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Vongkulsiri S, Vanichseni S, Choontanom R, Keorochana N. Characteristics, Etiology, and Clinical Outcome of Retinal Vasculitis in Tertiary Hospital in Thailand. Ocul Immunol Inflamm 2024; 32:218-225. [PMID: 36731516 DOI: 10.1080/09273948.2023.2165110] [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: 05/09/2022] [Accepted: 12/31/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To analyze characteristics, etiology, and outcome of retinal vasculitis in Central Thailand. METHODS A retrospective cohort study. RESULTS Retinal vasculitis was found in 10% of uveitis, 74 from 741 uveitis, noninfectious (64.9%) and infectious group (35.1%). The most common cause was Behcet's disease (48.6%). Behcet's disease was the most common cause of all types of vascular leakage on angiography, including capillary (80.4%), venous (56.3%), and arterial leakage (56%). Final visual acuity was 0.86 ± 0.97 logMAR. Cataract was the most frequent complication (42.5%). Acute clinical course (p = .025) and retinal neovascularization (p = .031) were associated with infectious group. Forty-three percent of vasculitis complicated by ischemia required photocoagulation (33%) and anti-VEGF injection (17%). Furthermore, 17% of vasculitis underwent vitrectomy. CONCLUSION One-half of the retinal vasculitis in Central Thailand were Behcet's disease. Acute onset and retinal neovascularization may suggest infectious etiology. Retinal ischemia should be cautious and undergo early interventions to prevent sight-threatening complications.
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Affiliation(s)
- Sritatath Vongkulsiri
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sujaree Vanichseni
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Raveewan Choontanom
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Narumon Keorochana
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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2
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Martinez-Velazquez L, Zhou P, López-Font FJ, Hoyek S, Feldman CH, Amato AA, Sobrin L, Patel NA. Retinal Vasculitis in a Patient With Isaacs Syndrome and Inclusion Body Myositis. JOURNAL OF VITREORETINAL DISEASES 2023; 7:165-170. [PMID: 37006658 PMCID: PMC10037760 DOI: 10.1177/24741264221133368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To report a case of bilateral occlusive retinal vasculitis in a patient with autoimmunity. Methods A case was analyzed and a literature review performed. Results A 55-year-old woman with autoimmune diagnoses of Isaacs syndrome and inclusion body myositis (IBM) reported decreased vision for 3 months. A fundus examination showed peripheral intraretinal hemorrhages in the right eye and an inferotemporal subhyaloid hemorrhage with adjacent intraretinal hemorrhages and preretinal fibrosis in the left eye. Fluorescein angiography showed temporal peripheral leakage and capillary dropout in both eyes, consistent with occlusive vasculitis. Scatter laser treatment to peripheral areas of retinal nonperfusion was followed by an intravitreal bevacizumab injection. Four months later, vision had stabilized at 20/15 in both eyes and the peripheral leakage had resolved. Conclusions This patient developed retinal vasculitis associated with the rare autoimmune neuromuscular disorders of Isaacs syndrome and IBM. An extensive workup showed the most plausible mechanism for the vasculitis was autoimmunity with a history of previously elevated antibodies levels associated with the antiphospholipid syndrome.
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Affiliation(s)
- Luis Martinez-Velazquez
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Paul Zhou
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Sandra Hoyek
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Candace H. Feldman
- Division of Rheumatology, Immunology,
and Immunity, Department of Medicine, Harvard Medical School and Brigham and Women's
Hospital, Boston, MA, USA
| | - Anthony A. Amato
- Department of Neurology, Harvard
Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Lucia Sobrin
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Nimesh A. Patel
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Bascom
Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL,
USA
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3
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Shukla D. Feasibility of standalone antitubercular therapy for retinal vasculitis. Eye (Lond) 2022; 36:1853. [PMID: 35039680 PMCID: PMC9391330 DOI: 10.1038/s41433-021-01910-6] [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: 09/14/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/09/2022] Open
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Shukla D, Kalliath J, Dhawan A. Tubercular Retinal Vasculitis: Diagnostic Dilemma and Management Strategies. Clin Ophthalmol 2021; 15:4681-4688. [PMID: 34938066 PMCID: PMC8686227 DOI: 10.2147/opth.s284613] [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: 10/08/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Ocular tuberculosis (OTB) is a rare, extrapulmonary manifestation of systemic TB, which has been a global etiology of uveitis for centuries, though concentrated in the developing world. OTB remains difficult to diagnose clinically despite a plethora of conventional and modern investigations. Tubercular retinal vasculitis (TRV) is a common and specific presentation of OTB but is variably defined in the literature in terms of clinical profile and the investigations essential for diagnosis and treatment. Ironically, the need and duration of antitubercular treatment is uncertain for this manifestation of ocular TB. The rationale and utility for corticosteroids is similarly equivocal for TRV. This review attempts to tease out a commonsense approach from the best available evidence and consensus in the literature to suspect, investigate and diagnose TRV with reasonable certainty, and institute appropriate treatment with due ethnic and geographic considerations.
