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Leong E, Cifuentes-González C, Hu Y W J, Perumal Samy R, Khairallah M, Rojas-Carabali W, Putera I, de-la-Torre A, Agrawal R. Clinical Insights: Antimicrobial Therapy for Infectious Uveitis. Ocul Immunol Inflamm 2024:1-21. [PMID: 38759216 DOI: 10.1080/09273948.2024.2345848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
Infectious uveitis is a major global cause of vision impairment. Despite the eye's immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection's etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis.
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Affiliation(s)
- Evangeline Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeremy Hu Y W
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ramar Perumal Samy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alejandra de-la-Torre
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Chawla R, Singh UB, Kumawat D, Venkatesh P. Presumed ocular tuberculosis - need for caution before considering anti-tubercular therapy. Eye (Lond) 2023; 37:3716-3717. [PMID: 37316712 PMCID: PMC10698026 DOI: 10.1038/s41433-023-02628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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3
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Baharani A, Reddy P RR, Patil PM. The Efficacy and Safety of Intravitreal Dexamethasone Implant as Anti-inflammatory Monotherapy in the Management of Tuberculosis-associated Intermediate Uveitis. Ocul Immunol Inflamm 2023; 31:1594-1602. [PMID: 34637663 DOI: 10.1080/09273948.2021.1986544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
AIM To study the long-term efficacy and safety of Ozurdex as anti-inflammatory monotherapy in the management of tuberculosis-associated intermediate uveitis (TBIU). METHODS Retrospective analysis of eyes with TBIU that received Ozurdex as anti-inflammatory monotherapy with a follow-up of at least 1 year. RESULTS 13 eyes (2 pseudophakic) of 11 patients were included. Mean BCVA improved from 0.65 to 0.11 at 3 months (p = .0005) and remained 0.11 at 1 year. Mean central foveal thickness improved from 452.87µ to 187.25µ at 3 months (p = .0009) and 184.62µ at 1 year in 8 eyes with CME. Mean vitreous haze improved from 2.38 to 0.11 at 3 months with no recurrences at 1 year. Mean IOP increased from 13.15mmHg to 15.53mmHg (p = .013) at 2 months and reduced to 12.46mmHg by 1 year. None required antiglaucoma medication. One eye underwent cataract surgery. The mean follow-up was 18.4 months. CONCLUSION Ozurdex is safe and efficacious in TBIU as anti-inflammatory monotherapy in conjunction with antitubercular therapy.
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Affiliation(s)
- Abhilasha Baharani
- Consultant Uvea Specialist, Neoretina Eyecare Institute, Hyderabad, India
| | - Raja Rami Reddy P
- Consultant Retina Specialist, Neoretina Eyecare Institute, Hyderabad, India
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Ireni S, Mooss VS, Kelgaonkar A, Babu K, Basu S. Tubercular Serpiginous-Like Choroiditis in Patients with Negative TB-Immunoreactivity Tests. Ocul Immunol Inflamm 2023:1-7. [PMID: 37769244 DOI: 10.1080/09273948.2023.2258399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Serpiginous-like choroiditis (SLC) denotes ocular tuberculosis (TB), in the presence of positive tuberculin skin test (TST) or interferon gamma release assay (IGRA). METHODS Retrospective review of SLC patients from a TB-endemic country, with negative TST and IGRA tests, but responsive to anti-TB therapy. RESULTS Fifteen patients (13 bilateral) with active SLC were included. Eleven (73.3%) patients had received corticosteroids ± immunosuppressive therapy prior to presentation. Chest radiographic abnormalities were found in four (26.7%) patients. We treated all patients with a combination of anti-TB therapy (ATT) and corticosteroids. Paradoxical worsening was noted in nine (60%) patients, complete resolution of lesions in 12 (80%), persistent inflammation (post-ATT) in one, while two were yet to complete ATT. None had recurrence after complete resolution of lesions (median follow-up of 71 weeks [range 15-676 weeks]). CONCLUSIONS TB-SLC may present with negative TST and IGRA tests but may still have clinical appearance, and treatment response, like test-positive disease.
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Affiliation(s)
- Sucheta Ireni
- Uveitis and Ocular Immunology, LV Prasad Eye Institute, Hyderabad, India
| | - Vidya S Mooss
- Department of Uveitis & Ocular Inflammation, Vittala International Institute of Ophthalmology & Prabha Eye Clinic and Research Center, Bangalore, India
| | - Anup Kelgaonkar
- Retina and Uveitis services, LV Prasad Eye Institute, Bhubaneswar, India
| | - Kalpana Babu
- Uveitis and Ocular Immunology, LV Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Uveitis and Ocular Immunology, LV Prasad Eye Institute, Hyderabad, India
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Putera I, Schrijver B, Ten Berge JCEM, Gupta V, La Distia Nora R, Agrawal R, van Hagen PM, Rombach SM, Dik WA. The immune response in tubercular uveitis and its implications for treatment: From anti-tubercular treatment to host-directed therapies. Prog Retin Eye Res 2023:101189. [PMID: 37236420 DOI: 10.1016/j.preteyeres.2023.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023]
Abstract
Tubercular uveitis (TB-uveitis) remains a conundrum in the uveitis field, which is mainly related to the diverse clinical phenotypes of TB-uveitis. Moreover, it remains difficult to differentiate whether Mycobacterium tuberculosis (Mtb) is present in the ocular tissues, elicits a heightened immune response without Mtb invasion in ocular tissues, or even induces an anti-retinal autoimmune response. Gaps in the immuno-pathological knowledge of TB-uveitis likely delay timely diagnosis and appropriate management. In the last decade, the immunopathophysiology of TB-uveitis and its clinical management, including experts' consensus to treat or not to treat certain conditions with anti-tubercular treatment (ATT), have been extensively investigated. In the meantime, research on TB treatment, in general, is shifting more toward host-directed therapies (HDT). Given the complexities of the host-Mtb interaction, enhancement of the host immune response is expected to boost the effectiveness of ATT and help overcome the rising burden of drug-resistant Mtb strains in the population. This review will summarize the current knowledge on the immunopathophysiology of TB-uveitis and recent advances in treatment modalities and outcomes of TB-uveitis, capturing results gathered from high- and low-burden TB countries with ATT as the mainstay of treatment. Moreover, we outline the recent progress of HDT development in the pulmonary TB field and discuss the possibility of its applicability to TB-uveitis. The concept of HDT might help direct future development of efficacious therapy for TB-uveitis, although more in-depth research on the immunoregulation of this disease is still necessary.
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Affiliation(s)
- Ikhwanuliman Putera
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Benjamin Schrijver
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Vishali Gupta
- Retina and Uvea Services, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rina La Distia Nora
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke NUS University, Singapore; Singapore Eye Research Institute, Singapore; Moorfields Eye Hospital, London, United Kingdom
| | - P Martin van Hagen
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S M Rombach
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Willem A Dik
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Gupta A. My tryst with academia - Reflections from an era gone by. Indian J Ophthalmol 2023; 71:1675-1680. [PMID: 37203016 PMCID: PMC10391421 DOI: 10.4103/ijo.ijo_865_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Amod Gupta
- Emeritus Professor, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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7
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Betzler BK, Putera I, Testi I, La Distia Nora R, Kempen J, Kon OM, Pavesio C, Gupta V, Agrawal R. Anti-tubercular therapy in the treatment of tubercular uveitis: A systematic review and meta-analysis. Surv Ophthalmol 2023; 68:241-256. [PMID: 36272559 DOI: 10.1016/j.survophthal.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
We quantitatively evaluated the efficacy of antitubercular therapy (ATT) in tubercular uveitis (TBU) patients. Main outcome measures include inflammation recurrence, inflammation reduction, complete resolution of inflammation, improved visual acuity (VA), ability to taper corticosteroids to < 10 mg/day without inflammatory progression, and use of adjunctive immunosuppressants while on ATT. This review is prospectively registered in PROSPERO (CRD42020206845). Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI:0.19-0.60) for TBU patients treated with ATT±corticosteroid versus no ATT. For TBU patients treated with ATT±corticosteroid, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation, and visual acuity improvement were 13% (n=310/2,216; 95%CI:9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI:51-78), respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI:78-99) of patients, 9% (n=121/1,376; 95%CI:6-13) of whom were administered concomitant immunosuppressive agents alongside ATT. We conclude that treatment of TBU with ATT±corticosteroid is associated with a high level of control or improvement of inflammation. More prospective studies with detailed reporting of ATT regimens, patient subgroups, and outcomes are required to better evaluate ATT effectiveness.
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Affiliation(s)
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Indonesia; Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Indonesia; Erasmus Medical Center, Rotterdam, The Netherlands
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, United States; Myungsung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and Myungsung Medical School, Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Onn Min Kon
- Chest and Allergy Clinic, St Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, England
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, Singapore.
