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1.
Autoimmun Rev ; 18(9): 102351, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323361

RESUMO

OBJECTIVE: Uveitis is the most common ophthalmological finding in the practice of rheumatology and clinical immunology. The condition is frequently idiopathic but about 60 causes of uveitis have been described. Our aim was to analyze the clinical patterns and etiologies of uveitis in a tertiary referral center. METHODS: The records of 912 consecutive patients referred to the department of internal medicine (Lyon University Hospital, Lyon, France) for the diagnostic work-up of uveitis were examined. Demographic, clinical, anatomical, and etiological features of uveitis were analyzed. RESULTS: The mean age at onset was 48.8 years; 59.8% of the patients were women and 78.2% were Caucasians. Anterior uveitis was the most common type of uveitis (40.6%), followed by panuveitis (31.7%), posterior (18.75%) and intermediate uveitis (9%). 46.9% of the patients had idiopathic uveitis. The most common etiologies were systemic diseases (37.3%), such as sarcoidosis (17.1%), HLA-B27-related uveitis and/or spondyloarthritis (12.5%), and tuberculosis (7.5%). CONCLUSION: We describe one of the largest cohorts of consecutive uveitis patients referred to a department of internal medicine. The high percentage of uveitis associated with underlying (systemic) diseases highlights the need for a multidisciplinary approach, in order to reduce the diagnostic delay.


Assuntos
Autoimunidade/fisiologia , Uveíte/epidemiologia , Uveíte/imunologia , Doença Aguda , Adulto , Idoso , Diagnóstico Tardio , Feminino , França/epidemiologia , Antígeno HLA-B27/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reumatologia , Sarcoidose/complicações , Sarcoidose/epidemiologia , Espondilartrite/complicações , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Uveíte/complicações , Uveíte/genética
3.
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
4.
J Fr Ophtalmol ; 42(6): 626-641, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31164292

RESUMO

Behçet's disease is a chronic multisystem disorder characterized by relapsing inflammation for which the underlying histopathology is an occlusive vasculitis. The disease has a high prevalence in the Mediterranean region, Far and Middle Eastern countries. It is clinically characterized by oral and genital ulcerations, ocular inflammatory involvement, skin lesions, vascular involvement and numerous other systemic manifestations. Uveitis is by far the most common ocular manifestation of Behçet's disease. It typically presents in the form of relapsing-remitting panuveitis with retinal vasculitis that may result in severe visual loss. Management of Behçet's uveitis relies on corticosteroid therapy, conventional immunosuppressive drugs and biological agents and requires a close collaboration between ophthalmologist and internist. A better understanding of the auto-inflammatory process and of the role of cytokines implicated in the pathogenesis of Behçet's disease will enable researchers to develop more specific and effective therapy.


Assuntos
Síndrome de Behçet/complicações , Uveíte/etiologia , Adulto , Idade de Início , Segmento Anterior do Olho , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/imunologia , Síndrome de Behçet/terapia , Fatores Biológicos/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Segmento Posterior do Olho , Recidiva , Vasculite Retiniana/etiologia , Uveíte/epidemiologia , Uveíte/terapia , Transtornos da Visão/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.
BMC Ophthalmol ; 19(1): 137, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248388

RESUMO

BACKGROUND: Uveitis in the pediatric population is uncommon, accounting for 2 to 14% of all uveitis cases, yet resulting in significant ocular morbidity. A number of studies have focused on patterns and complications of uveitis in the pediatric age group (≤ 16 years). In this report, we studied children with uveitis syndromes focusing on demographics, anatomic distribution, etiologies, treatment, and complications. We additionally divided subjects into two age groups to look into any differential characteristics pertaining to the younger age group and the role of amblyopia as a cause of visual loss. METHODS: Retrospective chart review of 80 eyes of 49 uveitis patients aged ≤16 years. Subjects were categorized by age of onset into visually immature (≤8 years) and visually mature group (> 8 years). Data compared between the two age groups included demographics, disease characteristics, visual outcomes and complications. RESULTS: Idiopathic uveitis was the most common diagnosis (51%). Anterior uveitis complications (posterior synechiae and band keratopathy) were more common in the younger group (p = 0.002 and p = 0.03 respectively) while posterior uveitis manifestations (vitreous haze and vasculitis) were more common in the older age group (p = 0.04 and p < 0.001 respectively). Amblyopia was the most common cause of vision loss in the visually immature versus cataract in the visually mature. CONCLUSION: Anterior uveitis and its complications were more common in visually immature group in our cohort. Amblyopia was identified as the main cause of visual loss in the younger population.


