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Kirino Y, Ideguchi H, Takeno M, Suda A, Higashitani K, Kunishita Y, Takase-Minegishi K, Tamura M, Watanabe T, Asami Y, Uehara T, Yoshimi R, Yamazaki T, Sekiguchi A, Ihata A, Ohno S, Ueda A, Igarashi T, Nagaoka S, Ishigatsubo Y, Nakajima H. Continuous evolution of clinical phenotype in 578 Japanese patients with Behçet's disease: a retrospective observational study. Arthritis Res Ther 2016; 18:217. [PMID: 27716399 PMCID: PMC5048408 DOI: 10.1186/s13075-016-1115-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/08/2016] [Indexed: 12/22/2022] Open
Abstract
Background It has been suggested that the phenotypes of Behçet’s disease (BD) in Japan are changing. To ask whether the evolution of BD holds true in recent-onset cases in Japan, we performed a retrospective study. Methods We reviewed the records of 578 patients with BD who met the 1987 revised diagnostic criteria of the Behçet’s disease research committee of Japan. The patients were divided into three groups based on the date of disease onset. We compared the demography, clinical features, and treatments among them with or without adjustment for the observation period. Patients having oral ulcers, genital ulcers, regional skin involvement, and uveitis are categorized as having complete-type BD, and the associated factors were determined by univariate and multivariate logistic regression analyses. Results Male patients had a higher propensity for uveitis and central nervous system (CNS) involvement, whereas female patients had higher rates of genital ulcers and arthritis. We found a significant trend in reduction of complete-type, genital ulcer, HLA-B51 carriers, and increment of gastrointestinal BD over time. Multiple regression analysis identified HLA-B51 positivity, earlier date of disease onset, and younger age of onset as independently associated with complete-type BD. Although treatments had been also chronologically changed, the causative relationship between therapeutic agents and phenotypical changes was not determined from the study. Conclusion The present study revealed that phenotypical evolution was characterized by decreased incidence of the complete type and increment of gastrointestinal involvement in Japanese patients with BD during the last 30 years. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1115-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan. .,Y-CURD study group, Yokohama, Japan.
| | - Haruko Ideguchi
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.,Y-CURD study group, Yokohama, Japan
| | - Akiko Suda
- Yokosuka Center for Rheumatic Diseases, Yokosuka City Hospital, Yokosuka, Japan.,Y-CURD study group, Yokohama, Japan
| | - Kana Higashitani
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
| | - Yosuke Kunishita
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Kaoru Takase-Minegishi
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Maasa Tamura
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Toshiyuki Watanabe
- Department of Rheumatology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Yukiko Asami
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Takeaki Uehara
- Department of Rheumatology, Chigasaki City Hospital, Chigasaki, Japan.,Y-CURD study group, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Tetsu Yamazaki
- Department of Rheumatology, Yamato City Hospital, Yamato, Japan.,Y-CURD study group, Yokohama, Japan
| | - Akiko Sekiguchi
- Department of Hematology and Rheumatology, Fujisawa City Hospital, Fujisawa, Japan.,Y-CURD study group, Yokohama, Japan
| | - Atsushi Ihata
- Department of Rheumatology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Shigeru Ohno
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Atsuhisa Ueda
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Toshihisa Igarashi
- Department of Rheumatology, Yamato City Hospital, Yamato, Japan.,Y-CURD study group, Yokohama, Japan
| | - Shohei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | | | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
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Sukavatcharin S, Kijdaoroong O, Lekhanont K, Arj-Ong Vallipakorn S. Pattern of Uveitis in a Tertiary Ophthalmology Center in Thailand. Ocul Immunol Inflamm 2016; 25:S94-S99. [PMID: 27603146 DOI: 10.1080/09273948.2016.1215475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the etiology and pattern of uveitis in a tertiary ophthalmology center in Thailand. METHODS A cross-sectional study was conducted on uveitis patients presenting to a uveitis clinic at Ramathibodi Hospital, Thailand, between February 2014 and January 2015. RESULTS A total of 758 uveitis patients were enrolled into this study. The most common identified cause was herpetic uveitis (17.2%), followed by Vogt-Koyanagi-Harada disease (13.5%), cytomegalovirus uveitis (12.7%), and HLA-B27/spondyloarthropathy-associated uveitis (12.4%). CONCLUSIONS Herpetic uveitis was the commonest form of infectious uveitis, whereas Vogt-Koyanagi-Harada disease was most frequently seen as the non-infectious cause of uveitis in Thailand.
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Affiliation(s)
| | - Ornsirin Kijdaoroong
- a Department of Ophthalmology , Ramathibodi Hospital , Oomyai , Sampran , Thailand
| | - Kaevalin Lekhanont
- a Department of Ophthalmology , Ramathibodi Hospital , Oomyai , Sampran , Thailand
| | - Sakda Arj-Ong Vallipakorn
- b Section for Epidemiology and Biostatistics , Faculty of Medicine, Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
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Al-Baker ZM, Bodaghi B, Khan SA. Clinical Patterns and Causes of Uveitis in a Referral Eye Clinic in Qatar. Ocul Immunol Inflamm 2016; 26:249-258. [PMID: 27541808 DOI: 10.1080/09273948.2016.1206573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the patterns and causes of uveitis in a referral eye clinic in Qatar. METHODS A retrospective study was conducted on all cases of uveitis that presented to the Uveitis Clinic at Hamad Medical Corporation from March 2007 to February 2011. All patients had detailed ocular, medical examination, and uveitis work up. RESULTS The study included 310 patients. Anterior uveitis was noted in 53.2% of cases (165/310), followed by panuveitis 16.8% (52/310), intermediate uveitis 16.5% (51/310), and posterior uveitis 13.6% (42/310). Causes of uveitis were determined in 69.7% (216/310) of cases. The most commonly identified causes of uveitis in our study were presumed ocular tuberculosis (14.5%), Fuchs uveitis (11.0%), Behçet disease (7.4%), and VKH disease (6.8%). CONCLUSIONS Anterior uveitis is the most common anatomic/clinical form of uveitis in Qatar and the etiologic diagnosis of uveitis should focus in particular on presumed ocular tuberculosis, Fuchs uveitis, Behçet disease, and VKH disease.
