis in pediatric and adult patients with particular attention to the biologic response modifier treatment options. Important multicenter studies have demonstrated the efficacy of adalimumab, both in adults (VISUAL I, VISUAL II, VISUAL III) and in children (SYCAMORE, ADJUVITE), while for other agents data are still scarce.


Assuntos
Adalimumab/administração & dosagem , Fatores Imunológicos/administração & dosagem , Uveíte/tratamento farmacológico , Adulto , Criança , Comportamento Cooperativo , Medicina Baseada em Evidências , Humanos , Inflamação/tratamento farmacológico , Uveíte/diagnóstico , Uveíte/patologia
3.
Orv Hetil ; 160(34): 1335-1339, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31423830

RESUMO

Introduction: Uveitis is characterized by inflammation of the middle layer of the eye. Its overall incidence is low. Autoimmune diseases and infections are the most common underlying diseases. Out of the autoimmune diseases, juvenile idiopathic arthritis is associated most frequently with uveitis. The topical ophthalmological treatment may fail in a significant proportion of the patients and immunomodulatory therapy may be required. Aim and method: In a retrospective study, data of 33 children diagnosed and treated with uveitis at the Department of Pediatrics and Ophthalmology, University of Pécs during the last 5 years were collected and analyzed. Results: The mean age of the patients was 9.3 (0.3-17.8) years. Boys and girls were equally affected with an exception of patients with juvenile idiopathic arthritis where female predominance was found. An underlying disease could be identified in 60% of the cases (20/33). Uveitis was associated in 12 patients with juvenile idiopathic arthritis, in 2 patients with Behcet's disease and in a single case with inflammatory bowel disease. Infections have been proven in 5 patients. The autoimmune diseases caused an eye inflammation typically in anterior localization, in contrast to the infections that resulted in posterior uveitis. The majority of the patients required systemic treatment. 3 of them received systemic corticosteroid and 18 patients methotrexate as disease-modifying antirheumatic drug. 13 children with severe disease activity required biological therapy (adalimumab injection). Remission could be achieved in 1.45 (0.75-2.5) months. Conclusion: Pediatric uveitis is of great importance. Early diagnosis, adequate therapy and follow-up require multidisciplinary cooperation. Orv Hetil. 2019; 160(34): 1335-1339.


Assuntos
Adalimumab/uso terapêutico , Artrite Juvenil/complicações , Terapia Biológica , Fatores Imunológicos/uso terapêutico , Imunomodulação , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Adolescente , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Uveíte/complicações , Uveíte/etiologia
4.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1971-1979, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312906

RESUMO

PURPOSE: To describe the characteristics of de novo uveitis in patients ≥ 60 years old. METHODS: Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared. RESULTS: A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group. CONCLUSION: In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.


Assuntos
Síndrome de Behçet/complicações , Neoplasias Oculares/complicações , Sarcoidose/complicações , Centros de Atenção Terciária/estatística & dados numéricos , Uveíte/diagnóstico , Fatores Etários , Idoso , Animais , Feminino , Angiofluoresceinografia/métodos , França/epidemiologia , Fundo de Olho , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Oftalmoscopia/métodos , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Uveíte/epidemiologia , Uveíte/etiologia
5.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1857-1861, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31177301