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Affiliation(s)
| | - Jay Kalliath
- Department of Ophthalmology, NMC Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Anuradha Dhawan
- Retina- Vitreous Service, Centre for Sight Group of Eye Hospitals, N. Delhi, India
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5
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dell'Omo R, Filippelli M, De Turris S, Cimino L, Steel DH, Pavesio CE, Govetto A, Chehaibou I, Parmeggiani F, Romano MR, Ziccardi L, Pirozzi E, Costagliola C. Fluorescein Angiography Findings in Eyes With Lamellar Macular Hole and Epiretinal Membrane Foveoschisis. Invest Ophthalmol Vis Sci 2021; 62:34. [PMID: 33512403 PMCID: PMC7846948 DOI: 10.1167/iovs.62.1.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The purpose of this paper was to study fluorescein angiography (FA) findings in eyes with lamellar macular hole (LMH), and epiretinal membrane (ERM) foveoschisis. Methods In this prospective, observational case series, 46 eyes of patients affected by either LMH or ERM foveoschisis were examined using optical coherence tomography (OCT) and FA. All patients underwent a comprehensive ophthalmological examination and a general workup to exclude uveitis. Main outcome measures were: presence of FA abnormalities, measurements of the areas of vascular leakage, and intensity of pixels in the vitreous. Results Twenty-four (52.2%) eyes with LMH and 22 (47.8%) with ERM foveoschisis were studied. Overall, FA abnormalities were found in 20 (83.3%) eyes with LMH and 18 (81.8%) with ERM foveoschisis. The median areas of posterior pole and peripheral leakage were 7.52 vs. 1.07 mm2 (P = 0.03) and 21.8 vs. 3.74 mm2 (P = 0.02) in the LMH and ERM foveoschisis group, respectively. Disk hyperfluorescence was found in 8 and 4 eyes and perivascular leak in 10 and 4 eyes with LMH and ERM foveoschisis, respectively. OCT-derived measurements of vitreous intensity did not differ between the two groups, and the investigational workup for uveitis was negative in all patients. Conclusions Discrete areas of central and peripheral leakage are commonly found in eyes with LMH and ERM foveoschisis, whereas perivascular leak and hyperfluorescence of the disc are less frequently observed. These findings suggest that breakdown of the retinal blood barrier, involving the posterior pole and the periphery, is frequently associated with these two vitreoretinal disorders.
