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1.
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
2.
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
3.
Medicine (Baltimore) ; 98(20): e15655, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096491

RESUMO

INTRODUCTION: Multispectral imaging (MSI) shows increasing strengths in detection of retinal and choroidal disease. The aim of this study was to evaluate the capacity of javascript:void(0), detecting retinal and choroidal abnormalities of uveitis which have not been described previously. PATIENT CONCERNS: The first case was a 49-year-old male patient who presented with visual disturbance and metamorphopsia in both eyes for 5 days, companying by a history of headache and hearing loss recently. The second case was related to a 45-year-old female patient who complained of blurred vision and a dark shadow before her right eye for 3 months. The third case corresponded to a 36-year-old male patient who presented with blurred vision and slight pain in his left eye for >1 week, and his blood tested positive for syphilis. DIAGNOSIS: Three Chinese patients with representative kind of uveitis were described in the study, including Vogt-Koyanagi-Harada syndrome, posterior uveitis with choroidal neovascularization, and syphilis-infected uveitis. Each affected eye had corresponding retinal and choroidal abnormalities evaluated by multiple ophthalmologic examinations. INTERVENTIONS: Case 1 was treated with oral prednisone at a dose of 1 mg/kg/d started at the early stage and then slowed tapering of the prednisone dose based on follow-up examinations. Case 2 received anti-VEGF treatment. Case 3 received the standard treatment for neurosyphilis. OUTCOMES: Due to timely diagnosis and treatment, all patients had a better prognosis. CONCLUSION: MSI provides a novel way to view retinal and choroidal abnormalities of uveitis, and may provide a supplemental method to morphological changes.


Assuntos
Doenças da Coroide/complicações , Técnicas de Diagnóstico Oftalmológico , Doenças Retinianas/complicações , Uveíte/etiologia , Adulto , China , Doenças da Coroide/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/diagnóstico por imagem , Uveíte/complicações , Transtornos da Visão/etiologia , Acuidade Visual
5.
Z Rheumatol ; 78(7): 610-619, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31127369

RESUMO

Prospective cohort studies collect demographic and clinical data of newly diagnosed patients using standardized questionnaires and validated measuring instruments. Therefore, they are a valuable data source for evaluating disease progression, outcome parameters and predictors. In this article a selection of results from four inception cohorts on juvenile idiopathic arthritis (JIA) are presented. In all cohorts, one half to three quarters of the patients achieved an inactive disease within the first year under observation but there were relevant differences between the different JIA categories. The time from symptom onset to diagnosis could be identified as an important predictor of this outcome. Data from the German JIA cohort showed that the health-related quality of life of patients and healthy control subjects had largely converged 3 years after inclusion. Young children with JIA and the detection of antinuclear antibodies have an increased risk of developing JIA-associated uveitis. Of these, the uveitis was inactive in approximately 80% after 1 year; however, at the time of diagnosis, almost 30% of patients already had uveitis-related complications. The previous therapy with methotrexate proved to be preventive for the development of uveitis. The early outcome of JIA patients is generally good. The differences in the JIA categories indicate the need to further individualize the therapy and to adapt it better to the risk profile of the individual patient. Data on long-term outcomes will provide information on which factors have a decisive influence on the course of the disease and how the care of children and adolescents with JIA can be further improved.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil , Produtos Biológicos/uso terapêutico , Metotrexato/uso terapêutico , Uveíte , Adolescente , Artrite Juvenil/complicações , Artrite Juvenil/tratamento farmacológico , Criança , Pré-Escolar , Humanos , Estudos Prospectivos , Qualidade de Vida , Uveíte/etiologia , Uveíte/prevenção & controle
6.
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
7.
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
8.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936327

RESUMO

Azathioprine (AZA) is an immunosuppressive drug that is widely used in the treatment of autoimmune diseases. Although AZA is used widely, many studies reported that AZA-related hepatotoxicity is rather rare. We aimed to present a case with severe cholestatic hepatitis due to AZA use for Behcet's disease. Three weeks after starting AZA for the treatment of uveitis, the patient was admitted to our clinic with cholestasis and constitutional symptoms. In liver biopsy, findings were in accordance with drug reaction, and the AZA treatment was stopped. After 2 months, bilirubin levels and liver tests results became normal. As a result, given that AZA may cause severe cholestasis, the drug should be stopped if idiosyncrasy or hypersensitivity develops. If there is a debate in the diagnosis, histopathological evaluation of the liver would be the major issue because of the correct diagnosis of the drug toxicity and excluding other aetiologies.