RESUMO

PURPOSE: To evaluate the frequency, etiology, treatment, and visual prognosis of retinal detachment (RD) in patients with uveitis. METHODS: A retrospective review was performed in 707 consecutive patients (1042 eyes) with uveitis, of whom 97 (13.7%) (157 eyes [15.1%]) had RD. RESULTS: There were 126 (12.1%) eyes with exudative retinal detachment (ERD), 16 (1.5%) with tractional retinal detachment (TRD), and 15 (1.4%) with rhegmatogenous retinal detachment (RRD). Panuveitis was most commonly associated with RD (144 (91.1%) eyes). Infectious causes were more common in RRD, and non-infectious etiologies were most common in ERD and TRD. Oral prednisone was the initial therapy in ERD. Additionally, in these cases, cyclosporine was prescribed most frequently (47.1% patients), followed by azathioprine (26.4% patients). Fourteen (87.5%) eyes with TRD and all RRD cases underwent surgery. In patients with ERD, the mean best-corrected visual acuity (BCVA) was 1.1 ± 0.7 LogMAR at baseline and 0.6 ± 0.2 LogMAR at last visit (p = 0.001). In patients with TRD, mean BCVA was 0.7 ± 0.4 LogMAR at baseline and 0.6 ± 0.4 LogMAR at last visit (p = 0.056). In patients with RRD, mean BCVA was 1.6 ± 0.9 LogMAR at baseline and 20 1.3 ± 0.9 LogMAR at last visit (p = 0.185). CONCLUSION: In Saudi Arabia, ERD is observed in 12.1% of the eyes with uveitis, and less than 2% of eyes had TRD or RRD. Visual prognosis is usually good after ERD. Infection is the most frequent cause of RRD associated with uveitis and the visual prognosis is poor.


Assuntos
Previsões , Descolamento Retiniano/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Uveíte/complicações , Acuidade Visual , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Prognóstico , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Uveíte/diagnóstico , Uveíte/epidemiologia , Adulto Jovem
6.
Indian J Ophthalmol ; 67(7): 1207-1209, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238468

RESUMO

The tuberculids are a group of distinct clinicopathological form of skin lesions representing hypersensitivity reaction to hematogenous dissemination of Mycobacterium tuberculosis or its antigen from an underlying active or a silent focus of tuberculosis elsewhere in the body in an individual with a strong antituberculous cell-mediated immunity and by definition do not show bacilli on special stains and are culture-negative. Ocular involvement can occur in tuberculosis, both due to direct invasion by the bacilli as well as an immune-mediated reaction; however, immune-mediated tuberculous uveitis occurring as a hypersensitivity response in association with PNT has hardly been reported in the literature. Here we report one such rare case.


Assuntos
Antígenos de Bactérias/imunologia , Infecções Oculares Bacterianas/imunologia , Mycobacterium tuberculosis/imunologia , Pele/patologia , Tuberculose Cutânea/complicações , Tuberculose Ocular/imunologia , Uveíte/imunologia , Adulto , Biópsia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/etiologia , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Necrose , Pele/microbiologia , Tuberculose Cutânea/diagnóstico , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/etiologia , Uveíte/diagnóstico , Uveíte/etiologia
7.
Pan Afr Med J ; 32: 132, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223420

RESUMO

Sarcoidosis is a multisystem granulomatous disorders of unknown cause, characterised by the presence of epithelioid granulomas and giant-cell granulomas without caseous necrosis. Ocular sarcoidosis mainly manifests as bilateral anterior granulomatous uveitis. The involvement of the posterior segment in patients with ocular sarcoidosis is rare and manifests as periphlebitis or choroidal invasion. Isolated papillary edema is uncommon; hence the peculiarity of our case study. Posterior involvement is a prognostic indicator of poor outcome, threatening visual acuity. Early management, in close cooperation with pneumologists and based on systemic corticosteroid therapy, improves visual outcome and reduces complications.


Assuntos
Oftalmopatias/diagnóstico , Papiledema/diagnóstico , Sarcoidose/diagnóstico , Uveíte/diagnóstico , Oftalmopatias/patologia , Feminino , Granuloma/diagnóstico , Granuloma/patologia , Humanos , Pessoa de Meia-Idade , Papiledema/patologia , Prognóstico , Sarcoidose/patologia , Uveíte/patologia , Acuidade Visual
8.
Semin Ophthalmol ; 34(4): 252-255, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31177936