Assuntos
Ambliopia/etiologia , Catarata/etiologia , Doenças da Córnea/etiologia , Medição de Risco/métodos , Centros de Atenção Terciária/estatística & dados numéricos , Uveíte/epidemiologia , Acuidade Visual , Distribuição por Idade , Fatores Etários , Ambliopia/epidemiologia , Catarata/epidemiologia , Criança , Pré-Escolar , Doenças da Córnea/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Líbano/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Uveíte/complicações , Uveíte/fisiopatologia
8.
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
9.
J Fr Ophtalmol ; 42(5): 441-450, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30975438

RESUMO

PURPOSE: To evaluate the medical-surgical management of cataract surgery in children with chronic uveitis in various French pediatric ophthalmology centers. MATERIALS AND METHODS: Two-part study: first, a descriptive observational segment on the evaluation of French practices. A questionnaire was sent to the various pediatric ophthalmologists in France. A second retrospective chart review, including children with non-infectious chronic uveitis who had cataract surgery in the pediatric ophthalmology department of Bordeaux University Hospital from 2008 to 2017. RESULTS: Twenty-one ophthalmologists responded to the questionnaire. Only 23.8% systematically initiated immunosuppressive drugs (aside from corticosteroids) before surgery. A total of 88.2% prescribed oral corticosteroid treatment preoperatively. Eleven surgeons administered intravenous corticosteroid boluses during the surgery, and primary lens implantation is the most common method used in 95.2%. A total of 76.2% initiated oral steroid therapy after surgery. Postoperatively, all surgeons started local therapy with high-dose corticosteroids. At one year, 100% achieved improvement of visual acuity greater than or equal to 2 lines. On our service, 10 eyes (7 children) underwent cataract surgery. Seven were treated with systemic immunosuppressive drugs (aside from corticosteroids) and 80% of cases received oral corticosteroid therapy a few days before surgery. An intravenous corticosteroid bolus was administered preoperatively in 8 cases, and primary lens implantation was performed in 100% of cases. Postoperatively, 5 children received oral corticosteroid treatment. All were treated with local high dose steroids. At one year, the mean best-corrected visual acuity was 0.18 LogMar (0-0.7, SD: 0.25). CONCLUSION: When performed with an aggressive anti-inflammatory protocol, cataract surgery leads to a good visual outcome in selected children with chronic uveitis.


Assuntos
Extração de Catarata , Catarata/terapia , Padrões de Prática Médica/estatística & dados numéricos , Uveíte/cirurgia , Adolescente , Corticosteroides/uso terapêutico , Catarata/complicações , Catarata/epidemiologia , Extração de Catarata/efeitos adversos , Extração de Catarata/estatística & dados numéricos , Criança , Pré-Escolar , Doença Crônica , Terapia Combinada , Feminino , França/epidemiologia , Hospitais Pediátricos , Humanos , Implante de Lente Intraocular , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Uveíte/complicações , Uveíte/tratamento farmacológico , Uveíte/epidemiologia
10.
Rev Esp Salud Publica ; 932019 Mar 25.
Artigo em Espanhol | MEDLINE | ID: mdl-30907380