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Affiliation(s)
| | - Bahram Bodaghi
- b DHU Vision and Handicaps, APHP , University of Pierre and Marie Curie , Paris , France
| | - Shaukat Ayub Khan
- a Ophthalmology Section , Rumailah Hospital, Hamad Medical Corporation , Doha , Qatar
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Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C, Androudi S. A Focus on the Epidemiology of Uveitis. Ocul Immunol Inflamm 2016; 26:2-16. [PMID: 27467180 DOI: 10.1080/09273948.2016.1196713] [Citation(s) in RCA: 320] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Uveitis is a common, sight-threatening inflammatory ocular disease and includes multiple heterogeneous clinical entities. The prevalence of various types of uveitis depends upon multiple factors, such as age, sex, race, geographic distribution, environmental influence, genetics, and social habits. Epidemiologic research of uveitis is necessary to understand the etiology and immunopathogenesis of this group of diseases. The present study attempts to concentrate on the most recent information on the epidemiology of uveitis and compare it with previous knowledge. METHODS An extensive literature search was performed in the Medline database (PubMed) and included surveys completed until 2015. Articles that reported prevalence and incidence were studied. References cited in the articles were also studied. RESULTS The incidence and prevalence of uveitis differs based on age, anatomic location of the inflammatory process (anterior, intermediate, posterior uveitis, panuveitis), gender, histopathology (granulomatous, non-granulomatous), type of inflammatory process (acute, chronic, recurrent), and etiology (infectious, non-infectious). Prevalence differs by geographic location. Idiopathic anterior uveitis is the most common form of uveitis in the community. Infectious causes are common (30-60%) in the developing countries. Herpes and toxoplasmosis are the leading infectious causes of uveitis. Non-infectious uveitic conditions are generally more common in the developed world. An increase in the prevalence of infectious etiologies, including tuberculosis and syphilis, has been seen in developed countries. Introduction of new treatment options has also changed patterns of disease. CONCLUSIONS Introduction of new uveitis entities, changes in the incidence of already known disease and increased availability of diagnostic testing have all altered the epidemiology of uveitis in recent years. Knowledge of regional patterns of disease is essential. A more detailed classification of uveitis with the establishment of uniform diagnostic criteria and prospective population based studies would certainly benefit epidemiologic research and clinical practice.
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Affiliation(s)
- Theodora Tsirouki
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | - Anna Dastiridou
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | | | - Ourania Tounakaki
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | - Irini Brazitikou
- b 2nd Department of Ophthalmology , Papageorgiou Hospital , Thessaloniki , Greece
| | | | - Sofia Androudi
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
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Chen SC, Chuang CT, Chu MY, Sheu SJ. Patterns and Etiologies of Uveitis at a Tertiary Referral Center in Taiwan. Ocul Immunol Inflamm 2016; 25:S31-S38. [PMID: 27463023 DOI: 10.1080/09273948.2016.1189577] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To analyze the patterns and etiologies of uveitis at a tertiary referral center in Taiwan. METHODS This retrospective chart review of uveitis patients from January 2001 to December 2014 updates a previous study a decade ago (2003). RESULTS We identified 450 patients, among whom anterior uveitis was most common, followed by panuveitis, posterior uveitis, and intermediate uveitis. A specific diagnosis was identified in 331 patients. In 73 infectious uveitis cases, herpetic anterior uveitis was the leading cause, followed by endogenous bacterial endophthalmitis and acute retinal necrosis. In 258 non-infectious uveitis cases, HLA-B27-associated uveitis was most commonly seen, followed by Vogt-Koyanagi-Harada disease and Posner-Schlossman syndrome. Compared with our previous study, we found more viral infection and sarcoidosis but fewer cases of Behçet disease, tuberculosis, and toxoplasmosis. CONCLUSIONS Our results provide useful information about the patterns and etiologies of uveitis in a selected population in Taiwan.
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Affiliation(s)
- Shih-Chou Chen
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan and
| | - Chiu-Tung Chuang
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan and
| | - Ming-Ying Chu
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan and
| | - Shwu-Jiuan Sheu
- a Department of Ophthalmology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan and.,b School of Medicine , National Yang-Ming University , Taipei , Taiwan
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56
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Siak J, Jansen A, Waduthantri S, Teoh CS, Jap A, Chee SP. The Pattern of Uveitis among Chinese, Malays, and Indians in Singapore. Ocul Immunol Inflamm 2016; 25:S81-S93. [DOI: 10.1080/09273948.2016.1188968] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jay Siak
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Anne Jansen
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | | | - Chin-Sheng Teoh
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Aliza Jap
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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57
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Kee AR, Gonzalez-Lopez JJ, Al-Hity A, Gupta B, Lee CS, Gunasekeran DV, Jayabalan N, Grant R, Kon OM, Gupta V, Westcott M, Pavesio C, Agrawal R. Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis. Surv Ophthalmol 2016; 61:628-53. [PMID: 26970263 DOI: 10.1016/j.survophthal.2016.03.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 03/01/2016] [Indexed: 02/01/2023]
Abstract
Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of anti-tubercular therapy (ATT) in patients with intraocular tuberculosis and factors associated with favorable outcome. Twenty-eight studies are included in this review, with a total of 1,917 patients. Nonrecurrence of inflammation was observed in pooled estimate of 84% of ATT-treated patients (95% CI 79-89). There was minimal difference in the outcome between patients treated with ATT alone (85% successful outcome; 95% CI 25-100) and those with concomitant systemic corticosteroid (82%; 95% CI 73-90). The use of ATT may be of benefit to patients with suspected intraocular tuberculosis; however, this conclusion is limited by the lack of control group analysis and standardized recruitment and treatment protocols. We propose further prospective studies to better establish the efficacy of ATT and ascertain the factors associated with favorable treatment outcomes.
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Affiliation(s)
- Ae Ra Kee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Aws Al-Hity
- Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Bhaskar Gupta
- Royal Berkshire Hospitals NHS Foundation Trust, Reading, UK; Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | | | - Nirmal Jayabalan
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, Singapore
| | - Robert Grant
- Kingston and St George's University of London, Kingston, UK
| | - Onn Min Kon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vishali Gupta
- Advance Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mark Westcott
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; School of Materials Science & Engineering, Nanyang Technological University, Singapore, Singapore; Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
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Tuberculous Panophthalmitis with Lymphadenitis and Central Nervous System Tuberculoma. Case Rep Infect Dis 2016; 2016:6785382. [PMID: 27051539 PMCID: PMC4804051 DOI: 10.1155/2016/6785382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis (TB) is a serious infectious disease that spreads globally. The ocular manifestations of TB are uncommon and diverse. TB panophthalmitis has been rarely reported. Here, we described a 38-year-old Thai man presenting with panophthalmitis of the right eye. Further investigation showed that he had concurrent TB lymphadenitis and central nervous system (CNS) tuberculoma, as well as HIV infection, with a CD4 cell count of 153 cells/mm3. Despite the initial response to antituberculous agents, the disease had subsequently progressed and enucleation was required. The pathological examination revealed acute suppurative granulomatous panophthalmitis with retinal detachment. Further staining demonstrated acid-fast bacilli in the tissue. Colonies of Mycobacterium tuberculosis were obtained from tissue culture. He was treated with antiretroviral agents for HIV infection and 12 months of antituberculous agents. Clinicians should be aware of the possibility of TB in the differential diagnosis of endophthalmitis and panophthalmitis, especially in regions where TB is endemic.