RESUMO

Introduction: Infectious uveitis is a serious inflammatory condition that often causes grave ocular morbidity including permanent vision loss and damage to the structures of the eye. The most common causes of infectious uveitis include herpesviruses and Toxoplasma gondii. Traditionally, these infections have been identified and differentiated based on characteristic clinical examination findings; however, there is often overlap between these presentations and the unique cause of a given patient's infection is not always clear. Therefore, a reliable and fast method for definitively diagnosing infectious uveitis would be helpful and potentially sight-saving. Several groups have recently found experimental success with real-time multiplex polymerase chain reaction (PCR) techniques. Methods: A comprehensive review of the literature was undertaken to further understand the current state of real-time multiplex PCR and its clinical use. Search terms including "real time multiplex PCR", "infectious uveitis", and "uveitis diagnosis" were used. Appropriate English-language articles were included in this review. Results: Publications from four main groups (two from the United States, one from Japan, and one from India) citing success with real-time multiplex PCR were compared and contrasted. All four groups used the same technique to develop a highly sensitive and specific multiplex PCR analysis and found that their tests maintained high sensitivity and specificity during validation testing. These tests confirmed clinical suspicions in the majority of cases of infectious uveitis, but there were also cases of clinical misdiagnosis that were corrected based on molecular pathogen detection. These patients were then initiated on appropriate antimicrobial therapy with subsequent clinical improvement. Discussion: Real-time multiplex PCR is a highly sensitive and specific laboratory assay that allows for rapid and reliable molecular diagnosis of causative agents in infectious uveitis. This in turn facilitates swift initiation of effective therapy and prevents long-term ocular damage and vision loss.


Assuntos
Infecções Oculares , Reação em Cadeia da Polimerase Multiplex/métodos , Uveíte/diagnóstico , DNA Viral/genética , Infecções Oculares/diagnóstico , Infecções Oculares/parasitologia , Infecções Oculares/virologia , Herpesviridae/genética , Infecções por Herpesviridae/diagnóstico , Humanos , Sensibilidade e Especificidade , Toxoplasma/genética , Toxoplasmose Ocular/diagnóstico
9.
Indian J Ophthalmol ; 67(6): 975-977, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124539

RESUMO

A 13-year-old boy with a 4-year history of idiopathic pediatric uveitis and recurrent uveitic macular edema had failed conventional immunomodulatory therapy and presented to us with a vision of 6/24 [right eye (OD)] and 6/9 [left eye (OS)]. Fluorescein angiography showed diffuse vascular leakage along with cystoid macular edema (CME). Intravenous tocilizumab (10 mg/kg body) was given as 14 injections over 12 months. Repeat fluorescein angiography every 3 months showed a dramatic improvement in the vascular leakage and resolution of CME. At 13 months OF follow-up, vision had improved to 6/9p (OD) and 6/6(OS) with no recurrence of inflammation or CME.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Uveíte/tratamento farmacológico , Adolescente , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravenosas , Edema Macular/complicações , Edema Macular/diagnóstico , Masculino , Tomografia de Coerência Óptica , Uveíte/complicações , Uveíte/diagnóstico , Acuidade Visual
10.
Tidsskr Nor Laegeforen ; 139(8)2019 May 07.
Artigo em Norueguês | MEDLINE | ID: mdl-31062556

RESUMO

BACKGROUND: Uveitis and acute renal failure can be seen in various immune-mediated systemic diseases. Here we present a case of a young man with a rare inflammatory oculorenal syndrome. CASE REPORT: A man in his thirties was admitted with a constellation of fatigue, flank pain, weight loss and bilateral acute anterior uveitis. Laboratory tests showed anaemia, leukocytosis with eosinophilia, as well as elevated creatinine and C-reactive protein, and urine analyses demonstrated mild proteinuria. Work-up excluded sarcoidosis, Sjögren's syndrome, systemic lupus erythematosus, ANCA-associated vasculitides, Behçet disease, spondyloarthritis and infection. Renal biopsy showed severe tubulointerstitial nephritis. INTERPRETATION: Following exclusion of the abovementioned disorders, a diagnosis of tubulointerstitial nephritis and uveitis (TINU) syndrome was made. TINU syndrome is a rare inflammatory disorder which can be diagnosed in patients presenting with uveitis and tubulointerstitial nephritis after exclusion of other causes of similar oculorenal involvement.