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Affiliation(s)
- Roberto dell'Omo
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Mariaelena Filippelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - David H Steel
- Department of Ophthalmology, Sunderland Eye Infirmary, Sunderland, United Kingdom and Newcastle University, Sunderland, Newcastle, United Kingdom
| | | | - Andrea Govetto
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Ismael Chehaibou
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Francesco Parmeggiani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Mario R Romano
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lucia Ziccardi
- Neurophysiology and Neurophthalmology Unit, IRCCS- Fondazione Bietti, Rome, Italy
| | - Enza Pirozzi
- Institute of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
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6
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Huvard MJ, Pecen PE, Palestine AG. The Clinical Characteristics of Noninfectious Occlusive Retinal Vasculitis. Ophthalmol Retina 2021; 6:43-48. [PMID: 33901715 DOI: 10.1016/j.oret.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/21/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To characterize the clinical features of occlusive retinal vasculitis (ORV). DESIGN Retrospective case series. PARTICIPANTS Forty-two patients with ORV. METHODS A retrospective chart review identified all patients with ORV seen at the University of Colorado uveitis service between January 2013 and April 2020. All included patients demonstrated noninfectious uveitis and evidence of vascular occlusion in the presence of retinal vascular inflammation on widefield fluorescein angiography. MAIN OUTCOME MEASURES Demographic data, visual acuity, clinical findings, and fluorescein angiography findings. RESULTS We identified 73 eyes from 42 patients (15 men, 27 women) with ORV. Thirty-one of 42 patients had bilateral disease. Most eyes (54/73) showed mixed arteriolar and venous vasculitis compared with primarily arteriolar (6/73) or venous (15/73) vasculitis. Thirteen of 42 patients had an underlying systemic condition, most commonly granulomatosis with polyangiitis; however, bilaterality was not associated with a systemic condition. Retinal nonperfusion was present equally in zone 2 (28/73) and zone 3 (28/73) compared with zone 1 (16/73). Retinal or iris neovascularization was present in 25 of 73 eyes. Eighteen of 42 patients required more than 1 immunosuppressive medication (average, 1.33) to prevent progressive vascular occlusive disease. CONCLUSIONS Occlusive retinal vasculitis is a heterogeneous entity with significant risk of visual impairment. Systemic disease was more prevalent in this specific cohort compared with cohorts from prior studies of retinal vasculitis.
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Affiliation(s)
- Michael J Huvard
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paula E Pecen
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.
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7
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Shukla D. Re: Agrawal et al.: 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. 2021;128:277-287). Ophthalmology 2021; 128:e34-e35. [PMID: 33865623 DOI: 10.1016/j.ophtha.2021.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022] Open
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8
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Wang P, Chin EK, Almeida DR. Idiopathic retinal arterial occlusive vasculitis in the setting of multiple arterial occlusions. Am J Ophthalmol Case Rep 2021; 22:101086. [PMID: 33912730 PMCID: PMC8065184 DOI: 10.1016/j.ajoc.2021.101086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose We present a patient with vaso-occlusive retinal vasculitis to summarize this uncommon entity and review the clinical features and management challenges applicable to patients with retinal vasculitis. Observations A 76-year-old male presented with sudden-onset severe central vision loss. On examination, vitreous hemorrhage, neovascularization of the optic nerve, peripheral segmental periphlebitis, vessel sclerosis, vascular sheathing, and retinal hemorrhages were observed, and a diagnosis of active vaso-occlusive retinal vasculitis was made. The patient then underwent a complete infectious, inflammatory, and neoplastic workup which returned negative. The patient was treated with locally with a sub-Tenon's injection of 40 mg triamcinolone on presentation and later with oral prednisone. At three-month follow-up, vision improved to 20/300 with regressing neovascularization and clearing of vitreous hemorrhage in the right eye (OD). Conclusions Considering novel associations of occlusive retinal vasculitis, it is important to recognize that idiopathic occlusive retinal vasculitis, although uncommon, can occur and represents a prototypical disease form. It is imperative that these patients have a complete infectious, inflammatory, and neoplastic workup owing to the possible overlap of masquerade clinical signs and symptoms.
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Affiliation(s)
- Patrick Wang
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - Eric K Chin
- Retina Consultants of Southern California, Redlands, CA, USA.,Loma Linda University Medical Center, Veterans Affair Hospital, Loma Linda, CA, USA
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9
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Affiliation(s)
- Emmett T. Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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10
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Wang LU, Chen FT, Chen YJ, Wang JK, Chang SW, Hsu YR. Clinical and Epidemiological Profiles of Retinal Vasculitis in Northern Taiwan. Ocul Immunol Inflamm 2020; 30:310-317. [DOI: 10.1080/09273948.2020.1811352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ling-Uei Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Fang-Ting Chen
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun-Ju Chen
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Shu-Wen Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
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11
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Retinal vasculitis: A framework and proposal for a classification system. Surv Ophthalmol 2020; 66:54-67. [PMID: 32450158 DOI: 10.1016/j.survophthal.2020.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Abstract
Retinal vasculitis, a poorly understood process involving inflammation or ischemia of the retinal vessel wall, may occur in association with a systemic process, although it can also be isolated to the retina. Because of the limited ability to perform histopathological studies on retinal vessels, there is no gold standard for diagnosis. Thus, there is utility in creating a classification system for retinal vasculitis and improving diagnostic strategies for this disease. We provide a framework for understanding retinal vasculitis based on size, location, and etiology. We hope that this information can be implemented in the clinical setting to provide some diagnostic strategies for this often confusing entity.