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8
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Tubercular serpiginous choroiditis. J Ophthalmic Inflamm Infect 2022; 12:37. [PMID: 36352169 PMCID: PMC9645760 DOI: 10.1186/s12348-022-00312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022] Open
Abstract
Tubercular association with serpiginous choroiditis, also called ‘serpiginous-like choroiditis’ or ‘multifocal serpiginoid choroiditis’ (MSC) is reported from world over, especially from endemic countries. Though the exact mechanism is not yet clear, a direct or indirect infectious trigger by Mycobacterium tuberculosis (MTB) is believed to cause choroiditis. The link of immune mechanisms with ocular inflammation caused by MTB is emerging, and has been supported by both experimental and human data. The molecular and histopathological findings of tubercular serpiginous-like choroiditis have been demonstrated in clinicopathological reports, as well as in animal models. Young to middle-aged healthy males are more frequently affected. The choroiditis lesions of tubercular serpiginous-like choroiditis evolve as multifocal lesions, affecting the retinal periphery as well as posterior pole. They begin as discrete lesions, and spread in a serpiginoid pattern to become confluent. Fundus imaging including autofluorescence is extremely helpful in monitoring patients for response to therapy. Its diagnosis is essentially clinical. Corroborative evidence is obtained by a positive tuberculin skin test, or a positive QuantiFERON-TB Gold (Cellestis, Carnegie, Victoria, Australia) test, and/or radiological (chest X-ray or chest CT scan) evidence of TB elsewhere in the body. Systemic corticosteroids are the mainstay of therapy to control active inflammation, while ATT helps to reduce recurrence of inflammatory attacks. Immunosuppressive agents are indicated in cases with relentless progression, paradoxical worsening, or recurrent choroiditis.
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Kelgaonkar A, Govindhari V, Khalsa A, Basu S. Anti-tubercular therapy alone for treatment of isolated tubercular retinal vasculitis. Eye (Lond) 2022; 36:1777-1782. [PMID: 34373615 PMCID: PMC9391439 DOI: 10.1038/s41433-021-01727-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the time to resolution of perivascular infiltrates in tubercular retinal vasculitis (TRV) between anti-tubercular therapy (ATT) alone, and in combination with systemic corticosteroids. METHODS Observational retrospective cohort study in a tertiary eye centre in eastern India. Patients with TRV who were treated with anti-tubercular therapy (ATT) alone (Group A), or in combination with systemic corticosteroids (Group B) were included in the study. Eyes with additional inflammatory signs (cystoid macular oedema, vitritis ≥2+, optic disc oedema) were excluded. Resolution was defined as complete disappearance of perivascular infiltrates on seven-field fundus photographs. Descriptive statistics were used for demographic data. A linear mixed effects model was applied to adjust for intereye correlations, in patients with bilateral disease. The primary outcome measure was time to resolution of perivascular infiltrates. Secondary outcome measure was need for laser or surgical intervention for management of complications of TRV. RESULTS Fifty eyes of 39 patients (Group A 21/18 and Group B 29/21) were included. Both groups had similar demographics and severity of vasculitis. All patients had complete resolution of TRV. On adjusting for intereye correlation, the mean difference in time to resolution between the two groups (Group A, 3.24 [95% CI 2.69-3.77] months, and Group B, 4.76 [95% CI 3.52-5.99] months) was not statistically significant (0.96 weeks [-0.52 to 2.45] p = 0.21). Vaso-occlusive complications and healing patterns were similar in both groups. CONCLUSIONS ATT alone, may be sufficient for resolution of perivascular infiltrates, in TRV without additional inflammatory signs.
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Affiliation(s)
- Anup Kelgaonkar
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Vishal Govindhari
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
- Pushpagiri Vitreoretina Institute, West Maredpally, Secunderabad, India
| | - Ashish Khalsa
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Soumyava Basu
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India.
- L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
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Fan J, Wu CY, Davis JL. A Middle-aged Man With Macular Lesions and Vitritis. JAMA Ophthalmol 2022; 140:740-741. [PMID: 35551599 DOI: 10.1001/jamaophthalmol.2022.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jason Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Chris Y Wu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
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Magesan K, Sachidanandam R, Verma A, Biswas J. Retino-choroidal evaluation of the macular region in eyes with tubercular serpiginous-like choroiditis using swept-source optical coherence tomography angiography. Int Ophthalmol 2022; 42:2651-2664. [PMID: 35364747 DOI: 10.1007/s10792-022-02254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
AIM To analyse the alterations in retino-choroidal angioarchitecture in eyes with active tubercular serpiginous-like choroiditis (TB-SLC) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS This prospective cross-sectional study enrolled 34 eyes diagnosed with TB-SLC and 34 age-matched healthy controls. Data acquisition with SS-OCTA using the PLEX Elite 9000 (Carl Zeiss Meditec Inc., Dublin, CA, USA) with a 6 × 6 mm pattern centered on the foveal center was done. Automated retinal vessel length density (VLD) and perfusion density (PD) and foveal avascular zone architecture were obtained from the ARI hub. Choroidal vascularity index (CVI) and choriocapillaris flow deficits (CCFD) were obtained using Image J. RESULTS Eyes with TB-SLC showed significantly reduced vessel indices in all retinal layers (P < 0.05), decreased CVI (P = 0.001) and increased CCFD (P = 0.001) as compared to healthy eyes. CCFD was increased significantly in the involved quadrants in eyes with TB-SLC when compared with the uninvolved quadrants and corresponding healthy quadrants in control subjects. CCFD showed a significant negative correlation with visual acuity (r = - 0.46, P = 0.006). CONCLUSION Eyes with TB-SLC manifest reduced VLD and PD, decreased CVI and increased CCFD. The CCFD alterations are non-uniform in these eyes, mainly located under the regions with disease activity.
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Affiliation(s)
- Kowsigan Magesan
- Medical Research Foundation, Elite School of Optometry, Chennai, Tamil Nadu, India
| | - Ramya Sachidanandam
- Medical Research Foundation, Elite School of Optometry, Chennai, Tamil Nadu, India
| | - Aditya Verma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, College Road 18, Nungambakkam, Chennai, 600006, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, 41, College Road 18, Nungambakkam, Chennai, Tamil Nadu, 600006, India.
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12
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Kalra G, Agarwal A, Marchese A, Agrawal R, Bansal R, Gupta V. Automated lesion segmentation and quantification for prediction of paradoxical worsening in patients with tubercular serpiginous-like choroiditis. Sci Rep 2022; 12:5392. [PMID: 35354885 PMCID: PMC8967847 DOI: 10.1038/s41598-022-09338-y] [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: 05/20/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
To develop and evaluate a fully automated pipeline that analyzes color fundus images in patients with tubercular serpiginous-like choroiditis (TB SLC) for prediction of paradoxical worsening (PW). In this retrospective study, patients with TB SLC with a follow-up of 9 months after initiation of anti-tubercular therapy were included. A fully automated custom-designed pipeline was developed which was initially tested using 12 baseline color fundus photographs for assessment of repeatability. After confirming reliability using Bland–Altman plots and intraclass correlation coefficient (ICC), the pipeline was deployed for all patients. The images were preprocessed to exclude the optic nerve from the fundus photo using a single-shot trainable WEKA segmentation algorithm. Two automatic thresholding algorithms were applied, and quantitative metrics were generated. These metrics were compared between PW + and PW- groups using non-parametric tests. A logistic regression model was used to predict probability of PW for assessing binary classification performance and receiver operator curves were generated to choose a sensitivity-optimized threshold. The study included 139 patients (139 eyes; 92 males and 47 females; mean age: 44.8 ± 11.3 years) with TB SLC. Pilot analysis of 12 images showed an excellent ICC for measuring the mean area, intensity, and integrated pixel intensity (all ICC > 0.89). The PW + group had significantly higher mean lesion area (p = 0.0152), mean pixel intensity (p = 0.0181), and integrated pixel intensity (p < 0.0001) compared to the PW- group. Using a sensitivity optimized threshold cut-off for mean pixel intensity, an area under the curve of 0.87 was achieved (sensitivity: 96.80% and specificity: 72.09%). Automated calculation of lesion metrics such as mean pixel intensity and segmented area in TB SLC is a novel approach with good repeatability in predicting PW during the follow-up.
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Affiliation(s)
- Gagan Kalra
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Alessandro Marchese
- Department of Ophthalmology, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Duke NUS Medical School, Singapore, Singapore
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Papasavvas I, Tugal-Tutkun I, Herbort CP. Mechanisms, Pathophysiology and Current Immunomodulatory/Immunosuppressive Therapy of Non-Infectious and/or Immune-Mediated Choroiditis. Pharmaceuticals (Basel) 2022; 15:ph15040398. [PMID: 35455395 PMCID: PMC9031533 DOI: 10.3390/ph15040398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 12/19/2022] Open
Abstract
Non-infectious choroiditis comprises immune-mediated diseases resulting from diverse pathophysiological mechanisms. These conditions are sub-divided into two main groups, (1) diseases of the choriocapillaris and (2) diseases of the choroidal stroma. The purpose of this study is to expose the pathophysiology of the most common diseases of both these groups and recommend the optimal immunomodulatory/immunosuppressive therapy of each analyzed condition based on literature data and data from our own centers. Material and Methods: Narrative review. In the group of choriocapillaritis entities or primary inflammatory choriocapillaropathies (PICCPs) including multiple evanescent white dot syndrome (MEWDS), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), idiopathic multifocal choroiditis (MFC) and serpiginous choroiditis (SC), as well as secondary choriocapillaritides including acute syphilitic posterior multifocal placoid chorioretinitis (ASPMPC) and tuberculosis-related SC (TB-SC), were analyzed. In the group of stromal choroidites, HLA-A29 birdshot retinochoroiditis (BRC) and Vogt-Koyanagi-Harada (VKH) disease were included. For each entity a literature search, in the PubMed database, on treatment was performed and analyzed and the therapeutic attitudes of our own centers were presented. Management of immune-mediated choroiditis implies vigorous immunosuppressive therapy given in a prompt and prolonged fashion in most of these entities.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey;
| | - Carl P. Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, CH-1003 Lausanne, Switzerland;
- Correspondence:
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Neß T, Winterhalter S, Stübiger N. Infectious Posterior Uveitis - Toxoplasmosis, Treponema, Tuberculosis (TTT). Klin Monbl Augenheilkd 2022; 239:666-675. [PMID: 35320874 DOI: 10.1055/a-1727-1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture, diagnostic and treatment strategies of these diseases are presented.