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Al Dhibi HA, Al Shamsi HN, Al-Mahmood AM, Al Taweel HM, Al Shamrani MA, Arevalo JF, Gupta V, The KKESH Uveitis Survey Study Group. Patterns of Uveitis in a Tertiary Care Referral Institute in Saudi Arabia. Ocul Immunol Inflamm 2016; 25:388-395. [DOI: 10.3109/09273948.2015.1133836] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hassan A. Al Dhibi
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hanan N. Al Shamsi
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ammar M. Al-Mahmood
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hassan M. Al Taweel
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed A. Al Shamrani
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - J. Fernando Arevalo
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vishali Gupta
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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Du L, Kijlstra A, Yang P. Vogt-Koyanagi-Harada disease: Novel insights into pathophysiology, diagnosis and treatment. Prog Retin Eye Res 2016; 52:84-111. [PMID: 26875727 DOI: 10.1016/j.preteyeres.2016.02.002] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
Abstract
Vogt-Koyanagi-Harada (VKH) disease is one of the major vision-threatening diseases in certain populations, such as Asians, native Americans, Hispanics and Middle Easterners. It is characterized by bilateral uveitis that is frequently associated with neurological (meningeal), auditory, and integumentary manifestations. Although the etiology and pathogenesis of VKH disease need to be further elucidated, it is widely accepted that the clinical manifestations are caused by an autoimmune response directed against melanin associated antigens in the target organs, i.e. the eye, inner ear, meninges and skin. In the past decades, accumulating evidence has shown that genetic factors, including VKH disease specific risk factors (HLA-DR4) and general risk factors for immune mediated diseases (IL-23R), dysfunction of immune responses, including the innate and adaptive immune system and environmental triggering factors are all involved in the development of VKH disease. Clinically, the criteria of diagnosis for VKH disease have been further improved by the employment of novel imaging techniques for the eye. For the treatment, early and adequate corticosteroids are still the mainstream regime for the disease. However, immunosuppressive and biological agents have shown benefit for the treatment of VKH disease, especially for those patients not responding to corticosteroids. This review is focused on our current knowledge of VKH disease, especially for the diagnosis, pathogenesis (genetic factors and immune mechanisms), ancillary tests and treatment. A better understanding of the role of microbiome composition, genetic basis and ongoing immune processes along with the development of novel biomarkers and objective quantitative assays to monitor intraocular inflammation are needed to improve current management of VKH patients.
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Affiliation(s)
- Liping Du
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, Limburg, The Netherlands; Wageningen UR Livestock Research, Wageningen, The Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China.
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Abstract
The World Health Organization currently estimates that nearly two billion people, or one-third of the world’s population, are infected by tuberculosis, and that roughly 10% of the infected people are symptomatic. Tuberculosis affects the lungs in 80% of patients, while in the remaining 20% the disease may affect other organs, including the eye. Uveitis can be seen concurrently with tuberculosis, but a direct association is difficult to prove. Ocular tuberculosis is usually not associated with clinical evidence of pulmonary tuberculosis, as up to 60% of extrapulmonary tuberculosis patients may not have pulmonary disease. The diagnosis of tuberculous uveitis is often problematic and in nearly all reported cases, the diagnosis was only presumptive. Tuberculous uveitis is a great mimicker of various uveitis entities and it can be considered in the differential diagnosis of any type of intraocular inflammation. It is still unknown if ocular manifestations result from a direct mycobacterium infection or hypersensitivity reaction and this is reflected on the management of tuberculous uveitis. Prevalence of tuberculosis as an etiology of uveitis may reach up to 10% in endemic areas. Tuberculous uveitis is a vision-threatening disease that inevitably leads to blindness if not properly diagnosed and treated. The aim of this review is to illustrate the various clinical features and management of presumed tuberculous uveitis. The current review focuses on the diagnostic criteria, significance of tuberculin skin test, and use of systemic corticosteroids in the management of tuberculous uveitis as recommended in recent publications.
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Affiliation(s)
- Faiz I Shakarchi
- Ibn Al-Haetham Teaching Eye Hospital, Al-Mustansiriya University, Baghdad, Iraq ; Department of Opthalmology, Medical College, Al-Mustansiriya University, Baghdad, Iraq
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Venkatesh P, Gogia V, Shah B, Gupta S, Sagar P, Garg S. Patterns of uveitis at the Apex Institute for Eye Care in India: Results from a prospectively enrolled patient data base (2011–2013). Int Ophthalmol 2015; 36:365-72. [DOI: 10.1007/s10792-015-0128-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
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Llorenç V, Mesquida M, Sainz de la Maza M, Keller J, Molins B, Espinosa G, Hernandez MV, Gonzalez-Martín J, Adán A. Epidemiology of uveitis in a Western urban multiethnic population. The challenge of globalization. Acta Ophthalmol 2015; 93:561-7. [PMID: 25683136 DOI: 10.1111/aos.12675] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 01/01/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the anatomical pattern and etiological spectrum of uveitis in an urban multi-ethnic population from Barcelona, Spain. General and specific epidemiological data for the most prevalent aetiologies are also calculated. METHODS A cross-sectional study of consecutive uveitis cases was performed between 1 January 2009 and 31 December 2012. Exogenous endophthalmitis, surgery-related, post-traumatic and toxic uveitis along with masquerade syndromes were excluded. Anatomical (Standard Uveitis Nomenclature criteria) and aetiological patterns (by tailored tests), age, sex, geographical origin and laterality were analysed. Mean incidence and prevalence were calculated for a mid-period reference population. RESULTS From 1022 patients included, 52% were anterior uveitis (AU), 23% posterior, 15% panuveitis and 9% intermediate uveitis. Aetiologically, 26% were unclassifiable, 29% infectious, 25% associated with systemic immune diseases, and 20% corresponded to ocular-specific syndromes. Among classified causes, herpesvirus (12%), toxoplasma (7%), Behçet's disease (BD) (5%), HLA-B27-isolated AU (5%), ankylosing spondylitis (5%), tuberculosis-related uveitis (TRU) (5%), birdshot chorioretinopathy (3%) and sarcoidosis (3%) were the most frequent. Non-Spanish origin was recorded in 22%, with 47% of Vogt-Koyanagi-Harada and 36% of toxoplasma cases coming from South America, 10% of BD and 11% of TRU from Africa and 24% of TRU cases from Asia. A mean annual incidence of 51.91 cases/100,000 inhabitants was found for the referral population. CONCLUSION In our referral area, 74% of the uveitis cases can be correctly classified. A large myriad of uveitis aetiologies with a strong geographical origin burden are found in Western urban multi-ethnic populations.