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12
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Diagnostic and Therapeutic Challenges. Retina 2020; 40:387-390. [DOI: 10.1097/iae.0000000000002353] [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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13
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Kawali A, Bavaharan B, Sanjay S, Mohan A, Mahendradas P, Shetty B. A Long-Term Follow-up of Retinal Vasculitis – Do They Develop Systemic Disease? Ocul Immunol Inflamm 2020; 28:1181-1186. [PMID: 31906773 DOI: 10.1080/09273948.2019.1697455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Bharathi Bavaharan
- Department of Vitreo Retina Services, Narayana Nethralaya, Bangalore, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ashwin Mohan
- Department of Vitreo Retina Services, Narayana Nethralaya, Bangalore, India
| | | | - Bhujang Shetty
- Department of General Ophthalmology, Narayana Nethralaya, Bangalore, India
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Sheemar A, Temkar S, Takkar B, Sood R, Sinha S, Chawla R, Vohra R, Venkatesh P. Ultra-Wide Field Imaging Characteristics of Primary Retinal Vasculitis: Risk Factors for Retinal Neovascularization. Ocul Immunol Inflamm 2018; 27:383-388. [PMID: 30207804 DOI: 10.1080/09273948.2018.1508729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: To evaluate patterns of retinal vasculitis with ultra-wide field imaging (UWF) and ascertain the risk factors for retinal neovascularization. Methods: Consecutive patients of retinal vasculitis were included prospectively. Patients with retinal vasculitis secondary to uveitis were excluded. UWF was done for all the patients. Retinal involvement was classified into three zones and area of capillary non-perfusion was stratified into clock hours. Results: Two hundred patients were included, 85% (n = 170) were male. Mean age was 28.99 ± 10.56 years. Clinical examination revealed 65% cases (n = 130) to be bilateral, while UWF angiography detected 72.5% (n = 145) to have bilateral involvement. Retinal neovascularization was present in 47% (n = 188).Presence of posterior disease had very high odds ratio for development of retinal neovascularization as compared to cases restricted to retinal periphery (OR = 45.03, CI = 6.10-332.30, p = < 0.001). Conclusion: UWF imaging is useful in detecting retinal vasculitis, which is otherwise obscure to clinical examination and assessing risk factors for retinal neovascularization.
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Affiliation(s)
- Abhishek Sheemar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Shreyas Temkar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Brijesh Takkar
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rita Sood
- b Department of Medicine , All India Institute of Medical Sciences , New Delhi , India
| | - Sanjeev Sinha
- b Department of Medicine , All India Institute of Medical Sciences , New Delhi , India
| | - Rohan Chawla
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rajpal Vohra
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Pradeep Venkatesh
- a Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
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Majumder PD, Sitaula RK, Biswas J. Pediatric Eales Disease: An Indian Tertiary Eye Center Experience. J Pediatr Ophthalmol Strabismus 2018; 55:270-274. [PMID: 29709043 DOI: 10.3928/01913913-20180213-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical profiles, etiologies, treatment modalities, and outcomes for Eales disease in patients younger than age 16 years in India. METHODS Retrospective review of medical records of patients with Eales disease who had a minimum 5-year follow-up period. RESULTS A total of 25 eyes of 13 patients were included. Of these 13 patients, 12 (94%) had bilateral Eales disease and 11 (84.6%) were men. Mean patient age was 14.1 years (range: 11 to 16 years). Diminution of vision (36%) was the most common presenting complaint, followed by both diminutions of vision and floaters (32%). Sclerosed vessels were seen in all eyes, and 21 (84%) eyes had active periphlebitis at presentation. Neovascularization elsewhere was seen in 20 (80%) eyes and neovascularization of the optic disc was seen in 1 (4%) eye. Veno-venous shunts were found in 12 (48%) eyes, and 18 (72%) eyes had vitreous hemorrhage. All eyes received photocoagulation; 84.6% of patients received oral steroids, with 7.7% of patients treated with azathioprine and 38.4% treated with anti-tubercular therapy. Vitrectomy was performed in 36% of eyes for non-clearing vitreous hemorrhage and tractional retinal detachment. Vision improved in 7 (28%) eyes, was stable in 12 (48%) eyes, and worsened in 6 (24%) eyes. Recurrence of the disease more than five times during the 5-year follow-up period occurred in 20% of patients. CONCLUSIONS Recurrent vasculitis and vitreous hemorrhage in children should raise the suspicion of pediatric Eales disease. [J Pediatr Ophthalmol Strabismus. 2018;55(4):270-274.].