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Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | | | - Nicole Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Abdi F, Mohammadi SS, Falavarjani KG. Intravitreal Methotrexate. J Ophthalmic Vis Res 2021; 16:657-669. [PMID: 34840688 PMCID: PMC8593537 DOI: 10.18502/jovr.v16i4.9756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Intravitreal methotrexate (MTX) has been proven to be an effective treatment for various intraocular diseases. In this article, a comprehensive review was performed on intravitreal applications of methotrexate. Different aspects of the administration of intravitreal MTX for various clinical conditions such as intraocular tumors, proliferative vitreoretinopathy, diabetic retinopathy, age-related macular degeneration, and uveitis were reviewed and the adverse effects of intravitreal injection of MTX were discussed. The most common indications are intraocular lymphoma and uveitis. Other applications remain challenging and more studies are needed to establish the role of intravitreal MTX in the management of ocular diseases.
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Affiliation(s)
- Fatemeh Abdi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S. Saeed Mohammadi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
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16
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Soni D, Karkhur S, Sharma B. Distinct recurrence pattern in a case of bilateral tubercular posterior uveitis: reporting a unique clinical morphology and management challenge. BMJ Case Rep 2021; 14:14/6/e241894. [PMID: 34162610 DOI: 10.1136/bcr-2021-241894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intraocular tuberculosis has protean clinical manifestations and remains an important etiological differential for uveitis in an endemic region. A 27-year-old male presented with visual acuity of counting fingers close to face in right (OD) and 20/25 in left eye (OS). Examination revealed a choroidal granuloma in OS and healed serpiginous-like choroiditis in OD. Antitubercular therapy was started with systemic corticosteroids. Granuloma resolved completely; however, the patient presented with neuroretinitis and posterior scleritis, as first and second recurrence, respectively, within a oneyear period. These were managed with systemic corticosteroids and immunosuppressive therapy was added, after second recurrence. The patient responded well and maintains remission. This case presented a clinical challenge with distinct recurrence patterns of tubercular posterior uveitis in the same eye, which has not been reported before. Successful management entailed use of antitubercular therapy, corticosteroids, and immunosuppressive therapy in a step-ladder approach, resulting in preservation of vision and achieving long-term remission.
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Affiliation(s)
- Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Tsui J, Ho M, Lui G, Li T, Chen L, Iu L, Brelen M, Young AL. The clinical presentation and treatment outcomes of ocular tuberculosis: a 5-year experience in an endemic area. Int Ophthalmol 2021; 41:3199-3209. [PMID: 34037904 DOI: 10.1007/s10792-021-01886-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the clinical presentations of ocular tuberculosis infection (OTB) and the treatment regimen and outcome in an endemic area. METHODS This is a retrospective case series of patients with presumed OTB treated in a tertiary teaching hospital in Hong Kong in 2014-2019. RESULTS Among the nineteen patients recruited, the most common clinical presentation of OTB was retinal vasculitis (42.1%), followed by scleritis, intermediate uveitis, and choroidal tuberculoma (15.8% respectively). 94.7% and 94.4% of the subjects were treated with ATT and steroid, respectively, and 31.6% were put on systemic immunosuppressant prior to the initiation of ATT. Apart from those suffering from intermediate uveitis, most demonstrated good clinical response within 8 weeks of ATT initiation. CONCLUSION Ocular involvement of TB has been increasingly recognized, especially in endemic regions like Hong Kong. High index of suspicion is recommended for OTB in typical clinical phenotypes or recurrent/resistant ocular inflammation unresponsive to conventional therapy. TB retinal vasculitis was the most common presentation of OTB in this study and OTB generally requires treatment with either regional or systemic steroid together with ATT.
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Affiliation(s)
- Jolly Tsui
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Lui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lijia Chen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Tsui E, Fern CM, Goldberg NR. TREATMENT OF REFRACTORY TUBERCULAR SERPIGINOUS-LIKE CHOROIDITIS WITH INTRAVITREAL METHOTREXATE. Retin Cases Brief Rep 2021; 15:169-173. [PMID: 29979252 DOI: 10.1097/icb.0000000000000767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To describe a case of tubercular serpiginous-like choroiditis that progressed, despite antitubercular medication, corticosteroids, and immunomodulatory treatment, which ultimately quieted after two intravitreal methotrexate injections. METHODS Case report. RESULTS A 35-year-old woman reported a shadow in the left eye for 2 weeks. She presented with tubercular serpiginous-like choroiditis in the right eye 2 years prior. At that time, she was started on antituberculosis therapy but was noncompliant and lost to follow-up. On re-presentation, there was a new active left-eye serpiginous lesion, with repeat positive QuantiFERON gold testing. Four antituberculosis drugs were started, followed by corticosteroids and azathioprine, with continued progression despite aggressive treatment. She was finally given 2 intravitreal methotrexate injections (400 μg/0.1 cc) 1 month apart, with final arrest of lesion extension. The uveitis remained quiet for over 24 months, and the patient was able to discontinue all systemic therapy. CONCLUSION Intravitreal methotrexate injections halted progression of treatment-refractory tubercular serpiginous-like choroiditis.
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Affiliation(s)
- Edmund Tsui
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Craig M Fern
- Northern Westchester Hospital Center, Mt. Kisco, New York
| | - Naomi R Goldberg
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York; and
- Department of Ophthalmology, Hofstra Northwell School of Medicine, Hempstead, New York
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19
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Marchese A, Agarwal AK, Erba S, Scialdone A, Miserocchi E, Bandello F, Introini U, Jampol LM, Casalino G. Placoid lesions of the retina: progress in multimodal imaging and clinical perspective. Br J Ophthalmol 2021; 106:14-25. [PMID: 33468489 DOI: 10.1136/bjophthalmol-2020-318337] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
Placoid lesions of the retina may be secondary to a wide spectrum of acquired inflammatory conditions that have been reported as single entities with different presentation and clinical course. These conditions include acute posterior multifocal placoid pigment epitheliopathy, persistent placoid maculopathy, serpiginous choroiditis, serpiginous-like choroiditis, relentless placoid chorioretinitis and acute syphilitic posterior placoid chorioretinitis. In this article, we will group these conditions under the name of 'placoids'. The recognition of the specific condition may be challenging in clinical practice, often resulting in diagnostic and therapeutic delay. Given the complex nature of placoids and their similarities, a systematic approach including differentiating between infectious and non-infectious aetiologies increases the chance of reaching the correct diagnosis. Detailed history and comprehensive clinical examination are the first steps to formulate a diagnostic hypothesis that should be corroborated by multimodal imaging and appropriate investigations. The advent of multimodal imaging has made it possible to extensively study placoids and revealed a constellation of specific findings that may help clinicians in the diagnostic process. The treatment of the conditions other than syphilis is complex and sometimes challenging. Our article is aimed at giving an overview of the individual entities associated with placoids and discussing the differential diagnosis. A practical and systematic approach is then proposed.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Aniruddha Kishandutt Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Stefano Erba
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Elisabetta Miserocchi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Ugo Introini
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
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Betzler BK, Gupta V, Agrawal R. Clinics of ocular tuberculosis: A review. Clin Exp Ophthalmol 2021; 49:146-160. [DOI: 10.1111/ceo.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Vishali Gupta
- Advanced Eye Centre Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
- National Healthcare Group Eye Institute Tan Tock Seng Hospital Singapore Singapore
- Moorfields Eye Hospital, National Health Service Foundation Trust London UK
- Singapore Eye Research Institute Singapore Singapore
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21
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Clinical and Imaging Factors Associated With the Outcomes of Tubercular Serpiginous-like Choroiditis. Am J Ophthalmol 2020; 220:160-169. [PMID: 32710829 DOI: 10.1016/j.ajo.2020.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To analyze baseline clinical and imaging risk factors associated with poor outcome in patients with tubercular serpiginous-like choroiditis (TB SLC). DESIGN Retrospective clinical study. METHODS Charts and fundus photographs of consecutive patients with active TB SLC seen at a single tertiary referral center with 6 months follow-up after initiation of treatment were reviewed. Logistic mixed models were performed to determine the clinical and imaging factors associated with the response to therapy, including the opacity of choroiditis graded according to a 3-point scale. RESULTS This study included 203 eyes of 183 patients with active TB SLC. Poor initial best-corrected visual acuity (BCVA) and foveal and optic disc involvement were associated with poor response to therapy at 6 months (odds ratio [OR] 4.489, 95% confidence interval [CI]: 1.92-10.47; P = .001; OR 2.892, 95% CI: 1.23-6.81; P = .015; OR 11.633, 95% CI: 3.17-42.71; P < .001, respectively). The high opacity grades (2 and 3) were also associated with poor outcomes OR 9.541; 95% CI: 2.94-30.91; P = .001). Poor baseline BCVA and high grade of opacity of the lesions were the composite risk factors for paradoxical worsening of TB SLC (OR 7.555, 95% CI: 1.78-32.02; P = 0.006; OR 7.434, 95% CI: 1.34-41.18; P =0.021, respectively). CONCLUSIONS TB SLC with higher grades of lesion opacity at baseline may be associated with greater risk of poor therapeutic response and paradoxical worsening. Grading of baseline lesion opacity may be used in future prospective studies to predict the biological behavior of the lesions and may serve as a guide to therapeutic interventions.