Assuntos
Azatioprina/efeitos adversos , Síndrome de Behçet/tratamento farmacológico , Colestase/induzido quimicamente , Imunossupressores/efeitos adversos , Fígado/patologia , Prurido/induzido quimicamente , Uveíte/tratamento farmacológico , Adulto , Azatioprina/uso terapêutico , Síndrome de Behçet/complicações , Síndrome de Behçet/fisiopatologia , Doença Hepática Induzida por Substâncias e Drogas , Colestase/tratamento farmacológico , Colestase/patologia , Humanos , Imunossupressores/uso terapêutico , Icterícia/induzido quimicamente , Fígado/efeitos dos fármacos , Masculino , Náusea/induzido quimicamente , Prurido/tratamento farmacológico , Prurido/patologia , Resultado do Tratamento , Uveíte/etiologia , Vômito/induzido quimicamente
9.
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
10.
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
11.
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
12.
N Engl J Med ; 380(10): 924-934, 2019 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-30855742

RESUMO

BACKGROUND: Multiple health problems have been reported in survivors of Ebola virus disease (EVD). Attribution of these problems to the disease without a control group for analysis is difficult. METHODS: We enrolled a cohort of EVD survivors and their close contacts and prospectively collected data on symptoms, physical examination findings, and laboratory results. A subset of participants underwent ophthalmologic examinations. Persistence of Ebola virus (EBOV) RNA in semen samples from survivors was determined. RESULTS: A total of 966 EBOV antibody-positive survivors and 2350 antibody-negative close contacts (controls) were enrolled, and 90% of these participants were followed for 12 months. At enrollment (median time to baseline visit, 358 days after symptom onset), six symptoms were reported significantly more often among survivors than among controls: urinary frequency (14.7% vs. 3.4%), headache (47.6% vs. 35.6%), fatigue (18.4% vs. 6.3%), muscle pain (23.1% vs. 10.1%), memory loss (29.2% vs. 4.8%), and joint pain (47.5% vs. 17.5%). On examination, more survivors than controls had abnormal abdominal, chest, neurologic, and musculoskeletal findings and uveitis. Other than uveitis (prevalence at enrollment, 26.4% vs. 12.1%; at year 1, 33.3% vs. 15.4%), the prevalence of these conditions declined during follow-up in both groups. The incidence of most symptoms, neurologic findings, and uveitis was greater among survivors than among controls. EBOV RNA was detected in semen samples from 30% of the survivors tested, with a maximum time from illness to detection of 40 months. CONCLUSIONS: A relatively high burden of symptoms was seen in all participants, but certain symptoms and examination findings were more common among survivors. With the exception of uveitis, these conditions declined in prevalence during follow-up in both groups. Viral RNA in semen persisted for a maximum of 40 months. (Funded by the National Institute of Allergy and Infectious Diseases and the National Eye Institute; PREVAIL III ClinicalTrials.gov number, NCT02431923.).


Assuntos
Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/complicações , Dor/etiologia , Sobreviventes , Uveíte/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Epidemias , Fadiga/etiologia , Feminino , Cefaleia/etiologia , Doença pelo Vírus Ebola/epidemiologia , Humanos , Libéria/epidemiologia , Estudos Longitudinais , Masculino , Transtornos da Memória/etiologia , RNA Viral/isolamento & purificação , Sêmen/virologia , Carga Viral
13.
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
14.
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.
Rev. bras. oftalmol ; 78(1): 62-64, jan.-fev. 2019. graf
Artigo em Português | LILACS | ID: biblio-990788

RESUMO

Resumo A Síndrome de Blau é uma doença de caráter hereditário autossômico dominante a qual também pode ocorrer de forma esporádica via mutação "de novo". Em geral, tem aparecimento precoce ainda na primeira infância e sua tríade clássica inclui artrite, dermatite e uveíte. Este trabalho visa relatar as manifestações clínicas e principalmente oftalmológicas de uma paciente diagnosticada com Síndrome de Blau com ênfase ao achado incomum de infiltrados corneanos subepiteliais, raramente descrito na literatura.