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17
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New imaging techniques in retinal vasculitis. Med Clin (Barc) 2017; 149:261-266. [PMID: 28687121 DOI: 10.1016/j.medcli.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 11/21/2022]
Abstract
The term retinal vasculitis (RV) encompasses a heterogeneous group of sight-threatening conditions that are included in the intraocular inflammatory diseases that affect the posterior segment of the eye. Based on the nature of the inflammatory process, RV are classified into predominantly inflammatory or ischaemic (occlusive RV). The diagnosis is clinical and the aetiology can be infectious or non-infectious (immune-mediated). RV can be an isolated ocular syndrome or be associated with a systemic disease, of which they can represent the first manifestation. New retinal imaging techniques such as ultra-wide field fluorescein angiography and optical coherence tomography angiography will help us classify the RV and aid the diagnostic process, which can be challenging and require a multidisciplinary approach. Therefore, clinical knowledge of RV is essential for prompt diagnosis and to establish the appropriate treatment.
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Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, Thorne JE. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol 2017; 179:171-178. [PMID: 28501390 DOI: 10.1016/j.ajo.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the incidence rates of visual loss and ocular complications in patients with retinal vasculitis (RV). DESIGN Retrospective cohort study. METHODS Clinical data were collected for 96 patients (175 eyes) diagnosed with RV from 2003 to 2013. Main outcome measures included rates of visual loss and ocular complications. Comparison of outcomes in patients with a relapsing vs nonrelapsing disease also were analyzed. RESULTS Over a median follow-up of 44 months (range: 1-153 months), the rate of visual loss to 20/50 or worse was 0.13 per eye-year (/EY, 95% confidence interval [CI], 0.09/EY to 0.18/EY) and to 20/200 or worse was 0.06/EY (95% CI, 0.04/EY to 0.08/EY). The most common complications were cataract (0.31/EY), epiretinal membrane (0.16/EY), and recurrent macular edema (0.09/EY). Patients with a relapsing course (median number of relapses = 1, range: 1-6) appeared to have greater risk for visual loss to 20/50 (odds ratio [OR] = 2.07; 95% CI, 0.88-4.90, P = .09) and 20/200 or worse (OR = 2.49; 95% CI, 0.98-6.30, P = .05). Immunosuppressive drug therapy lowered the risk of visual loss, independent of relapsing disease course (OR = 0.79; 95% CI, 0.66-0.94, P = .01 and OR = 0.73; 95% CI, 0.57-0.93, P = .01 for the 20/50 or worse and 20/200 or worse thresholds, respectively). CONCLUSIONS Rates of visual loss and complications among patients with RV were similar to reported rates in noninfectious uveitides. Treatment with immunosuppressive drugs lowered the risk of visual loss. A relapsing course suggested an increased risk for visual loss but was not statistically significant, perhaps owing to low numbers of recurrences.
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19
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Biswas J, K.R. R, Pal B, Gondhale HP, Kharel (Sitaula) R. Long-Term Outcomes of a Large Cohort of Patients with Eales’ Disease. Ocul Immunol Inflamm 2017; 26:870-876. [DOI: 10.1080/09273948.2017.1298817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jyotirmay Biswas
- Medical and Vision Research Foundations, Sankara Nethralaya, Uvea and Ocular Pathology, Chennai, Tamil Nadu, India
| | - Reesha K.R.