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22
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Amara A, Ben Salah E, Guihot A, Fardeau C, Touitoue V, Saadoun D, Bodaghi B, Sève P, Trad S. [Observational study of QuantiFERON® management for ocular tuberculosis diagnosis: Analysis of 244 consecutive tests]. Rev Med Interne 2020; 42:162-169. [PMID: 33143863 DOI: 10.1016/j.revmed.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/19/2020] [Accepted: 09/30/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Ocular tuberculosis (TB) diagnosisremains difficult and quantiferon (QFT) contribution needs still yet to be specified, despite its generalization in France. The purpose of this observational study is to assess in which ocular inflammation (OI) presentation QFT is prescribed and to evaluate the added value of new QuantiFERON®-TB Gold Plus (QFT-Plus) test for diagnosis ocular TB diagnosis. PATIENTS AND METHODS Monocentric, observational study, carried out in an ophthalmology department over a period of 5 months. Inclusion criteria were defined as an existence of an OI for which a QFT-Plus test was part of the etiological investigations. Of the 316 consecutive files, 72 were excluded (indeterminate test, prescription before anti-TNFα or immunosuppressant initiation, missing data, wrong indication) and 244 were selected and divided into two groups: group one (anterior uveitis/episcleritis, n=129) and group two (intermediate/posterior uveitis/optic neuritis/ocular myositis, n=115). All positive QFT patients underwent an etiological investigation including thoracic imaging. RESULTS Forty-five patients, aged 52±12 years, had positive QFT (18.5%), including 18 patients for group 1 and 27 for group 2. Living in TB-endemic area, TB exposure and chest imaging abnormalities were identified in 70%, 27% and 22% of cases, respectively. OI was chronic in 36% of cases (group one, 4/18; group two, 12/27). None of the 18 patients, in group 1, received anti-tuberculosis treatment (ATT) or experienced a relapse during one-year follow-up. Four QFT+ patients, from group 2 (15%) had another associated disease explaining their uveitis. Among the 23 other patients without identified etiology, 13 had at least one relevant ophthalmological signs predictive of TB uveitis (posterior synechiae, retinal vasculitis and/or choroidal granuloma) (59%). Eleven patients received a 6-month ATT trial. Radiological abnormalities and granulomas at angiography were significantly more frequent among treated patients (p=0.03 and 0.001, respectively). A full OI recovery was observed for 8 patients (73%), considered ex-post as ocular TB. Nine patients in group 2 received rifampicin/isoniazid dual therapy for 3 months, but no conclusion could be drawn as to the benefit of such prescription on OI. QFT rate comparison, according to CD4 stimulation by ESAT-6/CFP-10 peptides or by CD4/CD8 co-stimulation, was comparable and found only 4 cases of discrepancy (1.6%). None of these 4 cases had ocular TB diagnosis. CONCLUSION Positive QFT frequency among patients consulting for posterior OI remains high. In this study, radiological abnormalities and granulomas at angiography seemed to be more closely related to clinician decision for starting ATT trial in QFT+ patients, which was effective in 73% of cases. QFT-Plus does not seem more relevant than QFT-TB in exploring an OI. Prospective studies are necessary to codify QFT management in the etiological assessment of OI and clearly define ATT trial indications as well as their modalities.
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Affiliation(s)
- A Amara
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - E Ben Salah
- Département d'immunologie, hôpital Pitié Salpêtrière, AP-HP, Paris, France; UPMC UMRS CR7 - Inserm U1135, centre d'immunologie et des maladies infectieuses, Paris, France
| | - A Guihot
- Département d'immunologie, hôpital Pitié Salpêtrière, AP-HP, Paris, France; UPMC UMRS CR7 - Inserm U1135, centre d'immunologie et des maladies infectieuses, Paris, France
| | - C Fardeau
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - V Touitoue
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - D Saadoun
- Département de médecine interne et d'immunologie clinique, centre national de référence maladies autoimmunes systémiques rares, centre national de référence maladies autoinflammatoires et amylose, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; UMR 7211, département d'inflammation-immunopathologie-biothérapie (DHU i2B), UPMC université Paris 06, université de la Sorbonne, 75005 Paris, France
| | - B Bodaghi
- Service d'ophtalmologie, centre constitutif de référence maladies rares, université Paris-Sorbonne, hôpital Pitié-Salpêtrière, Paris, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, 103, Grande Rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Pôle IMER, hospices civils de Lyon, 69003 Lyon, France; HESPER EA 7425, université Claude Bernard, Lyon 1, 69008 Lyon, France
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, 92104 Boulogne-Billancourt, France; Université de Versailles-Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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Agarwal A, Invernizzi A, Markan A, Testi I, Keane PA, Agrawal R, Nguyen QD, Pavesio C, Gupta V. Imaging in Tubercular Choroiditis: Current Concepts. Ocul Immunol Inflamm 2020; 28:1223-1238. [PMID: 32976732 DOI: 10.1080/09273948.2020.1817500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Ocular tuberculosis has protean clinical manifestations. Because of its varied clinical presentation, multimodal imaging is very important to characterize the disease activity, presence of inflammation, determining therapeutic response, and detection of complications. METHODS Narrative review. RESULTS In this review, various imaging modalities employed in the management of ocular tuberculosis including fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) have been reviewed. Not only do these imaging tools complement each other in providing a comprehensive assessment of the pathology, they also help in gaining valuable insights regarding the evolution of the disease. CONCLUSIONS Fundus imaging plays a vital role in the diagnosis and management of patients with posterior uveitis due to tuberculosis. Fundus imaging may have a useful role in defining clinical endpoints for ocular tuberculosis in the future.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan , Milan, Italy
| | - Ashish Markan
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Pearse A Keane
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Rupesh Agrawal
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK.,Department of Ophthalmology, Singapore Eye Research Institute, Singapore , Singapore.,Department of Ophthalmology, Tan Tock Seng Hospital, Singapore , Singapore
| | - Quan Dong Nguyen
- Byers Eye Institute, Department of Ophthalmology, Stanford University , Palo Alto, CA, USA
| | - Carlos Pavesio
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research , Chandigarh, India
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Arora A, Katoch D, Jain S, Singh SR, Gupta V. Yellow Subretinal Lesions following Initiation of Antituberculosis Therapy in A Tubercular Choroidal Granuloma: A Sign of Paradoxical Worsening? Ocul Immunol Inflamm 2020; 30:29-33. [PMID: 32783681 DOI: 10.1080/09273948.2020.1780272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the presentation and management of atypical subretinal lesions following initiation of antitubercular therapy for a tubercular choroidal granuloma. CASE REPORT An 18-year-old female was diagnosed with choroidal granuloma and shallow exudative retinal detachment in the left eye. Biopsy from a cervical lymph node was positive for tuberculosis. She was treated with antitubercular therapy (ATT) and oral steroids. After one week of therapy exudative detachment increased markedly and discrete yellowish-white subretinal lesions appeared first in the inferior periphery, then temporally and later involved the macula leading to a drop in visual acuity. A diagnosis of paradoxical worsening was considered and she was managed with a higher dose of oral corticosteroids, intravitreal methotrexate and intravitreal ranibizumab. The granuloma healed and the subretinal lesions as well as exudative detachment gradually resolved with improvement in visual acuity. CONCLUSION Subretinal yellow-white lesions may develop as a paradoxical response to ATT.
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Affiliation(s)
- Atul Arora
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahil Jain
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Simar Rajan Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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25
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Basu S, Elkington P, Rao NA. Pathogenesis of ocular tuberculosis: New observations and future directions. Tuberculosis (Edinb) 2020; 124:101961. [PMID: 33010848 DOI: 10.1016/j.tube.2020.101961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023]
Abstract
Ocular tuberculosis (OTB) encompasses all forms of intra- and extra-ocular inflammation associated with Mycobacterium tuberculosis (Mtb) infection. However, the organism is rarely found in ocular fluid samples of diseased eyes, rendering the pathomechanisms of the disease unclear. This confounds clinical decision-making in diagnosis and treatment of OTB. Here, we critically review existing human and animal data related to ocular inflammation and TB pathogenesis to unravel likely pathomechanisms of OTB. Broadly there appear to be two fundamental mechanisms that may underlie the development of TB-associated ocular inflammation: a. inflammatory response to live/replicating Mtb in the eye, and b. immune mediated ocular inflammation induced by non-viable Mtb or its components in the eye. This distinction is significant as in direct Mtb-driven mechanisms, diagnosis and treatment would be aimed at detection of Mtb-infection and its elimination; while indirect mechanisms would primarily require anti-inflammatory therapy with adjunctive anti-TB therapy. Further, we discuss how that most clinical phenotypes of OTB likely represent a combination of both mechanisms, with one being predominant than the other.
