Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 228
Filtrar
2.
Indian J Ophthalmol ; 68(10): 2291-2293, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32971697

RESUMO

Coronavirus disease 2019 (COVID-19) is a form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been declared a pandemic by the World Health Organization (WHO). Ocular manifestations related to COVID-19 are uncommon with conjunctivitis being reported in a few cases. We report a unique case of vasculitic retinal vein occlusion (RVO) secondary to COVID-19 in a 52-year-old patient who presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. All investigations for vasculitis were negative. This case supports the mechanism of thrombo-inflammatory state secondary to the "cytokine-storm" as the pathogenesis for systemic manifestations of COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/virologia , Infecções Oculares Virais/virologia , Pneumonia Viral/virologia , Vasculite Retiniana/virologia , Oclusão da Veia Retiniana/virologia , Administração Oral , Inibidores da Angiogênese/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Quimioterapia Combinada , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/tratamento farmacológico , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Ranibizumab/uso terapêutico , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
3.
Middle East Afr J Ophthalmol ; 27(2): 131-133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874048

RESUMO

The aim was to report a case of central retinal vein prethrombosis (CRVP), responsive to systemic steroids. An 18-year-old male presented with right sudden blurred vision and central scotoma for 2 days. Right best-corrected visual acuity (BCVA) measured 6/36, and fundoscopy revealed vascular congestion and blurred disc margins. Fluorescein angiography (FA) showed CRVP secondary to retinal vasculitis. Systemic oral prednisone was started. Six months later, right BCVA was 6/6, FA showed reduced vascular congestion, and retinal vasculitis and residual optic disc hyperfluorescence resolved. CRVP should be considered in young patients with sudden central scotoma. Early systemic steroids might be effective in the treatment of "active" retinal vasculitis.


Assuntos
Vasculite Retiniana , Oclusão da Veia Retiniana , Administração Oral , Adolescente , Diagnóstico Precoce , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Oftalmoscopia , Prednisona/uso terapêutico , Vasculite Retiniana/complicações , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/etiologia , Acuidade Visual/fisiologia
5.
Eur J Ophthalmol ; 30(5): 874-885, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31238716

RESUMO

BACKGROUND: Clinical presentation of Lyme-associated uveitis is poorly described. We reported here a case series of seven patients with uveitis related to Lyme disease and a review of the literature. METHODS: A retrospective study in our university hospital between 1 May 2003 and 31 July 2016 on 1006 uveitis patients and review of Pubmed library. RESULTS: Seven patients (71.4% male, mean age = 53 (38-70)) were diagnosed with a Lyme-associated uveitis. All anatomical types of uveitis were found (four intermediate, three anterior, and three posterior uveitis); most were unilateral (n = 6; 85.7%), one granulomatous and two with synechiae. Peripheral retinal vasculitis was present in four patients. They all had a risk of exposure or extra-ophthalmological symptoms. Antibiotic and steroid treatment was rapidly effective in all patients. Four patients presented recurrences of uveitis, of whom two received a second antibiotic treatment, which is quite common in literature. Persistent or recurrence of symptoms can be explained by three hypotheses: (1) reinfection, (2) relapse of original infection, and (3) autoimmune reaction. CONCLUSION: Lyme-associated uveitis appears varied. Hyalitis and involvement of the posterior segment and retinal vasculitis seem to be rather frequent. Its prognosis is mainly good, even if inflammation can be resistant or recurring.


Assuntos
Infecções Oculares Bacterianas/etiologia , Doença de Lyme/complicações , Uveíte/etiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Endoftalmite/etiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Recidiva , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/etiologia , Estudos Retrospectivos , Uveíte/diagnóstico , Uveíte/tratamento farmacológico
7.
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
8.
Harefuah ; 158(2): 105-108, 2019 Feb.
Artigo em Hebraico | MEDLINE | ID: mdl-30779487

RESUMO

INTRODUCTION: This is an article on a six year follow-up of a patient diagnosed with idiopathic retinal vasculitis. Her medical history, symptoms and findings are presented in detail, related to the diagnostic investigations and the resulting diagnosis. Patient follow-up was marked with repeated attempts to utilize steroid sparing strategies including antimetabolites such as Methotrexate and mycophenolate Mofetyl with only limited success. Biologic agent (anti TNF), Adalimumab, was also not successful. We discuss the difficulties experienced by the patient and her response to our inability to completely control her symptoms. On another level, we relate to our own difficulties to assess her response to therapy given her preserved vision on the one hand and her apparent uncontrolled retinal vascular leakage. The patient's ability to function in daily life reduces her willingness to endure therapy-related adverse events.