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Affiliation(s)
- Victor Llorenç
- Clínic Institute of Ophthalmology (ICOF); Hospital Clinic of Barcelona; Barcelona Spain
| | - Marina Mesquida
- Clínic Institute of Ophthalmology (ICOF); Hospital Clinic of Barcelona; Barcelona Spain
| | | | - Johannes Keller
- Clínic Institute of Ophthalmology (ICOF); Hospital Clinic of Barcelona; Barcelona Spain
| | - Blanca Molins
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS); Hospital Clínic of Barcelona; Barcelona Spain
| | - Gerard Espinosa
- Department of Autoimmune & Systemic Diseases (ICM); Hospital Clinic of Barcelona; Barcelona Spain
| | | | - Julian Gonzalez-Martín
- Department of Clinical Microbiology (CDB-CRESIB).; Hospital Clinic of Barcelona; Barcelona Spain
| | - Alfredo Adán
- Clínic Institute of Ophthalmology (ICOF); Hospital Clinic of Barcelona; Barcelona Spain
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Engelhard SB, Haddad Z, Bajwa A, Patrie J, Xin W, Reddy AK. Infectious uveitis in Virginia. Clin Ophthalmol 2015; 9:1589-94. [PMID: 26355608 PMCID: PMC4559241 DOI: 10.2147/opth.s86578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To report the causes, clinical features, and outcomes of infectious uveitis in patients managed in a mid-Atlantic tertiary care center. METHODS Retrospective, observational study of infectious uveitis patients seen at the University of Virginia from 1984 to 2014. RESULTS Seventy-seven of 491 patients (15.7%) were diagnosed with infectious uveitis (mean age 58 years, 71.4% female, 76.6% Caucasian). The mean follow-up was 5 years. Anterior uveitis was the most common anatomic classification (39 patients, 50.6%) followed by panuveitis (20 patients, 26.0%) and posterior uveitis (18 patients, 23.4%). The most common infectious etiology was herpetic anterior uveitis (37 patients, 48.1%) followed by toxoplasma uveitis (14 patients, 18.2%). The most prevalent viral pathogen was varicella-zoster virus (21 patients, 27.3%) followed by herpes simplex virus (20 patients, 26.0%). Acute retinal necrosis (ARN) was diagnosed in 14 patients (18.2%). Aqueous humor yielded an etiologic diagnosis in seven (50%) of ARN patients, four of whom tested positive for cytomegalovirus and three for varicella-zoster virus. On presentation, 43 patients (55.8%) had a visual acuity (VA) better than 20/40 and 17 (22.1%) had a VA worse than 20/200. VA at the final follow-up was better than 20/40 in 39 patients (50.6%) and worse than 20/200 in 22 patients (28.6%). In all, 16 (20.8%) and 10 (13.0%) patients required cataract and vitrectomy surgery, respectively. A total of 14 patients (18.2%) were on glaucoma topical treatment and four (5.2%) required glaucoma surgery. CONCLUSION The most common type of infectious uveitis seen over the study period was herpetic anterior uveitis secondary to varicella-zoster virus or herpes simplex virus, found to be most prevalent in patients over 60 years of age. This finding is comparable to other American epidemiologic studies. Ocular toxoplasmosis and ARN were also common causes of infectious uveitis. In all, 50.6% of patients had a VA better than 20/40 at the final follow-up visit, indicating the importance of prompt referral and appropriate treatment.
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Affiliation(s)
| | - Zeina Haddad
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Asima Bajwa
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Wenjun Xin
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Ashvini K Reddy
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
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Abdulaal MR, Abiad BH, Hamam RN. Uveitis in the Aging Eye: Incidence, Patterns, and Differential Diagnosis. J Ophthalmol 2015; 2015:509456. [PMID: 26090218 PMCID: PMC4452188 DOI: 10.1155/2015/509456] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/27/2015] [Indexed: 11/17/2022] Open
Abstract
Uveitis is a vision threatening inflammation of the eye that carries considerable morbidity. It is responsible for 10% of legal blindness in the United States and up to 25% in the developing world. Uveitis in patients more than 60 years of age is less common. The aging body has a changing response of the immune system, which might reflect a different pattern of uveitis in the elderly population. In this paper we review the incidence and patterns of uveitis in the elderly as reported in the literature and discuss changes with time. We also delineate a thorough differential diagnosis of de novo uveitis in the elderly.
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Affiliation(s)
- Marwan R. Abdulaal
- Department of Ophthalmology, American University of Beirut Medical Center, P.O. Box 11-0236/D41, Riad El Solh, Beirut 11072020, Lebanon
| | - Bachir H. Abiad
- Department of Ophthalmology, American University of Beirut Medical Center, P.O. Box 11-0236/D41, Riad El Solh, Beirut 11072020, Lebanon
| | - Rola N. Hamam
- Department of Ophthalmology, American University of Beirut Medical Center, P.O. Box 11-0236/D41, Riad El Solh, Beirut 11072020, Lebanon
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Untreated Active Tuberculosis in Pregnancy with Intraocular Dissemination: A Case Report and Review of the Literature. Case Rep Pulmonol 2015; 2015:370462. [PMID: 26693374 PMCID: PMC4674577 DOI: 10.1155/2015/370462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/04/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Tuberculosis (TB) is a disease that affects hundreds of millions of people across the world. However, the incidence in developed countries has decreased over the past decades causing physicians to become unfamiliar with its unspecific symptoms. Pregnant individuals are especially difficult because many symptoms of active TB can mimic normal physiological changes of pregnancy. We present a case report of a 26-year-old multiparous woman, G4P3003, at 38-week gestation with a history of positive PPD who emigrated from Ghana 6 years ago. She came to the hospital with an initial complaint of suprapubic pain, pressure, and possible leakage of amniotic fluid for the past week. Patient also complained of a productive cough for the past 3 to 4 months with a decrease in vision occurring with the start of pregnancy. Visual acuity was worse than 20/200 in both eyes. Definitive diagnosis of active TB was delayed due to patient refusal of chest X-ray. Fortunately, delay in diagnosis was minimized since patient delivered within 24 hours of admission. Active TB was confirmed with intraocular dissemination. Patient had optic atrophy OS (left eye) and papillitis, choroiditis, and uveitis OD (right eye) due to TB infiltration. Fetus was asymptomatic and anti-TB therapy was started for both patients.