Abstract The Blau syndrome is an autosomal dominant hereditary disease which can also occur sporadically via "de novo" mutation. Overall it has early onset and its classic triad includes arthritis, dermatitis and uveitis. This paper describes clinical and mainly especially ophthalmologic manifestations of a patient diagnosed with Blau syndrome with emphasis on an uncommon finding of corneal subepithelial infiltrates, rarely described in the literature.


Assuntos
Humanos , Feminino , Adolescente , Artrite/genética , Uveíte/etiologia , Uveíte/genética , Córnea , Dermatite/genética , Mutação , Síndrome
18.
Indian J Ophthalmol ; 67(1): 163-164, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30574934

RESUMO

Ophthalmic manifestations of multiple sclerosis are frequent including acute optic neuritis, ocular motor disturbances and intermediate uveitis. We report an unusual case of multiple sclerosis presenting as acute hypertensive uveitis. A 56-year-old man was referred by his family doctor with a 2-week history of right eye pain and decreased vision. Best-corrected visual acuity was Count Fingers on the right and 6/9-2 on the left. Intraocular pressure was 55mmHg and 14 mmHg on the right and left respectively. He had a right relative pupillary defect and a left internuclear ophthalmoplegia. Vitreous cells were present in the right eye and there was peripheral sclerosis and periphlebitis superior temporally. MRI Brain and Spine revealed multiple T2 hyperintense lesions consistent with multiple sclerosis. Multiple sclerosis may present initially with an acute elevation of intraocular pressure and intermediate uveitis.


Assuntos
Pressão Intraocular/fisiologia , Esclerose Múltipla/complicações , Hipertensão Ocular/etiologia , Uveíte/etiologia , Doença Aguda , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Hipertensão Ocular/diagnóstico , Uveíte/diagnóstico
19.
Indian J Ophthalmol ; 67(1): 69-74, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30574896

RESUMO

Purpose: To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation. Methods: Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. Results: 8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema. Conclusion: Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract.


Assuntos
Artrite Juvenil/complicações , Catarata/complicações , Dexametasona/administração & dosagem , Implante de Lente Intraocular/métodos , Facoemulsificação/métodos , Uveíte/etiologia , Acuidade Visual , Artrite Juvenil/diagnóstico , Criança , Implantes de Medicamento , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Pressão Intraocular , Período Intraoperatório , Injeções Intravítreas , Masculino , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Uveíte/diagnóstico
20.
Cesk Slov Oftalmol ; 73(5-6): 189-197, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30541299

RESUMO

AIM: To introduce the range of eye changes in sarcoidosis in the individual casuistics. MATERIALS: At the Ophthalmic Clinic of Teaching Hospital Královské Vinohrady in Prague were examined and treated six patients with ocular forms of sarcoidosis in the years from 1998 to 2015. Three patients were unilateral lesions of the lacrimal gland without systemic symptoms. One patient experienced orbital inflammatory syndrome that accompanied the hilar form of pulmonar sarcoidosis. Two other patients underwent intraocular inflammation, panuveitis / iridocyclitis and bilateral intermedial uveitis. Both of these patients also had systemic affections of mediastinal lymph nodes and lung, in the first of these, signs of neurosarcoidosis first appeared. RESULTS: In the treatment of lacrimal glands, the diagnosis was determined by histological examination of the removed lacrimal gland in external orbitotomies, also, the orbital process has been verified by biopsy and the subsequent comprehensive examination revealed the systemic process. Definitive diagnosis of sarcoidosis was established bioptically in both uveitides and has also been demonstrated in imaging methodologies including galli scintigraphy. All patients were successfully treated with corticosteroid therapy. CONCLUSION: Biopsy results have always been a surprise in orbital processes. Both cases of uveitis were associated with systemic involvement and initiated comprehensive investigation which showed the need for interdisciplinary collaboration in the diagnosis and treatment of sarcoidosis. Key words: sarkoidosis, biopsy, corticosteroids, gallii scintigraphy, MRI, uveitis.


Assuntos
Sarcoidose , Uveíte , Biópsia , Humanos , Imagem por Ressonância Magnética , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Síndrome , Uveíte/etiologia
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