RESUMO

OBJECTIVE: Immune-mediated inflammatory diseases (IMID) are chronic and highly disabling diseases that share inflammatory sequences and immunological dysregulations. Considered as a disease in itself, the prevalence of IMID is virtually unknown. The aim of this study was to assess the prevalence of 10 selected UDI, including rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, hidradenitis suppurativa, sarcoidosis and uveitis in Spain. METHODS: cross-sectional epidemiological study of point prevalence was made. This study was carried out through a series of computerized interviews in households chosen at random in 17 autonomous communities in Spain. A structured questionnaire was used to determine the frequency of diagnosis and the concurrence of 10 IMID in the respondents and other individuals belonging to the same family nucleus. The point prevalence estimates were used and compared with the objective of determining the frequency of IMID by age, sex and communities. The data were processed using Excel 2016 (Microsoft, Redmond, WA, USA) and the SPSS V.019 system (IBM Corp. Armonk, NY, USA) for statistical analysis using the usual statistical tests in this type of studies. RESULTS: Of the 7,980 respondents, 510 were diagnosed with an IMID, representing a cross-sectional study of 6.39% (95% CI: 6.02-6.76). One, two, three or more members of the family were affected in 87.2%, 7.8% and 5% of positive relatives in IMID, respectively. The most recurrent diseases were psoriasis (2.69% [95% CI: 2.32-3.06]) and rheumatic arthritis (1.07% [95% CI: 0.70-1.44]). There were differences in prevalence due to sex (p = 0.004) and age (p = 0.000). No significant differences were identified related to geographic location (p = 0.819). Attendance of at least 2 IMID was reported in 8.9% of respondents. CONCLUSIONS: The overall prevalence was of the IMID studied was 6.39%, psoriasis being the most frequent with 2.69%. This study constitutes an initial step to consider IMID as an independent disease within the health system..


Assuntos
Artrite/epidemiologia , Hidradenite Supurativa/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Sarcoidose/epidemiologia , Uveíte/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite/imunologia , Estudos Transversais , Feminino , Hidradenite Supurativa/imunologia , Humanos , Doenças Inflamatórias Intestinais/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Pessoa de Meia-Idade , Prevalência , Sarcoidose/imunologia , Espanha/epidemiologia , Uveíte/imunologia , Adulto Jovem
11.
Ann Agric Environ Med ; 26(1): 154-158, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30922047

RESUMO

INTRODUCTION AND OBJECTIVE: Toxocariasis, predominantly caused by Toxocara canis, is a common zoonotic parasitosis worldwide. Toxocara infection is a cause of vision impairment and blindness. The presented study investigates the frequency of antibodies against Toxocara among uveitis patients and the epidemiological factors associated with disease. MATERIAL AND METHODS: Fifty-four patients with uveitis and 59 healthy subjects were studied. Anti-Toxocara antibodies status was determined in all serum samples using enzyme linked immunosorbent assay (ELISA), and seropositive samples analyzed by Western blot (WB) technique. RESULTS: The frequency of Toxocara canis infection was found to be significantly higher in uveitis patients, compared to healthy controls by the use of ELISA test, being 14.8% and 1.7%, respectively. From 8 seropositive samples, 5 (62.5%) patients exhibited Toxocara immunoglobulin G (IgG) antibodies in response to Western blot, whereas in the control group, none were detected positive by Western blot. No significant difference was found between pet owners, nor between different places of residence. The seroprevalence to Toxocara among uveitis patients was significantly related to gender, age and medical diagnosis. The highest prevalence was found in patients with posterior uveitis (27.8%). CONCLUSIONS: Anti-Toxocara antibody titers are associated with the risk of vision impairment -uveitis. The risk factor associated with Toxocara exposure identified in this study warrants further investigation.


Assuntos
Estudos Soroepidemiológicos , Toxocaríase/epidemiologia , Uveíte/epidemiologia , Uveíte/parasitologia , Adolescente , Adulto , Idoso , Animais , Anticorpos Anti-Helmínticos/sangue , Western Blotting , Estudos de Casos e Controles , Gatos , Criança , Cães , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Toxocara canis/imunologia , Toxocara canis/isolamento & purificação , Toxocaríase/imunologia , Uveíte/imunologia
12.
J Fr Ophtalmol ; 42(4): e133-e146, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30850197

RESUMO

Behçet's disease is a chronic multisystem disorder characterized by relapsing inflammation for which the underlying histopathology is an occlusive vasculitis. The disease has a high prevalence in the Mediterranean region, Far and Middle Eastern countries. It is clinically characterized by oral and genital ulcerations, ocular inflammatory involvement, skin lesions, vascular involvement and numerous other systemic manifestations. Uveitis is by far the most common ocular manifestation of Behçet's disease. It typically presents in the form of relapsing-remitting panuveitis with retinal vasculitis that may result in severe visual loss. Management of Behçet's uveitis relies on corticosteroid therapy, conventional immunosuppressive drugs and biological agents and requires a close collaboration between ophthalmologist and internist. A better understanding of auto-inflammatory process and of the role of cytokines implicated in the pathogenesis of Behçet's disease will enable researchers to develop more specific and effective therapy.