Assuntos
Nefrite Intersticial/diagnóstico , Uveíte/diagnóstico , Adulto , Humanos , Masculino , Nefrite Intersticial/tratamento farmacológico , Nefrite Intersticial/patologia , Uveíte/tratamento farmacológico , Uveíte/patologia
11.
Zhonghua Yan Ke Za Zhi ; 55(4): 267-272, 2019 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-30982288

RESUMO

Objective: To investigate the ocular manifestations of human immunodeficiency virus (HIV) and syphilis coinfection. Methods: A retrospective analysis of the ocular manifestations was carried out in 27 patients (54 eyes) diagnosed as syphilis and HIV coinfection by the Department of Infectious Medicine in Peking Union Medical College Hospital during the years of 2006-2017. The research included 26 males and 1 female, aging from 24 to 76 years old, with a mean age of 40.40±12.94 years old. Ocular anterior segments were examined with slit-lamp microscope. Fundus examinations were conducted with papillary dilation, fundus photography. Results: At the first visit, there were 2 eyes without light perception, 4 eyes with light perception, 1 eye with hand movement, 1 eye with finger counting, 2 eyes with 0.01-0.09 eyesight, 8 eyes with 0.1-0.2 eyesight, 12 eyes with 0.25-0.4 eyesight, 15 eyes with 0.5-0.9 eyesight, 9 eyes with 1.0-1.5 eyesight. Among the 27 patients (54 eyes) coinfected with HIV and syphilis, keratic precipitates were identified in 20 eyes, aqueous flare positive in 20 eyes, float positive in 15 eyes, and iris posterior synechias in 7 eyes. Nineteen eyes were diagnosed as syphilis uveitis, including 2 eyes with syphilis anterior uveitis and 17 eyes with syphilis panuveitis, among which, vitreous inflammatory opacity was observed in all 19 eyes, disk atrophy in 2 eyes, optic edema in 1 eye, vitreous hemorrhage in 1 eye, retinal detachment in 2 eyes, retinal hemorrhage and white vein in 1 eye. In addition, 8 eyes were diagnosed as HIV retinopathy, all manifested as cotton-wool spot. Among the 8 eyes, 4 were diagnosed as cytomegalovirus retinitis, 3 showed retinal yellow-white lesions, and 1 was in late phase which showed retinal pigmentation. The incidence of both HIV and syphilis coinfection patients and male homosexuality population increased. The most common ocular manifestation of HIV and syphilis coinfection was syphilis panuveitis. Six patients first visited the Department of Ophthalmology, and were then diagnosed as HIV and syphilis coinfection. Conclusions: The ocular manifestations of HIV and syphilis coinfection are diversified, which can be manifested as fundus necrotic lesions as well as anterior and posterior inflammatory. For HIV positive patients, syphilis serologic test should be routinely performed. The same, syphilis positive patients should be tested for HIV serum antibodies, in order to improve the diagnosis level of HIV/syphilis coinfection and give timely etiological treatment, which is of vital importance for saving visual acuity. (Chin J Ophthalmol, 2019, 55:267-272).


Assuntos
Coinfecção/complicações , Infecções Oculares Bacterianas/complicações , Infecções Oculares Virais/complicações , Infecções por HIV/complicações , Sífilis/complicações , Uveíte/microbiologia , Adulto , Idoso , Coinfecção/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Uveíte/diagnóstico , Acuidade Visual , Hemorragia Vítrea/diagnóstico , Adulto Jovem
12.
Pediatr Rheumatol Online J ; 17(1): 15, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975163