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Barry RJ, Nguyen QD, Lee RW, Murray PI, Denniston AK. Pharmacotherapy for uveitis: current management and emerging therapy. Clin Ophthalmol 2014; 8:1891-911. [PMID: 25284976 PMCID: PMC4181632 DOI: 10.2147/opth.s47778] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Uveitis, a group of conditions characterized by intraocular inflammation, is a major cause of sight loss in the working population. Most uveitis seen in Western countries is noninfectious and appears to be autoimmune or autoinflammatory in nature, requiring treatment with immunosuppressive and/or anti-inflammatory drugs. In this educational review, we outline the ideal characteristics of drugs for uveitis and review the data to support the use of current and emerging therapies in this context. It is crucial that we continue to develop new therapies for use in uveitis that aim to suppress disease activity, prevent accumulation of damage, and preserve visual function for patients with the minimum possible side effects.
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Affiliation(s)
- Robert J Barry
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK
| | - Quan Dong Nguyen
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard W Lee
- Inflammation and Immunotherapy Theme, National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK ; Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Khochtali S, Gargouri S, Abroug N, Ksiaa I, Attia S, Sellami D, Feki J, Khairallah M. The spectrum of presumed tubercular uveitis in Tunisia, North Africa. Int Ophthalmol 2014; 35:663-71. [DOI: 10.1007/s10792-014-9992-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 12/19/2022]
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Mi H, Ho SL, Lim WK, Wong EP, Teoh SC. Trends in Patterns of Posterior Uveitis and Panuveitis in a Tertiary Institution in Singapore. Ocul Immunol Inflamm 2014; 23:329-338. [DOI: 10.3109/09273948.2014.946148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Mao Y, Peng XY, You QS, Wang H, Zhao M, Jonas JB. Tuberculous uveitis in China. Acta Ophthalmol 2014; 92:e393-7. [PMID: 24479692 DOI: 10.1111/aos.12351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/07/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess tuberculous uveitis in Chinese patients. METHODS The hospital-based observational case series study included patients who attended a third-referral hospital and presented with chronic and recurrent uveitis without primarily detected aetiology. The patients underwent the tuberculin skin test (TST) and/or interferon gamma release test (IGRA). Patients with positive test results received standard antituberculous therapy. Patients who responded to the therapy and did not show recurrence of uveitis in the follow-up period were diagnosed as tuberculous uveitis and formed the study group. The remaining patients were diagnosed as non-tuberculous uveitis and formed the control group. The clinical characteristics were compared between both groups. RESULTS The study group with tuberculous uveitis included 46 patients and the non-tuberculous group 38 patients. Multifocal choroiditis [n = 9 (20%) versus n = 1(3%); p = 0.04] and retinal vasculitis [n = 25(54%) versus 8 = (21.1%); p = 0.002] were significantly more common in the study group. Of 25 patients with retinal vasculitis in the study group, 11 patients (44%) additionally showed choroiditis lesions, compared with only one (13%) of eight patients in the control group (p = 0.01). In multivariate regression analysis, multifocal choroiditis [odds ratio (OR): 32.1], choroidal granuloma (OR: 21.4) and retinal vasculitis (OR: 11.2) were independent predictors of tubercular uveitis. CONCLUSIONS About 50% of a group of 84 patients with primarily unexplained chronic posterior uveitis had tuberculosis and showed multifocal choroiditis, choroidal granuloma and retinal vasculitis. These features had a high predictive value for the diagnosis of tuberculous uveitis. Tuberculosis is an important part in the differential diagnosis of unexplained uveitis.
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Affiliation(s)
- Yu Mao
- Beijing Institute of Ophthalmology; Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Xiao Yan Peng
- Beijing Institute of Ophthalmology; Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology; Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Hong Wang
- Department of Ophthalmology; Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Meng Zhao
- Department of Ophthalmology; Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Jost B. Jonas
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg; Mannheim Germany
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Prospective head-to-head study comparing 2 commercial interferon gamma release assays for the diagnosis of tuberculous uveitis. Am J Ophthalmol 2014; 157:1306-14; 1314.e1-4. [PMID: 24508163 DOI: 10.1016/j.ajo.2014.01.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE To perform a head-to-head comparison of 2 commercially available interferon-gamma release assays, QuantiFERON-TB Gold In-Tube (Cellestis, Chadstone, Victoria, Australia) and T-SPOT.TB (Oxford Immunotech, Abingdon, Oxfordshire, UK), in the diagnosis of tuberculous uveitis. DESIGN Prospective cohort to study diagnostic accuracy. METHODS We recruited consecutive new patients who presented with uveitis to a tertiary institution over a 2-year period. All patients underwent complete ocular examination and systemic evaluation, including T-SPOT.TB, QuantiFERON-TB Gold In-Tube, and tuberculin skin test. Patients were followed-up for a minimum of 1 year after completion of antituberculous therapy where indicated. The main outcome measures were the sensitivity, specificity and accuracy of each test, estimated using Bayesian latent class analysis (presented with 95% Bayesian credible intervals) (Crl). Prior information was obtained from published meta-analyses for diagnostic tests: QuantiFERON Gold In-Tube sensitivity (0.64, 0.59-0.69) and specificity (0.99, 0.99-1.00); T-SPOT. tuberculosis sensitivity (0.50, 0.33-0.67) and specificity (0.91, 0.88-0.93). RESULTS From our study in patients with uveitis, QuantiFERON-TB Gold In-Tube was more specific but slightly less sensitive (sensitivity: 0.64, 0.60-0.69; specificity: 0.995, 0.988-0.999) than T-SPOT.TB (sensitivity: 0.67, 0.60-0.74; specificity: 0.91, 0.88-0.93). However, QuantiFERON Gold In-Tube was significantly more accurate in identifying true-positive tuberculous uveitis cases than was T-SPOT.TB among discordant cases (QuantiFERON Gold In-Tube positive 98% vs T-SPOT.TB positive 76%; ratio 1.28, 95% Crl: 1.11-1.72, ie, 95% Crl >1.0, statistically significant). CONCLUSION Based on statistical decision theory, our head-to-head study suggests that QuantiFERON-TB Gold In-Tube is the first-line test that should be performed in preference to T-SPOT.TB (and the tuberculin skin test) for diagnosing tuberculous uveitis.