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Affiliation(s)
- Soumyava Basu
- Retina and Uveitis Service, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, India.
| | - Paul Elkington
- NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Narsing A Rao
- USC-Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Agrawal R, Testi I, Bodaghi B, Barisani-Asenbauer T, McCluskey P, Agarwal A, Kempen JH, Gupta A, Smith JR, de Smet MD, Yuen YS, Mahajan S, Kon OM, Nguyen QD, Pavesio C, Gupta V. Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis-Report 2: Guidelines for Initiating Antitubercular Therapy in Anterior Uveitis, Intermediate Uveitis, Panuveitis, and Retinal Vasculitis. Ophthalmology 2020; 128:277-287. [PMID: 32603726 DOI: 10.1016/j.ophtha.2020.06.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022] Open
Abstract
TOPIC The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular Immunological Society, set up an international, expert-led consensus project to develop evidence- and experience-based guidelines for the management of tubercular uveitis (TBU). CLINICAL RELEVANCE The absence of international agreement on the use of antitubercular therapy (ATT) in patients with TBU contributes to a significant heterogeneity in the approach to the management of this condition. METHODS Consensus statements for the initiation of ATT in TBU were generated using a 2-step modified Delphi technique. In Delphi step 1, a smart web-based survey based on background evidence from published literature was prepared to collect the opinion of 81 international experts on the use of ATT in different clinical scenarios. The survey included 324 questions related to tubercular anterior uveitis (TAU), tubercular intermediate uveitis (TIU), tubercular panuveitis (TPU), and tubercular retinal vasculitis (TRV) administered by the experts, after which the COTS group met in November 2019 for a systematic and critical discussion of the statements in accordance with the second round of the modified Delphi process. RESULTS Forty-four consensus statements on the initiation of ATT in TAU, TIU, TPU, and TRV were obtained, based on ocular phenotypes suggestive of TBU and corroborative evidence of tuberculosis, provided by several combinations of immunologic and radiologic test results. Experts agreed on initiating ATT in recurrent TAU, TIU, TPU, and active TRV depending on the TB endemicity. In the presence of positive results for any 1 of the immunologic tests along with radiologic features suggestive of past evidence of tuberculosis infection. In patients with a first episode of TAU, consensus to initiate ATT was reached only if both immunologic and radiologic test results were positive. DISCUSSION The COTS consensus guidelines were generated based on the evidence from published literature, specialists' opinions, and logic construction to address the initiation of ATT in TBU. The guidelines also should inform public policy by adding specific types of TBU to the list of conditions that should be treated as tuberculosis.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom; Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Baharam Bodaghi
- Department of Ophthalmology, Sorbonne University, Paris, France
| | - Talin Barisani-Asenbauer
- OCUVAC-Centre of Ocular Inflammation and Infection, Laura Bassi Centre of Expertise, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - Peter McCluskey
- Save Sight Institute, Department of Ophthalmology, University of Sydney, Sydney, Australia
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts; MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Abeba, Ethiopia
| | - Amod Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Marc D de Smet
- MIOS SA-Medical/Surgical Retina and Ocular Inflammation, Lausanne, Switzerland
| | - Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, Singapore, Republic of Singapore
| | | | - Onn Min Kon
- Chest and Allergy Clinic, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Stanford, California
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Testi I, Betzler B, Gupta V, Kon OM, Agrawal R, Pavesio C. Current clinical management of ocular tuberculosis. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1736044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Bjorn Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vishali Gupta
- Advance Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Onn Min Kon
- Chest and Allergy Clinic, St. Mary’s Hospital, Imperial College Healthcare National Health Service Trust, London, UK
| | - Rupesh Agrawal
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Mishra SB, Saoji K, Pathengay A. Dual lesion margins on fundus autofluorescence associated with paradoxical worsening following treatment for tubercular serpiginous-like choroiditis. Indian J Ophthalmol 2020; 68:536-538. [PMID: 32057028 PMCID: PMC7043150 DOI: 10.4103/ijo.ijo_536_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 31-year-old male presented with decreased vision in the right eye associated with an active plaque-like serpiginoid choroiditis. The lesion showed a unique feature of dual margins of hyperautofluorescence of the lesion on fundus autofluoresence (FAF) imaging. Systemic investigations suggested a tubercular etiology. He was started on antitubercular treatment and a conventional dose of oral corticosteroids (1mg/kg body weight). However, the lesions showed paradoxical worsening and required increased immunosuppression in the form of local steroids and oral immunomodulators. The presence of dual margins of hyperautofluorescence could suggest increased inflammatory activity leading to paradoxical worsening on treatment requiring increased immunosuppression.
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Affiliation(s)
- Sai Bhakti Mishra
- Department of Retina and Uveitis, GMR Varalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Ketan Saoji
- Department of Retina and Uveitis, GMR Varalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Avinash Pathengay
- Department of Retina and Uveitis, GMR Varalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
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Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis-Report 1: Guidelines for Initiating Antitubercular Therapy in Tubercular Choroiditis. Ophthalmology 2020; 128:266-276. [PMID: 32115264 DOI: 10.1016/j.ophtha.2020.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022] Open
Abstract
TOPIC An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular choroiditis. CLINICAL RELEVANCE The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. METHODS An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like choroiditis, tuberculoma, and tubercular focal or multifocal choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. RESULTS Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular choroiditis. Experts agreed on initiating ATT in tubercular choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. DISCUSSION Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.
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30
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Agrawal R, Agarwal A, Jabs DA, Kee A, Testi I, Mahajan S, McCluskey PJ, Gupta A, Palestine A, Denniston A, Banker A, Invernizzi A, Fonollosa A, Sharma A, Kumar A, Curi A, Okada A, Schlaen A, Heiligenhaus A, Kumar A, Gurbaxani A, Bodaghi B, Islam Shah B, Lowder C, Tappeiner C, Muccioli C, Vasconcelos-Santos DV, Goldstein D, Behra D, Das D, Makhoul D, Baglivo E, Denisova E, Miserocchi E, Carreno E, Asyari F, Pichi F, Sen HN, Uy H, Nascimento H, Tugal-Tutkun I, Arevalo JF, Davis J, Thorne J, Hisae Yamamoto J, Smith J, Garweg JG, Biswas J, Babu K, Aggarwal K, Cimino L, Kuffova L, Agarwal M, Zierhut M, Agarwal M, De Smet M, Tognon MS, Errera MH, Munk M, Westcott M, Soheilian M, Accorinti M, Khairallah M, Nguyen M, Kon OM, Mahendradas P, Yang P, Neri P, Ozdal P, Amer R, Lee R, Distia Nora RL, Chhabra R, Belfort R, Mehta S, Shoughy S, Luthra S, Mohamed SO, Chee SP, Basu S, Teoh S, Ganesh S, Barisani-Asenbauer T, Guex-Crosier Y, Ozyazgan Y, Akova Y, Habot-Wilner Z, Kempen J, Nguyen QD, Pavesio C, Gupta V. Standardization of Nomenclature for Ocular Tuberculosis – Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop. Ocul Immunol Inflamm 2019; 28:74-84. [DOI: 10.1080/09273948.2019.1653933] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
- School of Material Science and Engineering, Nanyang Technological University, Singapore
| | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Douglas A. Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aera Kee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | - Sarakshi Mahajan
- Byers Eye Institute, Department of Ophthamology, Stanford University, Palo Alto, California, United States of America
| | - Peter J. McCluskey
- Discipline of Ophthalmology, Save Sight Institute, Faculty of Medicine and Health,The University of Sydney, Sydney, Australia
| | - Amod Gupta
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Alastair Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Alay Banker
- Banker’s Retina Clinic and Laser Centre, 5 Subhash Society, Ahmedabad, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alex Fonollosa
- Hospital Universitario Cruces, Cruces-Barakaldo, Bilbao, Vizcaya (Spain)
| | - Aman Sharma
- Department of Rheumatology, PGIMER, Chandigarh, India
| | - Amitabh Kumar
- Department of Uvea, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Andre Curi
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Brazil
| | - Annabelle Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ariel Schlaen
- Hospital Universitario Austral, Hospital de Clinicas “Jose de San Martín”, Universidad de Buenos Aires
| | | | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Gurbaxani
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | - Bahram Bodaghi
- Department of Ophthalmology, Sorbonne University, Paris, France
| | | | - Careen Lowder
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cristina Muccioli
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo, SP, Brazil
| | | | - Debra Goldstein
- Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
| | - Digambar Behra
- Deptartment of Pulmonary Medicine, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Dipankar Das
- Department of Ocular Pathology, Uveitis & Neuro-Ophthalmology Services; Sankaradeva Nethralaya, Guwahati, India
| | - Dorine Makhoul
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Edoardo Baglivo
- Department of Ophthalmology, Clinique de l’oeil, Geneva, Switzerland
| | | | - Elisabetta Miserocchi
- Ophthalmology Department, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ester Carreno
- Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - Fatma Asyari
- INOIIS, Department of Ophthalmology University of Indonesia, Indonesia
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - H. Nida Sen
- The Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Harvey Uy
- Ocular Immunology and Uveitis Service, Asian Eye Institute, Makati, Philippines
| | - Heloisa Nascimento
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo, SP, Brazil
| | - Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Turkey
| | - J Fernando Arevalo
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Janet Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer Thorne
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Justine Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Justus G. Garweg
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland; University of Bern, Bern, Switzerland
| | | | - Kalpana Babu
- Vittala International Institute of Ophthalmology, Bangalore, India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | - Lucia Kuffova
- Section of Immunity, Infection and Inflammation, Division of Applied Medicine, University of Aberdeen, School of Medicine and Dentistry, Aberdeen
| | | | - Manfred Zierhut
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Manisha Agarwal
- Dr Shroff’s Charity Eye Hospital Daryaganj, New Delhi, India
| | - Marc De Smet
- Department of Ophthalmology ZNA Middelheim, Antwerp, Belgium
| | - Maria Sofia Tognon
- Ocular Immunology Unit, Department of Ophthalmology, S. Antonio Hospital, Padova, Italy
| | - Marie-Helene Errera
- Centre National d’Ophtalmologie des 15-20, Paris, Sorbonne-Universités, Paris 6, France
| | - Marion Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark Westcott
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | | | - Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | | | - Onn Minn Kon
- Chest and Allergy Clinic, St Mary’s Hospital, Imperial College Heathcare Service trust, London, United Kingdom
| | | | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Pinar Ozdal
- Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Richard Lee
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | | | - Romi Chhabra
- Department of Ophthalmology, University of Manchester, Manchester, United Kingdom
| | - Rubens Belfort
- Instituto da Visão, Hospital São Paulo, Universidade Federal de São Paulo, SP, Brazil
| | - Salil Mehta
- Department of Ophthalmology, Lilavati Hospital and Research Center, Bandra Reclamation, Mumbai, India
| | - Samir Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyad, Saudi Arabia
| | | | | | - Soon-Phaik Chee
- Singapore Eye Research Institute, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Talin Barisani-Asenbauer
- OCUVAC - Centre of Ocular Inflammation and Infection, Laura Bassi Centre of Expertise, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna
| | - Yan Guex-Crosier
- Jules Gonin Eye Hospital, FAA, University of Lausanne, Switzerland
| | - Yılmaz Ozyazgan
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Turkey
| | - Yonca Akova
- Department of Ophthalmology, Bayindir Kavaklidere Hospital, Ankara, Turkey
| | - Zohar Habot-Wilner
- Ophthalmology Division, Tel Aviv Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Quan Dong Nguyen
- Byers Eye Institute, Department of Ophthamology, Stanford University, Palo Alto, California, United States of America
| | - Carlos Pavesio
- Moorfields Eye Hospital, Department of Ophthamology, NHS Foundation Trust, London, United Kingdom
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthamology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ganesh SK, Abraham S, Sudharshan S. Paradoxical reactions in ocular tuberculosis. J Ophthalmic Inflamm Infect 2019; 9:19. [PMID: 31493128 PMCID: PMC6730739 DOI: 10.1186/s12348-019-0183-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/09/2019] [Indexed: 12/18/2022] Open
Abstract
Paradoxical reactions following initiation of anti-tubercular therapy have been documented most often in extrapulmonary tuberculosis. A combination of factors such as delayed hypersensitivity, decreased suppressor mechanisms, and an increased response to mycobacterial antigens mediated by the host’s immune system have been implicated in the development of these reactions. Similar worsening in patients with ocular tuberculosis while on treatment has been described. It is therefore important for the clinician to be aware of this occurrence, as prompt recognition and timely institution of corticosteroids and immunosuppressants can lead to restoration of vision. In these patients, an alteration or discontinuation of anti-tubercular therapy may not be indicated.