RESUMO

BACKGROUND: Although there are many reports on Juvenile Idiopathic arthritis-associated uveitis (JIA-U) from various countries, especially from Europe and North America, there are few reports from Asia. Our aim was to investigate the epidemiology, characteristics and predictors of JIA-U in Japan. METHODS: Data were retrospectively collected on 726 patients with JIA from medical records as of April 2016 at 15 medical centers specialized in pediatric rheumatic diseases. Of these, patients with uveitis were further investigated for the specific characteristics of this manifestation. RESULTS: The prevalence of uveitis was 6.1% in the 726 JIA patients examined. Incidence of uveitis was significantly higher in patients with an earlier arthritis onset (2.6-vs.-5.8 years, P < 0.0001), oligoarthritis (16.1%-vs.-1.6%, P < 0.001), or anti-nuclear antibodies. On the contrary, it was significantly less common in patients with rheumatoid factor or anti-cyclic citrullinated peptide antibodies. A history of using methotrexate (MTX), infliximab or adalimumab was also associated with uveitis occurrence. The median age at uveitis diagnosis was 5 years, and the median time from arthritis onset to uveitis diagnosis was 2 years. The occurrence of anterior and bilateral uveitis was 79.3 and 53.7%, respectively. There were no symptoms at uveitis diagnosis in 58.5% of cases. Complications arising between the time of uveitis diagnosis and the last observation increased from 31.7 to 56.1%; in particular, cataract was increased 3-fold. While no patients lost their vision, 61.9% did not recover normal vision (≥ 1.0), and in many cases active uveitis persisted, especially in males. In addition to steroid eye drops (97.6%) and MTX (15.4%), biological agents were used for treating the uveitis in 41.5% of patients. CONCLUSIONS: The epidemiology, characteristics and predictors of JIA-U in Japan are described here for the first time. Although the prevalence of JIA-U in Japan is lower than in predominantly Caucasian cohorts, as reported from North America and Europe, the epidemiology, characteristics and predictors were found to be similar.


Assuntos
Artrite Juvenil/complicações , Uveíte/epidemiologia , Adolescente , Antirreumáticos/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Reumatologia , Fatores de Risco , Uveíte/diagnóstico , Uveíte/etiologia
13.
Psychiatr Danub ; 31(Suppl 1): 44-49, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30946717

RESUMO

JIA is the most common rheumatic disease of childhood and JIA-U is its most frequent and most devastating extraarticular manifestation. This form of uveitis is usually asymptomatic, chronic anterior uveitis, often accompained with complications. JIA-U is the main cause of vision loss and even blidness in childhood. Thus, screening for JIA-U in all JIA patients and early treatment is of prime importance. Over the last 15-20 years, ever since IMT has been used, studies generally show trends toward decrease of JIA-U onset, complications frequency, improvement of prognosis and remission achievement. Despite evident improvements, over 20% JIA-U patients still develop complications in long-term follow-up. Moreover, about 50% JIA-U patients continue to have active uveitis in adulthood. Therefore, JIA-U is still associated with high risk of late sequelae and visual acuity loss, functionally and structurally eye damage and quality of life impairment.


Assuntos
Artrite Juvenil , Uveíte , Artrite Juvenil/complicações , Artrite Juvenil/diagnóstico , Criança , Doença Crônica , Humanos , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Uveíte/complicações , Uveíte/diagnóstico
14.
Adv Emerg Nurs J ; 41(2): 122-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033659

RESUMO

Eye trauma is a common presenting complaint in the emergency department. Correctly identifying the underlying pathology in eye trauma is critical to developing appropriate treatment plans that reduce the risk of long-term sequelae, and reduce or eliminate threats to vision. The clinical evaluation and diagnosis can be complex, and the presentation of serious eye conditions can be similar to that of more benign conditions. This article focuses on traumatic uveitis. It addresses the elements of history and examination that should suggest uveitis as the cause of pain and redness following trauma to the eye. It also outlines specific findings that can help differentiate uveitis from other causes of eye pain and redness following trauma. Included is a brief description of the pathophysiology of uveitis and the mechanism by which this inflammatory condition can result in loss of vision. Discussion includes recommended treatment. It offers a straightforward approach to making the diagnosis of traumatic uveitis.