Assuntos
Vasculite Retiniana , Doença Crônica , Feminino , Humanos , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores
9.
Turk J Ophthalmol ; 49(6): 361-363, 2019 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-31893593

RESUMO

Mycobacterium tuberculosis can spread through the entire body but rarely involves the eye. We report a patient with endophthalmitis in one eye and simultaneous retinal vasculitis in the fellow eye. Systemic work-up suggested infective endopericarditis. Polymerase chain reaction analyses of the vitreous and pericardial fluid were positive for M. tuberculosis. We initiated a four-drug antituberculous treatment regimen (isoniazid, ethambutol, pyrazinamide, and rifampin). After two weeks, we discontinued all the medications due to drug-induced hepatitis. We restarted isoniazid and rifampin, but hepatitis recurred. Finally, we chose isoniazid/ethambutol combination for 18 months, and also administered short-term systemic corticosteroid. His vision improved considerably with no recurrence of hepatitis or tuberculosis for 3 years after completion of treatment. Ocular tuberculosis can masquerade as other causes of intraocular inflammation, and a medical team consisting of an ophthalmologist and an infectious disease specialist might be needed for the diagnosis and management.


Assuntos
Endocardite/diagnóstico , Pericardite/diagnóstico , Tuberculose Ocular/diagnóstico , Uveíte/diagnóstico , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Etambutol/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Líquido Pericárdico/microbiologia , Pericardite/tratamento farmacológico , Pericardite/microbiologia , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/microbiologia , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologia , Uveíte/tratamento farmacológico , Uveíte/microbiologia , Corpo Vítreo/microbiologia
10.
Ocul Immunol Inflamm ; 27(1): 2-6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29020486

RESUMO

PURPOSE: To report on ocular manifestations and visual outcomes of Thai patients with Behçet's Uveitis (BU). METHODS: We reviewed medical records of 50 BU patients (31 males and 19 females). Ocular manifestations, treatment modalities, complications, and visual outcomes were registered. RESULTS: Ocular involvement was bilateral in 76% of patients, resulting in 89 affected eyes. Panuveitis and posterior uveitis were the most common types. Retinal vasculitis was noted in majority of affected eyes and specifically arteritis was noticed in 32/57(56%). Most patients received combination therapy of systemic corticosteroids and immunosuppressive agents (azathioprine 72%). At final visit, VA ≤20/200 was observed in 25 affected eyes (28%). Risk factors for poor visual outcome were poor visual acuity at presentation (p < 0.001) and development of optic atrophy (p = 0.01). CONCLUSIONS: Typical ocular manifestations of Thai patients with BU consisted of bilateral uveitis affecting posterior eye segment with high rate of complications and frequent visual loss.


Assuntos
Síndrome de Behçet/complicações , Vasculite Retiniana/complicações , Uveíte Posterior/complicações , Acuidade Visual/fisiologia , Adolescente , Adulto , Idade de Início , Azatioprina/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/fisiopatologia , Criança , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/fisiopatologia , Estudos Retrospectivos , Tailândia , Tonometria Ocular , Uveíte Posterior/tratamento farmacológico , Uveíte Posterior/fisiopatologia , Adulto Jovem
11.
Int Ophthalmol ; 39(5): 1155-1161, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29594790

RESUMO

PURPOSE: To report a case of resolution of retinal arterial aneurysms in a patient of idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) treated with oral steroids. METHODS: This study contains case report and review of literature. RESULTS: A 16-year-old girl with stage 2 IRVAN was treated with oral steroids alone. Fluorescein angiography confirmed the presence of aneurysms and absence of neovascularization in both eyes. The aneurysms resolved gradually over 4-month follow-up. CONCLUSIONS: This case demonstrates previously unreported reversibility of arterial aneurysms with steroid therapy alone in early stages of IRVAN.