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Affiliation(s)
- Sudha K Ganesh
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600 006, India.
| | - Sharanya Abraham
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600 006, India
| | - Sridharan Sudharshan
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600 006, India
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Abstract
Serpiginous choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like choroiditis (SLC) and multifocal serpiginoid choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC.
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Affiliation(s)
| | - Jyotirmay Biswas
- Department of Uvea and Department of Larsen and Toubro Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Amod Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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33
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Touhami S, Diwo E, Sève P, Trad S, Bielefeld P, Sène D, Abad S, Brézin A, Quartier P, Koné Paut I, Weber M, Chiquet C, Errera MH, Sellam J, Cacoub P, Kaplanski G, Kodjikian L, Bodaghi B, Saadoun D. Expert opinion on the use of biological therapy in non-infectious uveitis. Expert Opin Biol Ther 2019; 19:477-490. [PMID: 30888881 DOI: 10.1080/14712598.2019.1595578] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Conventional immunosuppressive drugs, anti-TNF alpha treatments and biotherapies are increasingly being used in non-infectious uveitis. AREAS COVERED The present work was led by a multidisciplinary panel of experts, including internal medicine specialists, rheumatologists and ophthalmologists, and proposes an extensive review on the use of biological agents in non-infectious uveitis. EXPERT OPINION In case of dependency to steroids or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or biological therapies such as anti-TNF alpha treatments (adalimumab, infliximab) can be used to achieve and maintain disease quiescence. Interferon is an efficient immunomodulatory drug that can be proposed as second-line therapy in specific indications (eg. refractory macular edema, sight-threatening Behçet's uveitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (steroids, sirolimus etc.) can be used as adjuvant therapies in case of unilateral relapse. Therapeutic response must always be evaluated by clinical examination and appropriate ancillary investigations.
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Affiliation(s)
- Sara Touhami
- a Ophthalmology Department , DHU ViewRestore, Pitié Salpêtrière Hospital , Paris , France
| | - Eléonore Diwo
- a Ophthalmology Department , DHU ViewRestore, Pitié Salpêtrière Hospital , Paris , France
| | - Pascal Sève
- b Internal Medicine Department , Hôpital de la Croix-Rousse, Hospices Civils de Lyon , Lyon Cedex 04 , France.,c Faculté de Médecine Lyon-Sud , Université Claude Bernard-Lyon 1 , Lyon , France
| | - Salim Trad
- d Internal Medicine Department , Hôpital Ambroise Paré , Boulogne-Billancourt , France
| | - Philip Bielefeld
- e Internal Medicine and systemic diseases department (Médecine Interne 2) , Dijon University hospital , Dijon , France
| | - Damien Sène
- f Internal Medicine Department , Lariboisière Hospital , Paris , France.,g INSERM UMR , Paris Diderot University , Paris , France
| | - Sebastien Abad
- h Internal Medicine Department , Hopital Avicenne , Bobigny , France.,i Sorbonne Paris Cité, Faculté de Médecine SMBH , Université Paris 13 , Bobigny , France.,j Faculté de médecine , Université Paris 13, Sorbonne Paris Cité , Bobigny , France
| | - Antoine Brézin
- k Ophthalmology Department, Hôpital Cochin , Paris Descartes University , Paris , France
| | - Pierre Quartier
- l Unité d'Immunologie-Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants Malades , Paris-Descartes University, Institut IMAGINE, Centre de référence des maladies rhumatologiques inflammatoires et auto-immunes systémiques rares de l'enfant (RAISE) , Paris , France
| | - Isabelle Koné Paut
- m Paediatric Rheumatology Department , centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, Bicêtre Hospital , Le Kremlin-Bicêtre , France
| | - Michel Weber
- n Ophthalmology Department , Nantes University Hospital , Nantes , France
| | - Christophe Chiquet
- o Ophthalmology Department , Grenoble Alpes University Hospital , La Tronche , France
| | - Marie-Hélène Errera
- p Ophthalmology Department , Quinze-Vingts National Eye Hospital , Paris , France
| | - Jérémie Sellam
- q Rheumatology Department, Saint-Antoine Hospital, AP-HP, CRSA Inserm UMRS_938, DHU i2B , Sorbonne Université , Paris , France
| | - Patrice Cacoub
- r Inflammation-Immunopathology-Biotherapy Department (DHU i2B) , Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 , Paris , France.,s Inflammation-Immunopathology-BiotherapyDepartment , INSERM, UMR_S 959 , Paris , France.,t Inflammation-Immunopathology-BiotherapyDepartment , CNRS, FRE3632 , Paris , France.,u Department of Internal Medicine and Clinical Immunology, Centre national de référence des maladies autoimmunes systémiques rares, Centre national de référence des maladies autoinflammatoires et de l'amylose , AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
| | - Gilles Kaplanski
- v Internal Medicine and Clinical immunology Department, Hôpital de la Conception , Aix-Marseille Université , Marseille , France
| | - Laurent Kodjikian
- w Department of Ophthalmology , Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I , Lyon , France.,x CNRS UMR 5510 Mateis , France
| | - Bahram Bodaghi
- a Ophthalmology Department , DHU ViewRestore, Pitié Salpêtrière Hospital , Paris , France
| | - David Saadoun
- r Inflammation-Immunopathology-Biotherapy Department (DHU i2B) , Sorbonne Universités, UPMC Univ Paris 06, UMR 7211 , Paris , France
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Agarwal A, Aggarwal K, Gupta V, Agrawal R, Nguyen QD. Advances in imaging and molecular diagnostics of ocular tuberculosis and selected observations from the Collaborative Ocular Tuberculosis Study (COTS). EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1555472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medicine and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Post Graduate Institute of Medicine and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medicine and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Quan Dong Nguyen
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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Agarwal A, Aggarwal K, Gupta V. Infectious uveitis: an Asian perspective. Eye (Lond) 2018; 33:50-65. [PMID: 30315262 DOI: 10.1038/s41433-018-0224-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023] Open
Abstract
Several intraocular infections can present with protean manifestations posing major diagnostic and management challenges. Infections such as tuberculosis, dengue and chikungunya fever have continued to remain major endemic diseases that are associated with uveitis in the Asia Pacific region. These entities often require a high index of clinical suspicion and laboratory analysis including assays of ocular fluids and/or tissues for confirmation of the diagnosis. Infectious uveitis caused by tuberculosis, dengue and chikungunya can present with characteristic clinical features and imaging findings on ancillary investigations; that may provide clue to the early diagnosis. Use of modern imaging modalities such as enhanced-depth imaging optical coherence tomography, optical coherence tomography angiography and ultra-wide field fundus photography greatly aid in the evaluation of these conditions. In the current review, we have discussed the epidemiology, clinical phenotypes, imaging characteristics, diagnosis and management of uveitis caused by tuberculosis, dengue and chikungunya.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Longitudinal analysis of serum cytokine profile among patients with tubercular multifocal serpiginoid choroiditis: a pilot study. Eye (Lond) 2018; 33:129-135. [PMID: 30185832 DOI: 10.1038/s41433-018-0157-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 12/09/2017] [Accepted: 02/14/2018] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To analyze the serum cytokines profile in patients with tubercular multifocal serpiginoid choroiditis (TB MSC) receiving anti-tubercular therapy (ATT) and oral corticosteroids. METHODS In this prospective longitudinal study, patients with active TB MSC were included. Serum levels of interferon (IFN)-γ, interleukin (IL)-10, and tumor necrosis factor (TNF)-α were analyzed using bead-based immunoassay. The levels of transforming growth factor (TGF)-β were measured using cytokine bead array. Serial measurement was performed at baseline, 1, 3, and 6 weeks after initiation of therapy. Patients developing paradoxical worsening (PW) of TB MSC were identified and their serum levels of cytokines were compared with those patients who showed healing of lesions. Comparison of cytokine levels with baseline values was also performed. RESULTS Twelve patients (three females) were included in the study. Four patients showed paradoxical worsening of TB MSC at 3.2 ± 1 weeks after initiation of therapy. Compared to patients who showed healing of lesions, patients with PW showed higher baseline IL-10 (not significant; p = 0.28). Among patients developing PW, levels of IFN-γ peaked at 1 week ((p = 0.01) and levels of TNF-α peaked at 3 weeks (p = 0.02) (coinciding with PW) compared to patients who showed healing. There was no significant difference in TGF-β levels at any time point in either group (p > 0.47). CONCLUSIONS Baseline and serial levels of inflammatory serum cytokines may help in predicting the response to ATT and corticosteroids in TB MSC. Patients with paradoxical worsening may show rise in pro-inflammatory cytokines after initiation of ATT indicating higher bacillary load.