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Lim SJ, Lee SE, Kim SH, Hong SH, You YS, Kwon OW, Kim HS. Prevalence ofToxoplasma gondiiandToxocara canisamong Patients with Uveitis. Ocul Immunol Inflamm 2014; 22:360-6. [DOI: 10.3109/09273948.2013.841491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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73
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Kianersi F, Mohammadi Z, Ghanbari H, Ghoreyshi SM, Karimzadeh H, Soheilian M. Clinical Patterns of Uveitis in an Iranian Tertiary Eye-care Center. Ocul Immunol Inflamm 2014; 23:278-282. [DOI: 10.3109/09273948.2014.902474] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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74
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Mi H, Ho SL, Lim WK, Wong EPY, Teoh SC. Trends in patterns of intermediate uveitis in a tertiary institution in Singapore. PLoS One 2014; 9:e91533. [PMID: 24626440 PMCID: PMC3953493 DOI: 10.1371/journal.pone.0091533] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/13/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose The study aims to describe the characteristics and etiologic causes of intermediate uveitis (IU) patients seen by a tertiary eye center in Singapore over 8 years. Methods This was a retrospective analysis of the clinical records of consecutive new cases of IU that presented to the uveitis subspecialty clinic from 2004–2011 at Tan Tock Seng Hospital. Data collected included demographics, clinical and laboratory findings. Diagnoses were based on standardized clinical history, ophthalmological examination and investigations. Results There were 66 new cases of IU, comprising 5.7% of 1168 new uveitis patients. The median age of diagnosis was 40 years (mean 39.4±15.9), with largest subgroup of the patients in the age group of 41–60 years (36.4%). The majority was Chinese (57.6%), followed by Asian Indians (18.2%) and Malays (16.7%). The ethnicity distribution was dissimilar to our ethnic distribution in Singapore (p<0.001) with an increased incidence of IU in the Asian Indian population. Most were idiopathic (59.1%) in etiology, followed by tuberculosis (TB) (15.2%). Ocular complications developed in 21 patients (31.8%), with cystoid macular edema (CME) being the commonest (28.8%). Severe vitritis occurred in 9.1% of patients, and was significantly associated with TB-associated IU (p<0.001). There was a downward trend for the incidence of the proportion of IU patients over the total uveitis patients (p = 0.021), with Spearman’s rho of −0.786. Conclusions Despite the downward trend, TB-associated IU was still of higher prevalence compared to less endemic areas, emphasizing the need for increased TB surveillance. A high index of suspicion for TB-associated IU is required in patients with severe vitritis. Comparisons with other countries revealed disparities in the IU etiologies, indicating possible geographical differences. Prevalence of known immune-mediated etiologies of IU is less compared to the western population. Our study also suggests a probable predisposition of the Singapore local Indian population for IU.
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Affiliation(s)
- Helen Mi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su L. Ho
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee K. Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Eagle Eye Centre, Singapore, Singapore
| | - Elizabeth P. Y. Wong
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Stephen C. Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Eagle Eye Centre, Singapore, Singapore
- * E-mail:
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Gender differences in vogt-koyanagi-harada disease and sympathetic ophthalmia. J Ophthalmol 2014; 2014:157803. [PMID: 24734166 PMCID: PMC3964687 DOI: 10.1155/2014/157803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/13/2014] [Accepted: 01/31/2014] [Indexed: 12/21/2022] Open
Abstract
Vogt-Koyanagi-Harada disease (VKH) and sympathetic ophthalmia (SO) are types of T-cell mediated autoimmune granulomatous uveitis. Although the two diseases share common clinical features, they have certain differences in gender predilections. VKH classically has been reported as more prevalent in females than males, yet some studies in Japan and China have not found differences in gender prevalence. Male patients have a higher risk of chorioretinal degeneration, vitiligo, and worse prognosis. Conversely, the changing levels of estrogen/progesterone during pregnancy and the menstrual cycle as well as higher levels of TGF-β show a protective role in females. Potential causes of female predilection for VKH are associated with HLA-DR and HLA-DQ alleles. SO, a bilateral granulomatous uveitis, occurs in the context of one eye after a penetrating injury due to trauma or surgery. In contrast to the female dominance in VKH, males are more frequently affected by SO due to a higher incidence of ocular injury, especially during wartime. However, no gender predilection of SO has been reported in postsurgical cases. No clinically different manifestations are revealed between males and females in SO secondary to either ocular trauma or surgery. The potential causes of the gender difference may provide hints on future treatment and disease evaluation.
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Hong BK, Khanamiri HN, Bababeygy SR, Rao NA. The utility of routine tuberculosis screening in county hospital patients with uveitis. Br J Ophthalmol 2014; 98:1091-5. [PMID: 24489378 DOI: 10.1136/bjophthalmol-2013-303937] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM To evaluate the utility of tuberculosis (TB) screening in diagnosing ocular TB in uveitis patients in a government-funded hospital. METHODS The charts of 142 consecutive patients seen during August 2011-July 2012 at the Los Angeles County Hospital uveitis clinic were reviewed for manifestation/laterality of uveitis, purified protein derivative (PPD) test results, interferon γ release assay, chest x-ray, birthplace, treatment history and diagnosis. 'Presumed TB-uveitis' was diagnosed when patients had positive TB screening and favourable response to anti-TB therapy, and definite ocular TB when Mycobacterium tuberculosis' presence was demonstrated. Post-test probabilities were determined. RESULTS TB screening was positive in 21.1%. Six patients were diagnosed with TB-related uveitis: one definite, four presumed and one systemic TB with uveitis. With regard to PPD positivity, being foreign-born was the only statistically significant factor with OR of 2.26 (95% CI 1.01 to 5.13; p<0.01) if born in Mexico and 4.90 (95% CI 1.74 to 13.83; p<0.01) if born in other foreign countries. The post-test probabilities of a positive PPD in a uveitis patient showed a 17.2% (overall) or 30.3% (foreign-born patients) chance of ocular TB. CONCLUSIONS PPD skin test plays an important role in the diagnosis of TB-associated uveitis in high-risk groups, such as immigrants from TB endemic regions.