- Little Flower Hospital, Angamaly Ernakulam Kerala, India
| | - Bikramjit Pal
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | | | - Ranju Kharel (Sitaula)
- Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
- Department of Ophthalmology, Maharajgunj Medical Campus, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Teaching University, Kathmandu, Nepal
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Pelegrín L, Hernández-Rodríguez J, Espinosa G, Llorenç V, Sainz-de-la-Maza M, Fontenla JR, Martínez JA, Cid MC, Adán A. Characterization of isolated retinal vasculitis. Analysis of a cohort from a single center and literature review. Autoimmun Rev 2017; 16:237-243. [PMID: 28137481 DOI: 10.1016/j.autrev.2017.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/06/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Isolated retinal vasculitis (IRV) is an inflammatory condition of unknown etiology confined to the retinal vessels. In contrast to secondary retinal vasculitis (RV), IRV has not been well characterized. OBJECTIVE To describe and characterize isolated forms of RV. METHODS We performed a retrospective review (2006-2016) of IRV patients from a multidisciplinary Uveitis Unit. RV diagnosis was based on funduscopic and fluorescein angiography findings. To distinguish between secondary RV and IRV, evaluations included clinical assessment, several inflammatory, autoimmune and microbiological laboratory markers, and a chest radiography. Ophthalmological features at disease onset, therapeutic interventions, ocular relapses, visual outcomes and laboratory findings were recorded. Our cases were subsequently compared with those from a literature review. RESULTS Among 192 patients with RV, 11 (5.7%) were diagnosed with IRV. Seven patients with initially presumed IRV were reclassified as secondary after further evaluation. IRV generally affected adult women. Bilateral ocular involvement and retinal phlebitis were common findings. 72% of patients presented with visual loss, which was severe in 27%. Treatments used included systemic glucocorticoids (82%), additional immunosuppressive agents (27%), intravitreal therapy (37%), panretinal photocoagulation (37%) and pars plana vitrectomy (26%). The annual relapse rate was 0.46. Although final visual acuity was considered good in 86%, 45% experienced worsening and only 27% improved. CONCLUSIONS IRV is a rare sight-threatening condition. Despite intensive local and systemic immunosuppressive treatment, visual improvement is observed in only 27% of cases. When IRV is suspected, a differential diagnosis excluding a systemic disease is always warranted. A multidisciplinary approach and a guided clinical, laboratory and imaging evaluation have proven to be useful to distinguish retinal single-organ vasculitis from secondary forms of RV.
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Affiliation(s)
- Laura Pelegrín
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - Gerard Espinosa
- Uveitis Unit, Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Víctor Llorenç
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maite Sainz-de-la-Maza
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José R Fontenla
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José A Martínez
- Department of Infectious Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Uveitis Unit, Department of Ophthalmology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Mahendradas P, Vala R, Kawali A, Akkali MC, Shetty R. Adaptive Optics Imaging in Retinal Vasculitis. Ocul Immunol Inflamm 2016; 26:760-766. [DOI: 10.1080/09273948.2016.1263341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Ruchi Vala
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Eye Hospital, Bangalore, India
| | | | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
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Chen EJ, Bin Ismail MA, Mi H, Ho SL, Lim WK, Teoh SC, Agrawal R. Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) - Report 1: Epidemiology and Classification. Ocul Immunol Inflamm 2016; 26:732-746. [PMID: 27918224 DOI: 10.1080/09273948.2016.1249376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To report the epidemiology and classification of ocular inflammation at a tertiary eye care center in Singapore. METHODS Retrospective cohort study of the clinical records of consecutive new cases from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database from 2004-2015. RESULTS A total of 2200 patients were studied from the OASIS database. The most common anatomic diagnosis was anterior uveitis (55.9%), posterior uveitis (17.5%), panuveitis (9.6%), and intermediate uveitis (4.7%). In addition, scleritis (6.1%), keratouveitis (2.8%), retinal vasculitis (2.2%), and episcleritis (1.2%) were observed. Etiology was established in 65.1%, with 35.2% of patients associated with non-infectious etiologies. The most common etiologies found were presumed tuberculosis (7.2%), followed by cytomegalovirus infection (6.9%), herpetic infection (6.3%), HLA-B27-associated anterior uveitis (4.2%), and ankylosing spondylitis (3.8%). CONCLUSIONS The pattern of ocular inflammation in Singapore has similarities with both Western and Asian populations. Anterior uveitis was the most common, with non-infectious etiologies being slightly more common than infectious etiologies.