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Trad S, Saadoun D, Errera MH, Abad S, Bielefeld P, Terrada C, Sène D, Bodaghi B, Sève P. [Ocular tuberculosis]. Rev Med Interne 2018; 39:755-764. [PMID: 29891262 DOI: 10.1016/j.revmed.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
Despite extensive investigations, including the use of Interferon-gamma release assays (IGRA), the diagnosis of intraocular tuberculosis (TB) remains challenging. Ocular evidence of Mycobacterium tuberculosis in low endemic countries for TB is extremely rare, leading mostly to a TB-related ocular inflammation presumptive diagnosis. This present work aims: to highlights the main clinical patterns suggestive of ocular TB; and the latest recommended guidelines for diagnosing ocular TB to clarify interferon-gamma release assay (IGRA) contribution and accuracy to the management of intraocular TB and its diagnosis, in addition to other available diagnostic tools, such as tuberculin skin test, bacteriologic and histologic analysis from intra/extra ocular sample and radiographic investigations; to define the accuracy of these diagnostic tools according to the endemic TB prevalence; and finally to identify therapeutic strategies adapted to the main clinical presentations of ocular TB. Our review of the literature shows that management of suspected ocular TB differs significantly based on whether patients are from high or low TB prevalence countries since accuracy of chest X-ray, tuberculin skin test and IGRA is significantly different. Taking into account these discrepancies, distinct guidelines should be determined for managing patients with suspected ocular TB, taking into consideration home prevalence of TB-patients.
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Affiliation(s)
- S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92104 Boulogne-Billancourt France.
| | - D Saadoun
- Centre national de référence maladies autoimmunes systémiques rares, centre national de référence maladies autoinflammatoires et amylose, département de médecine interne et d'immunologie clinique, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France
| | - M H Errera
- Service d'ophthalmologie du centre hospitalier national des Quinze-Vingts et DHU Sight Restore, 75012 Paris, France; Sorbonne universités, UPMC université Paris 06, 75006 Paris, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne assistance publique-hôpitaux de Paris (AP-HP), 125, route de Stalingrad, 93000 Bobigny, France; UMR1125, LI2P, faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, France
| | - P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon Bourgogne 21000 Dijon, France
| | - C Terrada
- Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France; Centre médical Roule-Péretti, 169, avenue Achille-Peretti, 92200, Neuilly-sur-Seine, France
| | - D Sène
- Département de médecine interne, APHP, hôpital Lariboisière, 75010 Paris, France; Université Paris Diderot, 75010 Paris, France
| | - B Bodaghi
- Département d'inflammation-immunopathologie-biothérapie (DHU i2B) université de la Sorbonne, UPMC université Paris 06, UMR 7211, 75005, Paris, France; Service d'ophthalmologie, hôpital Pitié-Salpêtrière, sorbonne université, AP-HP, , 75013 Paris, France
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France; Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France
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Sharma RK, Gupta V, Bansal R, Sharma K, Gupta A, Sachdeva N. Immune Profiling of T Cells Infiltrating Vitreous Humor in Tubercular Uveitis. Immunol Invest 2018; 47:615-631. [PMID: 29733740 DOI: 10.1080/08820139.2018.1470640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess cellular composition and local cytokine response in vitreous humor of tubercular uveitis. METHODS Cells were collected from vitreous cassettes and peripheral blood of 8 tubercular uveitis and 5 control subjects, undergoing vitrectomy and analyzed by flow cytometry for cellular composition, activation status, proinflammatory cytokine expression, and uptake of TLR9 ligand, CpG ODN 2216. RESULTS CD3 + T cells with equal proportion of CD4+ and CD8 + T cells formed major fraction of infiltrating cells. The vitreous humor showed higher expression of recent activation marker, CD69, and proinflammatory cytokines, IFN-γ and IL-17A, in CD4 + T cells as compared to peripheral blood. Lastly, intraocular CD4 + T cells showed reduced uptake of ODN 2216 than peripheral blood. CONCLUSIONS Our results indicate that local antigenic stimuli trigger T cell infiltration and activation of CD4 + T cells that are hyporesponsive to TLR9 stimulation. These infiltrating T cells might be responsible in further aggravating ocular inflammation.
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Affiliation(s)
- Ravi Kumar Sharma
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Vishali Gupta
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Reema Bansal
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Kusum Sharma
- b Department of Medical Microbiology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Amod Gupta
- a Department of Ophthalmology , Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Naresh Sachdeva
- c Department of Endocrinology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
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Diwo E, Sève P, Trad S, Bielefeld P, Sène D, Abad S, Brézin A, Quartier P, Koné Paut I, Weber M, Chiquet C, Errera MH, Sellam J, Cacoub P, Kaplanski G, Kodjikian L, Bodaghi B, Saadoun D. [Therapeutic strategy for the treatment of non-infectious uveitis proposed by an expert panel]. Rev Med Interne 2018; 39:687-698. [PMID: 29610003 DOI: 10.1016/j.revmed.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/01/2018] [Indexed: 02/07/2023]
Abstract
Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).
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Affiliation(s)
- E Diwo
- Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Faculté de médecine Lyon-Sud, université Claude Bernard-Lyon 1, France
| | - S Trad
- Service de médecine interne, hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | - P Bielefeld
- Internal medicine and systemic diseases department, médecine interne 2, university hospital Dijon Bourgogne, France; Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - D Sène
- Internal medicine department, Lariboisière hospital, AP-HP, Paris, France; Inserm UMR 1149, Paris Diderot university, Paris, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - A Brézin
- Service d'ophtalmologie, hôpital Cochin, université Paris Descartes, Paris, France
| | - P Quartier
- Unité d'immunologie-hématologie et rhumatologie pédiatriques, institut IMAGINE, centre de référence des maladies rhumatologiques inflammatoires et autoimmunes systémiques rares de l'enfant (RAISE), université Paris-Descartes university, hôpital Necker-Enfants-Malades, Assistance publique Hôpitaux de Paris, Paris, France
| | - I Koné Paut
- Paediatric rheumatology department, centre de références des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, university of Paris Sud, Bicêtre hospital, AP-HP, Paris, France
| | - M Weber
- Department of ophthalmology, Nantes university, Nantes university hospital, Nantes, France
| | - C Chiquet
- Department of ophthalmology, Grenoble-Alpes university, Grenoble Alpes university hospital, Grenoble, France
| | - M H Errera
- Department of ophthalmology at Quinze-Vingts National Eye Hospital and DHU Sight Restore, Paris, France; Sorbonne universities, UPMC université Paris 06, Paris, France
| | - J Sellam
- Service de rhumatologie, CRSA Inserm UMRS_938, DHU i2B, hôpital Saint-Antoine, Sorbonne Université, AP-HP, France
| | - P Cacoub
- Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France
| | - G Kaplanski
- Service de médecine interne et immunologie clinique, Aix-Marseille université, hôpital de la conception, 147, boulevard Baille, 1305 Marseille, France
| | - L Kodjikian
- Department of ophthalmology, Croix-Rousse university hospital, Hospices Civils de Lyon, university of Lyon I, 69004 Lyon, France; CNRS UMR 5510 Mateis, 69621 Villeurbanne, France
| | - B Bodaghi
- Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France.
| | - D Saadoun
- Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France.
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Koubaa M, Smaoui F, Gargouri S, Ben Ayed H, Rekik K, Abid I, Maaloul I, Feki J, Marrakchi C, Ben Jemaa M. [Ocular tuberculosis : A case series]. Rev Med Interne 2018; 39:326-331. [PMID: 29580651 DOI: 10.1016/j.revmed.2018.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 01/14/2018] [Accepted: 02/04/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1-2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis. METHODS We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay. RESULTS The patient's mean age was 40.7±9years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10±2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae. CONCLUSION Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis.