Assuntos
Aneurisma/etiologia , Prednisolona/administração & dosagem , Artéria Retiniana , Vasculite Retiniana/complicações , Retinite/complicações , Administração Oral , Adolescente , Aneurisma/diagnóstico , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Glucocorticoides/administração & dosagem , Humanos , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Retinite/diagnóstico , Retinite/tratamento farmacológico , Tomografia de Coerência Óptica
12.
Retina ; 39(8): 1623-1630, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29697588

RESUMO

PURPOSE: Tubercular retinal vasculitis (TRV) is a heterogeneous disease that can be difficult to manage because of nonspecific presentation and limitations of confirmatory tests for tuberculosis. This is a big data analysis on phenotypes and treatment outcomes for TRV. METHODS: Multicentre retrospective study of patients with TRV between January 2004 and December 2014 and a minimum follow-up of 1 year. RESULTS: Two hundred and fifty-one patients with TRV with a mean age of 38.9 ± 14.4 years (range, 9-86 years) were included. The patients were predominantly males (n = 167/251; 66.5%) of Asian ethnicity (n = 174/246; 70.7%), and geographical origin (n = 137/251; 54.6%). Most patients had features of occlusive type of RV (n = 113/185; 61.1%) except Caucasians (n = 11; 28.2%). There was no significant difference in treatment failure whether patients received antitubercular therapy (ATT) (P = 0.29), although treatment failure was less frequent in patients who received ATT (13.6%; n = 31/228) compared with those who did not (21.7%, n = 5/23). Less treatment failures were observed in patients with occlusive type RV who received ATT; however, this was not significant on survival analysis (P = 0.09). Treatment with ATT was associated with higher failure rates in patients of Hispanic and African American race and those with TRV associated with panuveitis (compared with posterior uveitis). CONCLUSION: In this multinational study of TRV, there was no significant therapeutic effect of ATT. However, a definitive conclusion about the role of ATT could not be made because of a few patients who did not receive ATT. Because this is a retrospective study with a limited 1-year follow-up, the effect of ATT may have been overestimated (or underestimated) in the duration of follow-up.


Assuntos
Vasculite Retiniana/diagnóstico , Tuberculose Ocular/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Criança , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/microbiologia , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologia , Adulto Jovem
14.
Clin Rheumatol ; 38(2): 407-415, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30099655

RESUMO

To compare the efficacy of adalimumab (ADA) and infliximab (IFX) in patients with non-infectious intermediate uveitis, posterior uveitis, and panuveitis. Demographic, clinical, instrumental, and therapeutic data from patients enrolled were collected at the start of treatment, at 12-month follow-up, and at the last follow-up assessment. One hundred seven patients (46 females, 187 eyes) were enrolled, 66 (61.7%) treated with ADA and 41 (38.3%) with IFX. Bilateral involvement was observed in 80 cases. The mean follow-up was 26.45 ± 21.71 months for ADA patients and 56.60 ± 56.04 months for IFX patients. The overall decrease of uveitis frequency during the first 12 months of treatment was 66.7% in the IFX group and 84.2% in the ADA group, compared to the previous 12 months (p = 0.09). A significantly higher corticosteroid dosage was found among patients treated with ADA at the last follow-up visit (p = 0.008). The percentage of patients co-administered with corticosteroids was significantly higher among ADA patients both at the 12-month visit (p = 0.03) and at the last visit (p = 0.0004). The frequency of uveitic macular edema (UME) was significantly higher among patients treated with ADA compared to those treated with IFX at the 12-month assessment (p = 0.015) and at the last follow-up visit (p = 0.011); central macular thickness was significantly higher in ADA group compared to the IFX group at the last follow-up assessment (p = 0.04). ADA and IFX have shown a similar efficacy in controlling uveitis relapses, but IFX showed a more pronounced corticosteroid sparing effect and a significantly higher capacity in resolving UME compared to ADA.


Assuntos
Adalimumab/uso terapêutico , Infliximab/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Uveíte Intermediária/tratamento farmacológico , Uveíte Posterior/tratamento farmacológico , Adulto , Síndrome de Behçet/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vasculite Retiniana/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
15.
J Med Case Rep ; 12(1): 310, 2018 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-30326970