Assuntos
Síndrome de Behçet/complicações , Síndrome de Behçet/fisiopatologia , Olho/fisiopatologia , Fenômenos Fisiológicos Oculares , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/epidemiologia , Produtos Biológicos/uso terapêutico , Olho/efeitos dos fármacos , Olho/patologia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Inflamação/complicações , Inflamação/tratamento farmacológico , Inflamação/epidemiologia , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/epidemiologia , Vasculite Retiniana/etiologia , Uveíte/tratamento farmacológico , Uveíte/epidemiologia , Uveíte/etiologia , Uveíte/fisiopatologia , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia
13.
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
14.
Medicine (Baltimore) ; 98(9): e14668, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817592

RESUMO

Noninfectious uveitis (NIU), which pathogenesis is often autoimmune nature, occurs as a symptom of systemic syndromes or only in the eye. The standard treatment of NIU is local, topical, and oral administration of corticosteroids (CS) in combination with immunomodulatory therapy (IMT). However, additional therapeutic strategies involving topical and systemic administration of CS or others to treat relapse or exacerbation of ocular inflammation in NIU which present as various ocular manifestations have not been established. The aim of this study was to investigate therapeutic strategies used for various ocular inflammations in relapse or exacerbation of NIU and to evaluate factors associated with the treatment pattern in Japan. The subjects were 198 eyes of 156 NIU patients with relapse or exacerbation of ocular inflammation at 6 university hospitals in Japan. The most frequent disease was sarcoidosis in 23.7% of the cases, followed by Behçet disease (BD) in 21.2%, Vogt-Koyanagi-Harada (VKH) disease in 13.6%, acute anterior uveitis (AAU) in 5.6%, tubulointerstitial nephritis and uveitis syndrome (TINU) in 4.0%, and juvenile idiopathic arthritis (JIA)-associated uveitis in 3.0%. Common ocular findings were worsened anterior inflammation (AI) in 67.2% of the cases, vitreous opacity (VO) in 46.5%, macular edema (ME) in 26.8%, retinal vasculitis (RV) in 23.7%, serous retinal detachment (SRD) in 9.1%, and optic perineuritis (OPN) in 4.0%. Reinforcement of betamethasone eye drop (ED) monotherapy for only AI in both unilateral and bilateral AI, sub-tenon injection of triamcinolone acetonide (STTA) for unilateral posterior inflammation including VO and ME, and systemic therapy using CS and/or IMT for bilateral anterior and posterior inflammation were significantly more frequent. Frequencies of exacerbated individual ocular findings in sarcoidosis and BD were similar, and severe ocular inflammation associated with panuveitis required both topical and systemic therapies. These results demonstrate that reinforcement of betamethasone EDs, topical administration of triamcinolone acetonide, and long-term administration of systemic corticosteroids are the major therapeutic strategies, and reinforcement of betamethasone EDs was used for exacerbated AI independently from its use for posterior inflammation. In addition, STTA was preferentially used for VO and ME associated with posterior inflammation.


Assuntos
Betametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Centros de Atenção Terciária , Uveíte/tratamento farmacológico , Adolescente , Adulto , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Uveíte/epidemiologia , Uveíte/etiologia , Adulto Jovem
15.
Ocul Immunol Inflamm ; 27(2): 169-180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30821631

RESUMO

PURPOSE: To describe the epidemiology of macular edema (ME) in patients with uveitis. METHODS: Review of articles listed on PubMed pertaining to uveitic ME. RESULTS: Reported rates of uveitic ME ranging from 20% to 70%, depending on the ancillary tests used (fundus examination, fluorescein angiography, optical coherence tomography). Macular edema might develop due to uveitis itself, or occur as an adverse effect of drugs taken for different diseases. It is more frequently observed in adults than in children, in chronic uveitis, and in intermediate uveitis. Males with ankylosing spondylitis are more prone to develop ME than females. Three patterns of uveitic ME are observed, either isolated or in combination: cystoid ME, the most frequently encountered pattern seen in up to 80% of cases, diffuse ME and serous retinal detachment. CONCLUSION: Older age, chronicity of uveitis and intermediate uveitis are risk factors for the development of ME in patients with uveitis.