Assuntos
Serviço Hospitalar de Emergência , Traumatismos Oculares/complicações , Uveíte/diagnóstico , Uveíte/etiologia , Diagnóstico Diferencial , Traumatismos Oculares/tratamento farmacológico , Traumatismos Oculares/enfermagem , Feminino , Humanos , Pessoa de Meia-Idade , Uveíte/tratamento farmacológico , Uveíte/enfermagem
15.
Curr Opin Ophthalmol ; 30(3): 179-186, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30844943

RESUMO

PURPOSE OF REVIEW: The aim of this review is to highlight recent changes in the treatment of juvenile idiopathic arthritis (JIA) - associated uveitis in the era of biologics. RECENT FINDINGS: Early introduction of steroid-sparing therapies is paramount for appropriate management. Biologic therapies have improved the therapeutic management of JIA-uveitis and adalimumab is currently approved for pediatric-onset noninfectious chronic anterior uveitis with an inadequate response to topical steroids and methotrexate. Recent studies suggest that ocular complications in JIA-uveitis are less frequent compared with previous publications. However, patients with JIA-uveitis seem to be particularly dependent on classical immunosuppressive drugs or biologics. Indications for primary lens implantation have expanded considerably with the evolution of materials and better control of inflammation with biologics. The rate of serious adverse events related to new therapeutic approaches seem acceptable, however longer term follow-up is necessary. SUMMARY: Improvement in the initial screening and improved inflammation control with biologics has considerably reduced the potentially sight-threatening prognosis of JIA-uveitis.


Assuntos
Artrite Juvenil/terapia , Terapia Biológica , Uveíte/terapia , Adalimumab/uso terapêutico , Artrite Juvenil/complicações , Artrite Juvenil/diagnóstico , Criança , Humanos , Metotrexato/uso terapêutico , Uveíte/diagnóstico , Uveíte/etiologia
16.
Indian J Ophthalmol ; 67(4): 490-495, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30900580

RESUMO

Purpose: To evaluate the long-term outcomes of cataract surgery in children with uveitis. Methods: Retrospective, noncomparative review of medical records of children (≤16 years) with uveitic cataract who had undergone cataract surgery between January 2001 and December 2014 at a tertiary care center was done. The main outcome measures were visual acuity and postoperative complications. Results: We recruited 37 children (58 eyes) who were diagnosed with uveitic cataract and underwent cataract surgery. The etiology of uveitis included juvenile idiopathic arthritis (n = 19), presumed intraocular tuberculosis (n = 8), idiopathic (n = 4), Behçet's disease (n = 2), Vogt-Koyanagi-Harada syndrome (n = 2), human leukocyte antigen B-27 associated uveitis (n = 1), and toxocariasis (n = 1). Phacoemulsification with intraocular lens (IOL) implantation was performed in 17 patients (27 eyes; 46.55%), while 20 patients (31 eyes; 53.44%) were left aphakic after pars plan lensectomy and vitrectomy. At an average follow-up of 3.69 ± 7.2 (SD) years, all cases had significant improvement in corrected distance visual acuity post cataract extraction; visual acuity of 20/40 or more was achieved in 32 eyes (55.17%). The most common complication was capsular opacification (37.93%). Incidence of secondary procedures as well as glaucoma was not statistically different in patients undergoing IOL implantation from those who were aphakic. Conclusion: Even though number of secondary procedures was more in pseudophakic group, meticulous choice of surgical technique and adequate immunosuppression lead to a modest gain of visual acuity in children undergoing IOL implantation in uveitis. However, scrupulous case selection and aggressive control of pre- and postoperative intraocular inflammation are the key factors in the postoperative success of these patients.