RESUMO

BACKGROUND: Eales' disease is a difficult to treat idiopathic form of retinal vasculitis. We present such a case with peculiar epidemiology in which the only efficient therapeutic approach in order to maintain functional vision was repeated intravitreal dexamethasone implants (Ozurdex®). To the best of our knowledge this is the first report of this kind in the literature. CASE PRESENTATION: This is the case of a 40-year-old white woman presenting in 2008 with recurrent floaters accompanied by blurring of vision in her right eye and severe visual loss in her left eye caused by retinal detachment; her age at presentation was 30 years. A diagnosis of Eales' disease was made by exclusion. She was stable until 2011 after childbirth (cesarean section). Despite aggressive systemic treatment with steroids, azathioprine, and mycophenolate mofetil, progression of the disease was noted that could only be controlled with repeated intravitreal dexamethasone implants (Ozurdex®) injected in her right eye. Her left eye underwent vitrectomy with silicone oil tamponade for tractional retinal detachment with satisfactory anatomical result but vision was limited to light perception. CONCLUSIONS: In our case the systemic therapy was much less effective than the intravitreal sustained-release dexamethasone implant (Ozurdex®) for reducing recurrences and halting disease progression. We believe that recurrent and severe cases could benefit from this addition to the classic treatment armamentarium.


Assuntos
Dexametasona/uso terapêutico , Progressão da Doença , Glucocorticoides/uso terapêutico , Neovascularização Patológica/tratamento farmacológico , Vasculite Retiniana/tratamento farmacológico , Adulto , Dexametasona/administração & dosagem , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Período Pós-Parto , Resultado do Tratamento
16.
Can J Ophthalmol ; 53(5): 435-440, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30340706

RESUMO

OBJECTIVE: Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare entity with a potentially poor visual prognosis. Our objective is to review the clinical presentation and long-term outcomes of patients with IRVAN syndrome. DESIGN: This is a retrospective case series. METHODS: We reviewed the charts of all the patients diagnosed with IRVAN syndrome at our tertiary care centre from 2002 to 2015. RESULTS: We included the long-term clinical outcomes of 7 eyes (5 patients) diagnosed with IRVAN syndrome. After a mean follow-up of 84.9 months, best-corrected visual acuity was 20/40 or better in the majority of eyes (70%). Four (57.1%) patients had systemic conditions, namely, multiple sclerosis, ischemic stroke, and positive antiphospholipid titres. All eyes were treated with laser photocoagulation. Four (40%) eyes received adjunctive intravitreal bevacizumab injections. CONCLUSION: IRVAN is an important diagnosis for clinicians to recognize. When treated in a timely manner, long-term visual outcomes can be favourable.


Assuntos
Aneurisma/diagnóstico , Aneurisma/cirurgia , Artéria Retiniana , Vasculite Retiniana/diagnóstico , Retinite/diagnóstico , Retinite/cirurgia , Acuidade Visual , Adulto , Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/cirurgia , Retinite/tratamento farmacológico , Estudos Retrospectivos , Síndrome , Fatores de Tempo
17.
Indian J Ophthalmol ; 66(9): 1355-1357, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30127171

RESUMO

We report a case of 22-year-old young male who presented with a 3-month history of gradual and painless decrease of vision in his right eye (RE). On ophthalmological examination, best-corrected visual acuity in his RE was counting finger close to the face. Left eye ophthalmic examination was unremarkable. RE indirect ophthalmoscopy revealed multiple telangiectatic vessels, aneurysmal dilations, extensive yellow (lipid) exudation over the posterior pole along with perivascular exudation, and multiple sclerosed vessels in peripheral retina. Fluorescein angiography also revealed progressive leakage from telangiectasias, multiple aneurysmal outpouchings, extensive capillary dropouts, and vascular communicating channels in all quadrants. Spectral-domain-optical coherence tomography of macula demonstrated marked intraretinal fluid. Based on the above findings, a diagnosis of healed retinal vasculitis with Coats'-like response was made. The patient received 4-weekly two intravitreal bevacizumab injections which resulted in stabilization of the retinal findings and improvement in visual acuity.


Assuntos
Bevacizumab/administração & dosagem , Telangiectasia Retiniana/etiologia , Vasculite Retiniana/complicações , Inibidores da Angiogênese/administração & dosagem , Angiofluoresceinografia , Fundo de Olho , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Masculino , Oftalmoscopia , Telangiectasia Retiniana/diagnóstico , Telangiectasia Retiniana/tratamento farmacológico , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Tomografia de Coerência Óptica , Adulto Jovem
18.
Medicine (Baltimore) ; 97(22): e10974, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29851850

RESUMO

INTRODUCTION: Kawasaki disease is a necrotizing vasculitis featuring fever, erythema, conjunctivitis, and lymphadenopathy. Ocular manifestations in Kawasaki disease are commonly limited to anterior segment, posterior segment lesions are rarely reported. CASE PRESENTATION: We report a unique case of ocular manifestations in an 11-year-old girl with incomplete Kawasaki disease. An 11-year-old Asian girl presented with severe enophthalmos, retinitis, retinal detachment, and choroidal detachment secondary to an unexplained fever for 10 days. CONCLUSION: To the best of our knowledge, this is the first documented case of incomplete Kawasaki disease with severe posterior segment lesions. The local use of dexamethasone in the eye was effective in our patient. Surgical intervention might not be necessary even though the initial symptoms could be devastating. The eye should be monitoring the eye routinely in patients with Kawasaki disease.