Assuntos
Edema Macular/epidemiologia , Uveíte/complicações , Acuidade Visual , Angiofluoresceinografia , Fundo de Olho , Saúde Global , Humanos , Incidência , Edema Macular/diagnóstico , Edema Macular/etiologia , Tomografia de Coerência Óptica , Uveíte/diagnóstico , Uveíte/epidemiologia
16.
Indian J Ophthalmol ; 67(2): 247-251, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30672479

RESUMO

Purpose: To evaluate clinical profile of patients with uveitis who developed central serous chorioretinopathy (CSC). Methods: Retrospective case series of consecutive patients of uveitis with CSC managed at a tertiary eye care center in India between 1994 and 2014. The data about clinical features, investigations, treatment, and outcomes were obtained from their medical records. Results: A total of 31 eyes of 26 patients with uveitis with a diagnosis of CSC between June 1994 and May 2014 were included in the study. The mean age of presentation was 42.8 ± 9.2 years, and 88.4% of the patients were male. CSC was bilateral in 19.2% of the patients, and in 38.4% patients uveitis was because of infectious etiology. CSC developed in 23 (88.5%) patients when they were on oral corticosteroid. The most common cause of uveitis in our study was choroiditis (48.4%), followed by retinal vasculitis (12.9%). The mean time for resolution of CSC was relatively less in patients with uveitis because of infectious etiology. In 10% eyes vision remained the same and deterioration of vision was noted in 19% eyes. Best corrected visual acuity of the patients at the time of presentation with CSC was 0.56 ± 0.34 and after the resolution of CSC was 0.48 ± 0.5 (P < 0.0005). Conclusion: Patients with choroidal inflammations are more prone to develop CSC compared with other subtypes of uveitis. Management of CSC in uveitis can be challenging.


Assuntos
Coriorretinopatia Serosa Central/etiologia , Angiofluoresceinografia/métodos , Centros de Atenção Terciária/estatística & dados numéricos , Tomografia de Coerência Óptica/métodos , Uveíte/complicações , Acuidade Visual , Adulto , Idoso , Coriorretinopatia Serosa Central/diagnóstico , Coriorretinopatia Serosa Central/epidemiologia , Corioide/patologia , Feminino , Seguimentos , Fundo de Olho , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Uveíte/diagnóstico , Uveíte/epidemiologia
17.
BMJ Case Rep ; 12(1)2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642860

RESUMO

Tubercular uveitis is a common manifestation of tuberculosis (TB) in TB-endemic countries. Due to lack of gold standard diagnostic tests for confirming intraocular TB, it is often either underdiagnosed or rarely over diagnosed. We report a case of a 28-year-old woman with diminution of vision in the left eye. She was started on antitubercular treatment (ATT) and steroids but she did not comply with the treatment. She developed progressive painful loss of vision consequently and was treated with vitrectomy and silicone oil tamponade. After a complete course of ATT, she recovered, salvaging of eye and restoration of some vision was possible. Mycobacterium tuberculosis is rarely demonstrated in the ocular fluid samples of the suspected cases of TB due to the paucibacillary nature of the disease. A vitreous sample can be obtained from these patients. Surgical intervention in the form of vitrectomy and silicone oil tamponade can help in avoiding enucleation/evisceration.