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Affiliation(s)
- Bryan Kun Hong
- Doheny Eye Institute, Los Angeles, California, USA Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Hossein Nazari Khanamiri
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Simon R Bababeygy
- Doheny Eye Institute, Los Angeles, California, USA Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Narsing A Rao
- Doheny Eye Institute, Los Angeles, California, USA Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Xu M, Wang C, Tian Y, Kijlstra A, Yang P. Inhibition of Proinflammatory Cytokine by IL-25 in Vogt-Koyanagi-Harada Syndrome. Ocul Immunol Inflamm 2013; 22:294-9. [DOI: 10.3109/09273948.2013.854391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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81
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Tuberculosis of the eye in Italy: a forgotten extrapulmonary localization. Infection 2013; 42:335-42. [DOI: 10.1007/s15010-013-0554-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
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Lim SJ, Lee SE, Kim SH, Hong SH, You YS, Kwon OW, Kim HS. Prevalence of Toxoplasma gondii and Toxocara canis among Patients with Uveitis. Ocul Immunol Inflamm 2013; 23:111-7. [PMID: 24131311 DOI: 10.3109/09273948.2013.839798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the prevalence of Toxoplasma gondii and Toxocara canis in patients with uveitis. METHODS Patients with uveitis were examined. Serum antibodies to T. gondii and T. canis were tested by using the enzyme-linked immunosorbent assay. Polymerase chain reaction (PCR) was done using blood and aqueous humor (AH). RESULTS Ninety-eight patients were enrolled. Mean age was 43.5 ± 13.2 years. Six patients were seropositive for T. gondii with the following pattern: anterior uveitis, 1; posterior uveitis with retinitis, 2; pan uveitis, 2. One patient had a positive PCR result for T. gondii in AH, who showed panuveitis. Twenty-three patients were positive to serum IgG for T. canis with the following clinical manifestation: granuloma, 6; pigmented scar, 3; vitritis, 6--but none were PCR positive. CONCLUSIONS T. gondii and T. canis are still important causes of uveitis. Ocular toxocariasis is not an uncommon cause of uveitis, even in adults.
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Affiliation(s)
- Su Jin Lim
- The Retina Center of Nune Eye Hospital , Seoul , Korea
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Vos AG, Wassenberg MWM, de Hoog J, Oosterheert JJ. Diagnosis and treatment of tuberculous uveitis in a low endemic setting. Int J Infect Dis 2013; 17:e993-9. [PMID: 23706496 DOI: 10.1016/j.ijid.2013.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 02/04/2013] [Accepted: 03/18/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine factors associated with the diagnosis of tuberculous uveitis and the response to anti-tuberculous treatment (ATT). METHODS A retrospective case study was performed at the University Medical Centre Utrecht between October 2007 and December 2009. Patients with possible tuberculous uveitis (TBU) were selected from all patients with an unexplained uveitis. Demographics, ethnicity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tuberculin skin test (TST), QuantiFERON (QFT) test, and ocular findings were evaluated. An interdisciplinary panel discussed if there was a presumed TBU and decided to start treatment. When there was a decrease in intraocular cell count and/or improvement in visual acuity after ATT, the confirmation of presumed TBU was made. RESULTS Of 585 patients with unexplained uveitis, 66 (11.3%) fulfilled the definition of possible TBU. Ten (15.4%) patients were regarded as having presumed TBU and received ATT. All of them had latent tuberculosis (LTB). The ocular situation improved in seven patients (70%). A history of TB contact, abnormalities on chest radiology, and extraocular manifestations of TB were associated with a good response to ATT in the case of presumed tuberculous uveitis. CONCLUSIONS Tuberculous uveitis remains difficult to diagnose. No clearly correlating factors that predicted the response to ATT, including ocular parameters, could be identified.
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Affiliation(s)
- A G Vos
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, The Netherlands.
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Review on the worldwide epidemiology of uveitis. Eur J Ophthalmol 2013; 23:705-17. [PMID: 23661536 DOI: 10.5301/ejo.5000278] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE We describe the worldwide epidemiology of uveitis through a systematic literature review.
METHODS Data obtained from the most relevant studies published until November 2012 were reported.
RESULTS Results of our research were structured in sections about the epidemiology of uveitis by anatomical location of inflammation (anterior, intermediate, posterior, and panuveitis), type of inflammation (infectious and noninfectious), and by age (children and elderly). Difficulties encountered analyzing the different epidemiologic studies were discussed in a dedicated section.
CONCLUSIONS Limited information is available regarding the epidemiology of uveitis. Worldwide epidemiologic studies may help the clinician in the management of patients with inflammatory ocular diseases, enabling the comparison of different uveitis entities.
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Tan WJ, Poh EW, Wong PY, Ho SL, Lim WK, Teoh SC. Trends in Patterns of Anterior Uveitis in a Tertiary Institution in Singapore. Ocul Immunol Inflamm 2013; 21:270-5. [DOI: 10.3109/09273948.2013.779725] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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86
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Khairallah M, Accorinti M, Muccioli C, Kahloun R, Kempen JH. Epidemiology of Behçet disease. Ocul Immunol Inflamm 2013; 20:324-35. [PMID: 23030353 DOI: 10.3109/09273948.2012.723112] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Behçet disease (BD) is a multisystem inflammatory disorder that is an important cause of morbidity worldwide. BD is most common along the ancient "Silk Road" route in the Far East and Mediterranean basin. The eye is the most commonly involved organ in BD patients.The prototypical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Less commonly, BD may present in the form of conjunctivitis, conjunctival ulcers, keratitis, episcleritis, scleritis, and extraocular muscle paralysis. Uveitis in BD carries significant implications for the patient, because it is a chronic recurrent disease characterized by explosive attacks of severe inflammation that may cause significant, cumulative damage to the intraocular structures. This review summarizes the epidemiology of systemic and ocular clinical features of BD with particular focus on risk factors, clinical characteristics, complications, and prognosis of BD-associated uveitis.
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Affiliation(s)
- Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine and University of Monastir, Monastir, Tunisia.
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87
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Clinical characteristics of Vogt–Koyanagi–Harada syndrome in a tertiary medical centre in western region of Kingdom of Saudi Arabia. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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88
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Nazari Khanamiri H, Rao NA. Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis. Surv Ophthalmol 2013; 58:203-32. [PMID: 23541041 DOI: 10.1016/j.survophthal.2012.08.008] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 12/17/2022]
Abstract
Serpiginous choroiditis (SC) is a posterior uveitis displaying a geographic pattern of choroiditis, extending from the juxtapapillary choroid and intermittently spreading centrifugally. The choroiditis involves the overlying retinal pigment epithelium, and the outer retina. This intraocular inflammation typically involves both eyes in otherwise healthy, middle-aged individuals with no familial or ethnic predilection. Pathogenesis is unclear; based on limited histopathologic studies, however, favorable response to immunosuppressive agents, and the absence of association with systemic or local infectious or noninfectious diseases, an organ-specific autoimmune inflammation seems likely to be the underlying process. Patients, particularly from tuberculosis-endemic regions, may present with fundus changes simulating SC, but show evidence of active tuberculosis and/or the presence of mycobacterial DNA in the aqueous humor. This has been referred to as serpiginous-like choroiditis, but we prefer the description multifocal serpiginoid choroiditis (MSC). We present the distinguishing features of SC and infectious multifocal serpiginoid choroiditis simulating SC. The distinction is crucial to avoid unnecessarily treating SC with antimicrobial agents. Advances in diagnostic and imaging modalities can help differentiate SC from MSC. Novel local and systemic treatment approaches improve the outcome and preserve vision in SC.