Assuntos
Extração de Catarata/métodos , Catarata/complicações , Complicações Pós-Operatórias/epidemiologia , Uveíte/complicações , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Glaucoma/epidemiologia , Glaucoma/etiologia , Humanos , Índia/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Uveíte/diagnóstico , Uveíte/cirurgia
17.
PLoS Negl Trop Dis ; 13(3): e0007209, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30845141

RESUMO

BACKGROUND: In the wake of the West African Ebola virus disease (EVD) outbreak of 2014-2016, thousands of EVD survivors began to manifest a constellation of systemic and ophthalmic sequelae. Besides systemic arthralgias, myalgias, and abdominal pain, patients were developing uveitis, a spectrum of inflammatory eye disease leading to eye pain, redness, and vision loss. To investigate this emerging eye disease, resources and equipment were needed to promptly evaluate this sight-threatening condition, particularly given our identification of Ebola virus in the ocular fluid of an EVD survivor during disease convalescence. METHODOLOGY/PRINCIPAL FINDINGS: A collaborative effort involving ophthalmologists, infectious disease specialists, eye care nurses, and physician leadership at Eternal Love Winning Africa (ELWA) Hospital in Liberia led to the development of a unique screening eye clinic for EVD survivors to screen, treat, and refer patients for more definitive care. Medications, resources, and equipment were procured from a variety of sources including discount websites, donations, purchasing with humanitarian discounts, and limited retail to develop a screening eye clinic and rapidly perform detailed ophthalmologic exams. Findings were documented in 96 EVD survivors to inform public health officials and eye care providers of the emerging disease process. Personal protective equipment was tailored to the environment and implications of EBOV persistence within intraocular fluid. CONCLUSIONS/SIGNIFICANCE: A screening eye clinic was feasible and effective for the rapid screening, care, and referral of EVD survivors with uveitis and retinal disease. Patients were screened promptly for an initial assessment of the disease process, which has informed other efforts within West Africa related to immediate patient care needs and our collective understanding of EVD sequelae. Further attention is needed to understand the pathogensis and treatment of ophthalmic sequelae given recent EVD outbreaks in West Africa and ongoing outbreak within Democratic Republic of Congo.


Assuntos
Instituições de Assistência Ambulatorial , Programas de Triagem Diagnóstica , Implementação de Plano de Saúde , Doença pelo Vírus Ebola/complicações , Transtornos da Visão/diagnóstico , Transtornos da Visão/virologia , Programas de Triagem Diagnóstica/economia , Programas de Triagem Diagnóstica/estatística & dados numéricos , Surtos de Doenças , Ebolavirus/patogenicidade , Economia Hospitalar , Equipamentos e Provisões Hospitalares/economia , Olho/virologia , Recursos em Saúde , Hospitais , Humanos , Libéria , Sobreviventes , Uveíte/diagnóstico , Uveíte/etiologia
18.
J Fr Ophtalmol ; 42(3): 303-321, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30850198

RESUMO

Sarcoidosis is a systemic granulomatosis characterized by the formation of epithelioid and giant cell granulomas without caseous necrosis. To make the diagnosis, it is necessary to prove systemic granulomatosis involving at least two organs; but in practice, a combination of clinical, paraclinical and histologic findings is used. It affects predominantly women with a bimodal age distribution: 25-29years and 65-69years. The most commonly affected organs are the mediastinal lymphatic system, lungs, skin and eyes. Ophthalmological involvement is present in 20 to 50% of cases. The typical ocular presentation is that of granulomatous uveitis associated with venous retinal vasculitis and lesions of peripheral multifocal choroiditis. This ophthalmological presentation, although very evocative, is not always associated with systemic disease. The diagnosis of ocular sarcoidosis is then presumed in the absence of histological evidence. Algorithms combining ophthalmological and systemic signs have been proposed in cases of isolated uveitis. They make it possible to establish the diagnosis of ocular sarcoidosis with various levels of probability. The absence of significant granulomas on a systemic level during primary ocular involvement remains the main hypothesis to explain these diagnostic difficulties. Treatment is well described, as the uveitis of sarcoidosis is most often steroid responsive. In the case of corticosteroid-dependent uveitis, the first-line immunosuppressant remains methotrexate. The use of anti-tumor necrosis factor-alpha is an interesting alternative in patients whose ocular sarcoidosis is refractory to conventional immunosuppressants.