Assuntos
Oftalmopatias/microbiologia , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/microbiologia , Uveíte/microbiologia , Baixa Visão/etiologia , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Oftalmopatias/patologia , Feminino , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Cooperação do Paciente , Óleos de Silicone/administração & dosagem , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/patologia , Uveíte/diagnóstico , Uveíte/epidemiologia , Baixa Visão/diagnóstico , Vitrectomia/métodos
18.
Jpn J Ophthalmol ; 63(1): 1-6, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30460514

RESUMO

PURPOSE: To compare the approaches to uveitis in Japan and the United States. METHODS: This report is based on the author's personal experience, conversations with Japanese colleagues, and a literature search using the database of the US National Library of Medicine. RESULTS: The frequencies of specific forms of uveitis vary between the two countries. Options for therapy are affected by government regulations and the impact of insurance carriers. In both countries, there is a stepwise approach to therapy beginning with topical corticosteroids and ultimately advancing to biologics. Despite the differences, the goals for therapy, disease control with minimal toxicity, are the same. CONCLUSIONS: Genetic, environmental, and regulatory differences impact the approach to uveitis. Despite these factors, the goal for therapy is essentially the same.


Assuntos
Gerenciamento Clínico , Uveíte , Humanos , Japão/epidemiologia , Morbidade , Estados Unidos/epidemiologia , Uveíte/diagnóstico , Uveíte/epidemiologia , Uveíte/terapia
19.
Ocul Immunol Inflamm ; 27(2): 203-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29847196

RESUMO

PURPOSE: To describe the patterns of uveitis in South Africa. METHODS: Prospective cross-sectional study. RESULTS: One hundred and six patients were enrolled and 37.7% had human immune-deficiency virus (HIV) infection. Anterior and panuveitis occurred most frequently. Infectious, non-infectious and idiopathic uveitis were diagnosed in 66.0%, 17.0% and 17.0% of all cases, respectively. Eighty percent of HIV+ cases had infectious uveitis. Overall, intraocular tuberculosis (IOTB), herpetic and syphilitic uveitis were the commonest infectious causes. Sarcoidosis and HLA-B27-associated uveitis were the commonest non-infectious causes. In anterior uveitis, HIV+ cases most frequently had probable IOTB, syphilitic or idiopathic uveitis while HIV- cases had possible IOTB, idiopathic or HLA-B27-associated uveitis. In panuveitis, HIV+ cases mostly had syphilis, probable IOTB, toxoplasma and varicella-zoster virus whereas HIV- cases mostly had possible IOTB, sarcoidosis and idiopathic uveitis. CONCLUSION: Infectious uveitis is common in South Africa, especially amongst HIV+ patients. Causes of anterior and panuveitis differ between HIV+ and HIV- patients.


Assuntos
Soronegatividade para HIV , Soropositividade para HIV , HIV , Centros de Atenção Terciária/estatística & dados numéricos , Uveíte/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , África do Sul/epidemiologia , Uveíte/epidemiologia , Uveíte/etiologia
20.
Ocul Immunol Inflamm ; 27(5): 766-773, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29792538

RESUMO

Purpose: To test the frequency of single-nucleotide polymorphisms in the IL-10, IL23R-IL12RB2 genes in patients with Behcet's uveitis. Methods: Blood samples were collected from 89 Israeli and Turkish patients, and from healthy control subjects of different origins. Genomic DNA was extracted from peripheral blood leukocytes and genotyped. Results: The risk allele, A, in rs1800871, of IL-10 gene was highly prevalent in Behcet's uveitis and healthy control samples alike; highest among the Turkish groups. Prevalence of G allele, in rs1495965, in the IL23R-IL12RB2 gene was high in Behcet's uveitis patients, and among healthy Turkish and Israelis of Middle Eastern origin, while lower among the other Israeli control group (77.9%, 78.9%, 27.8%, respectively, P < 0.001). Conclusion: Our findings highlight the differences between populations and may account for the increased prevalence of the disease among Turkish and Israelis of Middle Eastern origin. Further studies are required to map other healthy and affected populations.


Assuntos
Síndrome de Behçet/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Receptores de Interleucina-12/genética , Receptores de Interleucina/genética , Uveíte/etiologia , Adulto , Síndrome de Behçet/complicações , Síndrome de Behçet/epidemiologia , Estudos de Casos e Controles , Feminino , Frequência do Gene , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Turquia/epidemiologia , Uveíte/epidemiologia
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