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Affiliation(s)
- M Koubaa
- Service des maladies infectieuses, CHU Hédi Chaker, Faculté de médecine, Université de Sfax, 3029 Sfax, Tunisie; Unité de recherche « Tuberculose extrapulmonaire », CHU Hédi Chaker, Sfax, Tunisie.
| | - F Smaoui
- Service des maladies infectieuses, CHU Hédi Chaker, Faculté de médecine, Université de Sfax, 3029 Sfax, Tunisie; Unité de recherche « Tuberculose extrapulmonaire », CHU Hédi Chaker, Sfax, Tunisie
| | - S Gargouri
- Service d'ophtalmologie, CHU Habib Bourguiba, université de Sfax, Tunisie
| | - H Ben Ayed
- Service d'épidémiologie et de médecine communautaire, CHU Hédi Chaker, université de Sfax, Tunisie; Unité de recherche « Tuberculose extrapulmonaire », CHU Hédi Chaker, Sfax, Tunisie
| | - K Rekik
- Service des maladies infectieuses, CHU Hédi Chaker, Faculté de médecine, Université de Sfax, 3029 Sfax, Tunisie; Unité de recherche « Tuberculose extrapulmonaire », CHU Hédi Chaker, Sfax, Tunisie
| | - I Abid
- Service d'ophtalmologie, CHU Habib Bourguiba, université de Sfax, Tunisie
| | - I Maaloul
- Service des maladies infectieuses, CHU Hédi Chaker, Faculté de médecine, Université de Sfax, 3029 Sfax, Tunisie; Unité de recherche « Tuberculose extrapulmonaire », CHU Hédi Chaker, Sfax, Tunisie
| | - J Feki
- Service d'ophtalmologie, CHU Habib Bourguiba, université de Sfax, Tunisie
| | - C Marrakchi
- Service des maladies infectieuses, CHU Hédi Chaker, Faculté de médecine, Université de Sfax, 3029 Sfax, Tunisie; Unité de recherche « Tuberculose extrapulmonaire », CHU Hédi Chaker, Sfax, Tunisie
| | - M Ben Jemaa
- Service des maladies infectieuses, CHU Hédi Chaker, Faculté de médecine, Université de Sfax, 3029 Sfax, Tunisie; Unité de recherche « Tuberculose extrapulmonaire », CHU Hédi Chaker, Sfax, Tunisie
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Invernizzi A, Iannaccone F, Marchi S, Mastrofilippo V, Coassin M, Fontana L, Salvarani C, McCluskey P, Cimino L. Interferon Alpha-2a for the Treatment of Post-Infectious Uveitis Secondary to Presumed Intraocular Tuberculosis. Ocul Immunol Inflamm 2018; 27:643-650. [DOI: 10.1080/09273948.2018.1431292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Save Sight Institute, Sydney Hospital and Sydney Eye Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Franca Iannaccone
- Ocular Immunology Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Sylvia Marchi
- Ocular Immunology Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Ocular Immunology Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Marco Coassin
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Luigi Fontana
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Carlo Salvarani
- Department of Rheumatology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Peter McCluskey
- Save Sight Institute, Sydney Hospital and Sydney Eye Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Luca Cimino
- Ocular Immunology Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
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Ganesh SK, Ali BS. Paradoxical worsening of a case of TB subretinal abscess with serpiginous-like choroiditis following the initiation of antitubercular therapy. Indian J Ophthalmol 2017; 65:761-764. [PMID: 28820170 PMCID: PMC5598195 DOI: 10.4103/ijo.ijo_184_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 37-year-old immunocompetent male patient presented with the blurring of vision, both eyes for the past1 year. Fundus examination revealed bilateral multiple subretinal abscesses with areas of healed serpiginous-like choroiditis. Laboratory investigations showed positive tuberculin skin test, positive QuantiFERON TB-Gold Test, and high resolution computed tomography chest showed enlarged mediastinal lymph nodes. The aqueous sample revealed polymerase chain reaction (PCR) positive for Mycobacterium tuberculosis (MTB) (MPB64 genome). He was treated antitubercular therapy (ATT) along with oral steroids. Although he responded well initially, he had recurrent inflammation and paradoxical worsening. This was managed with a high dose of intravenous corticosteroids, immune suppressive and ATT. He also had a diagnostic vitreous biopsy which was also PCR positive for MTB (IS6110 gene). He subsequently continued ATT along with corticosteroids and immune suppressive and responded well. We present this case report for its unusual presentation.
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Affiliation(s)
- Sudha K Ganesh
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamilnadu, India
| | - B Sowkath Ali
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamilnadu, India
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Agarwal A, Handa S, Aggarwal K, Sharma M, Singh R, Sharma A, Agrawal R, Sharma K, Gupta V. The Role of Dexamethasone Implant in the Management of Tubercular Uveitis. Ocul Immunol Inflamm 2017; 26:884-892. [DOI: 10.1080/09273948.2017.1400074] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabia Handa
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Sharma
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Kusum Sharma
- Department of Microbiology, Division of Mycobacteriology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Choroidal neovascular membranes secondary to intraocular tuberculosis misdiagnosed as neovascular age-related macular degeneration. Eur J Ophthalmol 2017; 28:216-224. [PMID: 29077184 DOI: 10.5301/ejo.5001047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Intraocular tuberculosis (IOTB) can be complicated by choroidal neovascularization (CNV). However, when the CNV development is not accompanied by clear signs of inflammation, the etiology can be missed, especially in countries nonendemic for tuberculosis. We describe the clinical and imaging features of CNVs presenting as the first sign of IOTB initially misdiagnosed as exudative age-related macular degeneration (AMD). METHODS A retrospective review of clinical and imaging data of patients initially misdiagnosed with neovascular AMD later diagnosed with inflammatory CNV secondary to IOTB at tertiary referral centers was conducted. Features of fundus photography, fluorescein angiography, indocyanine green angiography, and enhanced depth imaging optical coherence tomography were analyzed. Distinguishing features between neovascular AMD and IOTB-associated CNV were evaluated. RESULTS Five patients over 55 years of age, erroneously diagnosed with exudative AMD, were included in the study. Multimodal imaging analysis allowed identification of peculiar choroidal alterations such as choroidal granulomas or choroiditis suggestive for posterior uveitis. Systemic workup for granulomatous uveitis including immunologic investigations such as tuberculin skin test or QuantiFERON TB Gold® and radiologic investigations revealed tubercular etiology in all the cases, allowing correct diagnosis and management of the uveitis and related CNV. CONCLUSIONS Choroidal neovascularization represents a rare and unusual presenting sign of IOTB that can be misleading especially when it occurs in the elderly living in countries with low prevalence of the disease. Multimodal imaging can be helpful and should be employed, especially in atypical cases of CNV, in order to avoid misdiagnosis and/or diagnostic delays.
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Aggarwal K, Agarwal A, Deokar A, Singh R, Bansal R, Sharma A, Sharma K, Dogra MR, Gupta V. Ultra-Wide Field Imaging in Paradoxical Worsening of Tubercular Multifocal Serpiginoid Choroiditis after the Initiation of Anti-Tubercular Therapy. Ocul Immunol Inflamm 2017; 27:365-370. [PMID: 29020501 DOI: 10.1080/09273948.2017.1373829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional choroiditis lesions, PW and altering the course of therapy in TB MSC.
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Affiliation(s)
- Kanika Aggarwal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Aniruddha Agarwal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ankit Deokar
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ramandeep Singh
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Reema Bansal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Aman Sharma
- b Department of Internal Medicine , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Kusum Sharma
- c Department of Microbiology, Division of Mycobacteriology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Mangat R Dogra
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Vishali Gupta
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
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Jain L, Panda KG, Basu S. Clinical Outcomes of Adjunctive Sustained-Release Intravitreal Dexamethasone Implants in Tuberculosis-Associated Multifocal Serpigenoid Choroiditis. Ocul Immunol Inflamm 2017; 26:877-883. [PMID: 29020496 DOI: 10.1080/09273948.2017.1383446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To analyze the safety and efficacy of sustained-release intravitreal dexamethasone implant (Ozurdex) in management of TB-associated multifocal serpiginoid choroiditis (MSC). METHODS Retrospective review of TB-associated MSC patients, treated with anti-TB therapy (ATT) and adjunctive intravitreal Ozurdex. RESULTS Nine eyes of six patients were included. Four patients required Ozurdex implant for progressive or new lesions following ATT and two for additional systemic contraindications to corticosteroids - hyperglycemia and uncontrolled hypertension, respectively. The mean time to resolution was 9.17 ± 7.71 weeks. The mean follow-up post-injection was 13.11 ± 6.05 months (median 12 months [range 6-24.5 months]). Only one of nine eyes developed recurrent MSC lesions and this was attributed to possible autoimmune etiology. Two eyes (22.2%) developed steroid-induced glaucoma - one required implant removal. CONCLUSIONS Sustained-release intravitreal dexamethasone is a safe and efficacious adjunctive anti-inflammatory therapy for TB-associated MSC patients with contraindication for systemic corticosteroids or requiring supplemental anti-inflammatory therapy.
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Affiliation(s)
- Lubhani Jain
- a Retina and Uveitis Service , L V Prasad Eye Institute , Bhubaneswar , India
| | - Krushna Gopal Panda
- a Retina and Uveitis Service , L V Prasad Eye Institute , Bhubaneswar , India
| | - Soumyava Basu
- a Retina and Uveitis Service , L V Prasad Eye Institute , Bhubaneswar , India
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Diagnostic and Therapeutic Challenges. Retina 2017; 38:1436-1441. [PMID: 28834945 DOI: 10.1097/iae.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaur S, Aggarwal K, Agarwal A, Suri D, Gupta A, Singh R, Bansal R, Singh S, Singh N, Gupta A, Gupta V. Clinical Course and Outcomes of Pediatric Tubercular Uveitis in North India. Ocul Immunol Inflamm 2017; 26:859-864. [PMID: 28318350 DOI: 10.1080/09273948.2017.1296579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Savleen Kaur
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepti Suri
- Department of Pediatric Allergy Immunology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anju Gupta
- Department of Pediatric Allergy Immunology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surjit Singh
- Department of Pediatric Allergy Immunology Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nirbhai Singh
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amod Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Zhou MP, Bhat PV. Serpiginous choroidopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1276443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mei P. Zhou
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Pooja Vijay Bhat
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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