Assuntos
Catarata/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Descolamento Retiniano/etiologia , Vasculite Retiniana/etiologia , Angiografia , Criança , Dexametasona/administração & dosagem , Olho/patologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Vasculite Retiniana/tratamento farmacológico
19.
Infection ; 46(4): 549-554, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29869018

RESUMO

PURPOSE: Diagnosis of tuberculous uveitis (TBU) is often challenging and is usually made after excluding other causes of uveitis. We analysed the characteristics of TBU and variables associated with visual outcome. METHODS: A retrospective, observational analysis was performed in patients with presumptive TBU who were started on specific TB treatment between January 2006 and June 2016. Demographic, clinical, radiological, analytical and ophthalmic examination variables were studied. After completing TB treatment, a follow-up of at least 9 months was performed. A univariate and logistic regression analysis was applied to identify the variables associated with visual acuity and recurrences of uveitis. RESULTS: Forty affected eyes of 24 individuals were identified; 79% of patients were diagnosed during the last 3 years of the study period. Median delay from onset of symptoms to diagnosis was 12 weeks. Loss of visual acuity was the most frequent symptom (87.5%). Posterior uveitis was the most frequent localization (72.9%); 19 patients (79.2%) presented at least one of the Gupta signs predictive of TBU, but there were no confirmed diagnoses. OUTCOME: There was improvement in visual acuity in 74.4% of the eyes, but a complete response was achieved only in 56.4%. There was recurrence in two patients. The initiation of treatment ≥ 24 weeks after onset of symptoms was significantly associated with no improvement (p = 0.026). CONCLUSION: TBU can cause permanent damage to visual acuity, particularly in patients with delayed diagnosis. A prompt initiation of systemic TB treatment is essential to improve visual prognosis.


Assuntos
Tuberculose Ocular/epidemiologia , Uveíte/epidemiologia , Uveíte/microbiologia , Adulto , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Biomarcadores , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/microbiologia , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológico , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Testes Visuais
20.
Clin Rheumatol ; 37(10): 2805-2809, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29766375

RESUMO

The primary aim of the study was to evaluate the efficacy of tumor necrosis factor (TNF)-α blockers adalimumab (ADA) and infliximab (IFX) in refractory sight-threatening retinal vasculitis (RV) during a 12-month follow-up period. Secondary aims were to evaluate (i) any impact of concomitant conventional disease-modifying anti-rheumatic drugs (cDMARDs) and different lines of biologic therapy; (ii) any difference in terms of efficacy between ADA and IFX; (iii) consequences of biotherapies on the best-corrected visual acuity (BCVA); (iv) corticosteroid-sparing effect; and (vi) ocular complications during anti-TNF-α treatment. Demographic, clinical, and therapeutic data were retrospectively collected from the medical records and statistically analyzed. Forty-eight patients (82 eyes) were recruited, 22 (45.8%) of which received IFX and 26 (54.2%) ADA. The percentages of patients achieving RV remission within 3 and 12 months were 54 and 86%, respectively. A significant decrease in RV detection was identified from baseline to 3-month (p < 0.0001) and 12-month (p < 0.0001) assessments and between 3-month and 12-month visits (p = 0.004). No differences were identified in terms of RV resolution between (i) patients undergoing monotherapy and those co-administered with cDMARDs at 3-month (p = 0.560) and 12-month (p = 0.611) follow-up; (ii) biologic-naïve patients and those already exposed to other biologics at 3-month (p = 0.497) and 12-month (p > 0.99) visits; and (iii) patients treated with ADA and those treated with IFX (p = 0.357). During the study period, a statistically significant corticosteroid-sparing effect was observed (p = 0.0002), while BCVA values did not significantly change (p = 0.950). Anti-TNF-α monoclonal antibodies have proved excellent results in patients with recalcitrant sight-threatening RV.


Assuntos
Adalimumab/uso terapêutico , Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Infliximab/uso terapêutico , Vasculite Retiniana/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...