Assuntos
Sarcoidose , Adulto , Distribuição por Idade , Idoso , Corioidite/diagnóstico , Corioidite/epidemiologia , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Endoftalmite/diagnóstico , Endoftalmite/epidemiologia , Granuloma/diagnóstico , Granuloma/epidemiologia , Humanos , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/epidemiologia , Sarcoidose/diagnóstico , Sarcoidose/epidemiologia , Sarcoidose/patologia , Uveíte/diagnóstico , Uveíte/epidemiologia
19.
Can J Ophthalmol ; 54(1): 20-26, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30851770

RESUMO

Acute lymphoblastic leukemia (ALL) relapse implies a poor prognosis and demands emergency treatment. Leukemic infiltration of the anterior segment can masquerade as intraocular inflammation; a high index of suspicion for this complication is essential. We describe a case of ocular relapse in a 2-year-old male on maintenance therapy for ALL. A systematic review of all known cases of similar leukemic infiltration of the anterior segment of the eye in ALL was performed. A total of 106 patients in 43 reports described leukemic infiltration of the eye as an initial presentation of ALL or relapse. Ocular relapse may be the first visible manifestation of systemic disease, with concurrent disease in the CNS, bone marrow, or testes. Prognosis for ALL patients with ocular relapse is poor, with death after initial presentation reported as early as 16 days. Patients with a history of ALL presenting with any sign of ocular inflammation should be assessed for relapse and leukemic infiltration. As soon as a diagnosis of relapse has been confirmed, appropriate leukemia therapy should be initiated.


Assuntos
Segmento Anterior do Olho/diagnóstico por imagem , Infiltração Leucêmica/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Uveíte/diagnóstico , Pré-Escolar , Humanos , Infiltração Leucêmica/complicações , Masculino , Microscopia Acústica , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Prognóstico , Uveíte/etiologia
20.
Acta Ophthalmol ; 97(5): e792-e799, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30816018

RESUMO

PURPOSE: Aminobisphosphonates may cause orbital/ocular inflammation. Awareness of the clinical presentation and disease course is crucial. The purpose of this study was to analyse demographics, clinical presentation, disease course and treatment of aminobisphosphonate-associated orbital/ocular inflammation in a large series of patients. METHODS: A retrospective study of patients with aminobisphosphonate-associated orbital/ocular inflammation and a literature review to differentiate disease presentation and course between various aminobisphosphonates. RESULTS: Eight patients from our institution (6 women and 2 men, median age 62 years) were included. The used drugs were zoledronate, alendronate and risedronate. The most common clinical presentation was conjunctival hyperaemia/chemosis. Scleritis was the most common manifestation, followed by diffuse orbital inflammation and anterior uveitis. Ultrasound aided in diagnosis in all our patients. The aminobisphosphonate was halted in all patients, and some patients had anti-inflammatory treatment. Literature review included 68 patients (83 eyes), of them the most abundant drugs causing orbital/ocular inflammation were pamidronate (38 eyes) and zoledronate (35 eyes). Overall, among 76 patients, all drugs induced orbital disease, while uveitis was induced mostly by zoledronate and pamidronate, less by alendronate and not found among risedronate users. Time interval from drug administration to symptoms was hours to 28 days. Resolution was achieved in all patients, after 1-60 days from disease presentation, and the longer resolution period was found among alendronate users. CONCLUSION: Orbital/ocular inflammation was mostly caused by intravenous aminobisphosphonates. Uveitis was not induced by risedronate. The putative aminobisphosphonate should be halted at the onset of orbital/ocular involvement and prognosis is favourable.


Assuntos
Difosfonatos/efeitos adversos , Inflamação/induzido quimicamente , Doenças Orbitárias/induzido quimicamente , Uveíte/induzido quimicamente , Adulto , Idoso , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/administração & dosagem , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Inflamação/diagnóstico , Inflamação/tratamento farmacológico , Injeções Intravenosas , Imagem por Ressonância Magnética , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Adulto Jovem
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