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Affiliation(s)
- Hossein Nazari Khanamiri
- Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, USA
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89
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Sittivarakul W, Bhurayanontachai P, Ratanasukon M. Pattern of Uveitis in a University-based Referral Center in Southern Thailand. Ocul Immunol Inflamm 2013; 21:53-60. [DOI: 10.3109/09273948.2012.730651] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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90
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Chan CKM, Wu ZHY, Luk FOJ, Liu DTL, Fan AH, Lee VYW, Lai TYY. Clinical Characteristics of Intermediate Uveitis in Chinese Patients. Ocul Immunol Inflamm 2013; 21:71-6. [DOI: 10.3109/09273948.2012.736587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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91
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Cingu AK, Onal S, Urgancioglu M, Tugal-Tutkun I. Comparison of presenting features and three-year disease course in Turkish patients with Behçet uveitis who presented in the early 1990s and the early 2000s. Ocul Immunol Inflamm 2012; 20:423-8. [PMID: 23163330 DOI: 10.3109/09273948.2012.713159] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare Behçet uveitis patients who presented in the 1990s and 2000s. METHODS Records of 170 patients seen in 1990-1994 and 258 patients seen in 2000-2004 were reviewed. Presenting features were analyzed in the whole cohort. Uveitis attacks, vision, complications, and immunomodulatory treatment (IMT) were compared in patients with 3-year follow-up. RESULTS Posterior segment involvement was less common, visual acuity was better, and more patients received IMT before referral in the 2000s. Follow-up revealed no significant difference in number of uveitis attacks in the first 3 years. Less eyes lost useful vision, no patient became legally blind, and fewer severe ocular complications occurred in the 2000s. IMT was started within 3 months in more patients and interferon alfa-2a was used only in the latter study period. CONCLUSIONS The findings suggest a milder disease at referral, lower rate of severe complications, and a better 3-year visual outcome in patients who presented in the early 2000s.
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Affiliation(s)
- Abdullah Kursat Cingu
- Dicle University, Faculty of Medicine, Department of Ophthalmology, Diyarbakir, Turkey
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92
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93
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Llorenç Bellés V, Adán Civera A, Espinosa Garriga G, Cervera Segura R, González Martínez J, Pelegrín Colás L, Keller J, Rey Torrente A, Mesquida Febrer M. Caracterización de las uveítis diagnosticadas en un centro de referencia del área de Barcelona. Med Clin (Barc) 2012; 138:277-82. [DOI: 10.1016/j.medcli.2011.06.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/02/2011] [Accepted: 06/07/2011] [Indexed: 11/28/2022]
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94
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95
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Pathanapitoon K, Kongyai N, Sirirungsi W, de Groot-Mijnes JD, Leechanachai P, Choovuthayakorn J, Kunavisarut P, Rothova A. The diagnostic value of intraocular fluid analysis by polymerase chain reaction in Thai patients with uveitis. Trans R Soc Trop Med Hyg 2011; 105:650-4. [DOI: 10.1016/j.trstmh.2011.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 11/25/2022] Open
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96
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Understanding uveitis: The impact of research on visual outcomes. Prog Retin Eye Res 2011; 30:452-70. [DOI: 10.1016/j.preteyeres.2011.06.005] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 01/01/2023]
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98
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Abstract
Behçet's disease is a multisystem inflammatory disorder that is most common in countries along the ancient “Silk Road”. The eye is the most commonly involved vital organ in Behçet's patients and the typical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Uveitis is the initial manifestation of the disease in 10-15% of the patients. Anterior uveitis is always nongranulomatous. Diffuse vitritis, retinal infiltrates, sheathing of predominantly retinal veins, and occlusive vasculitis are the typical signs of posterior segment inflammation. Spontaneous resolution of acute inflammatory signs is a diagnostic feature. Fundus fluorescein angiography is the gold standard in monitoring inflammatory activity. Laser flare photometry is a useful noninvasive tool since flare readings correlate with fluorescein angiographic leakage. The most common complications are cataract, maculopathy, and optic atrophy. Male patients have a more severe disease course and worse visual prognosis. Immunomodulatory therapy is indicated in all patients with posterior segment involvement. Corticosteroids combined with azathioprine and/or cyclosporine is used initially. Biologic agents, including interferon alfa and infliximab, are used in resistant cases. Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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99
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M A, El-Asrar A, Abouammoh M, Al-Mezaine HS. Tuberculous uveitis. Middle East Afr J Ophthalmol 2011; 16:188-201. [PMID: 20404986 PMCID: PMC2855660 DOI: 10.4103/0974-9233.58421] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent years, ocular involvement due to TB has re-emerged. Tuberculous uveitis is a readily treatable disease and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patients with unexplained chronic uveitis and this will be influenced by the socio-economic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids resolves inflammation without recurrences after medical therapy.
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Affiliation(s)
- Ahmed M
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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100
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Choi DE, Birnbaum AD, Oh F, Tessler HH, Goldstein DA. Pediatric uveitis secondary to probable, presumed, and biopsy-proven sarcoidosis. J Pediatr Ophthalmol Strabismus 2011; 48:157-62. [PMID: 20506967 DOI: 10.3928/01913913-20100518-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 01/12/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe pediatric patients with uveitis diagnosed as having sarcoidosis. METHODS Medical records of pediatric patients evaluated between 1987 and 2008 were reviewed to identify those with ocular inflammation in whom a diagnosis of sarcoidosis was considered. A classification system including ocular findings and results of laboratory testing was devised and used to classify likelihood of sarcoidosis. RESULTS Four hundred sixty children younger than 17 years were evaluated. Based on the classification system designed, 13 patients (2.8%) had probable, presumed, or definite sarcoidosis. The mean age was 11.6 years (range: 5 to 16 years). Elevated angiotensin-converting enzyme was measured in 6 patients and lysozyme in 5 patients. Five of 12 patients in whom chest imaging was performed had signs of sarcoidosis. Anterior segment involvement was non-granulomatous more often than granulomatous. Seven patients had multifocal choroiditis and 4 patients had retinal periphlebitis. CONCLUSION Ocular sarcoidosis is uncommon in children, even at a tertiary referral center. Pulmonary involvement was detected in slightly less than half of the patients who had imaging, in contrast to previous reports of almost universal lung involvement in children 8 to 15 years old. The classification system of presumed, probable, and definite sarcoidosis presented may be useful in clinical practice.
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Affiliation(s)
- Daniel E Choi
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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