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Affiliation(s)
- Elizabeth J Chen
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore
| | | | - Helen Mi
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
| | - Su Ling Ho
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
| | - Wee Kiak Lim
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore.,c Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore
| | - Stephen C Teoh
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore.,c Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore
| | - Rupesh Agrawal
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore.,b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
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Donovan CP, Pecen PE, Baynes K, Ehlers JP, Srivastava SK. Retinal Vasculitis in Anti-Synthetase Syndrome. Ophthalmic Surg Lasers Imaging Retina 2016; 47:874-9. [DOI: 10.3928/23258160-20160901-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/23/2016] [Indexed: 11/20/2022]
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Abstract
AIMS To determine if characteristics of retinal vasculitis correlate with ocular complications, or the response to different lines of treatment. MATERIALS AND METHODS We performed a computerised database analysis of 56 patients evaluated for uveitis at the Casey Eye Institute from September 1985 until May 2010. All patients had non-infectious retinal vasculitis and at least 1 year of follow-up. RESULTS Although occlusive vasculitis was rare, retinal neovascularisation occurred much more commonly in the occlusive vasculitis subgroup than among the non-occlusive vasculitis subgroup (p<0.01). Epiretinal membrane (ERM) was found more commonly in the retinal vasculitis patients who presented with cotton wool spots and intraretinal haemorrhage compared to retinal vasculitis patients who presented with sheathing noted on clinical examination (p<0.01). Smoking was significantly related to vision loss. Age at presentation below 40 years correlated with therapy beyond oral corticosteroids CONCLUSIONS The heterogeneity of retinal vasculitis should be considered in providing prognostic information. Neovascularisation occurs more commonly in occlusive retinal vasculitis, and ERM is diagnosed more frequently in conjunction with cotton wool spots and intraretinal haemorrhage rather than just vascular sheathing. Cigarette use predicts visual loss and patients who are relatively young often receive treatment beyond oral corticosteroids.
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Affiliation(s)
- Amro Ali
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer H Ku
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Dongseok Choi
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA
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Apinyawasisuk S, Rothova A, Kunavisarut P, Pathanapitoon K. Clinical features and etiology of retinal vasculitis in Northern Thailand. Indian J Ophthalmol 2013; 61:739-42. [PMID: 24178403 PMCID: PMC3917393 DOI: 10.4103/0301-4738.120216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/02/2013] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report on the clinical features and etiology of patients with retinal vasculitis (RV). MATERIALS AND METHODS We reviewed medical records of 47 patients (75 affected eyes) diagnosed with RV. Clinical presentations, ocular complications, associated systemic diseases, and treatment regimens were registered. RESULTS Etiology of RV included infectious causes in 10/47, (21%) while an association with systemic and/or ocular non-infectious disorders was noted in 22/47 (47%). Eales' disease and Behcet's disease represented the most common clinical entities in non-infectious group while tuberculosis-associated RV was diagnosed in 6/10 (60%) among those with infectious disorders. RV was bilateral in 28/47 (60%) patients. Retinal veins were most commonly affected (72%, 34/47). Involvement of arteries was present in 12/47 (25%) and was associated with viral infections and Behcet's disease. Ocular complications developed in 60/75 (80%) eyes. The most common complications were elevated intraocular pressure and/or glaucoma (33/75, 44%). Retinal detachment, vitreous hemorrhage, and cystoid macular edema developed in similar percentages (15%). CONCLUSIONS RV in Thailand manifested mostly in male patients, was typically bilateral and involved mostly veins. Involvement of arteries was observed in patients with viral infections and Behcet's disease. Tuberculosis was the most common infectious cause.
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Affiliation(s)
- Supanut Apinyawasisuk
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aniki Rothova
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Braakenburg AM, Rothova A. The clinical characteristics of retinal vasculitis in HLA-B27-positive patients. Ocul Immunol Inflamm 2013; 22:197-202. [DOI: 10.3109/09273948.2013.835429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Saurabh K, Das RR, Biswas J, Kumar A. Profile of retinal vasculitis in a tertiary eye care center in Eastern India. Indian J Ophthalmol 2011; 59:297-301. [PMID: 21666315 PMCID: PMC3129755 DOI: 10.4103/0301-4738.81998] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims: To provide a fact file on the etiology, clinical presentations and management of retinal vasculitis in Eastern India. Materials and Methods: Retrospective, record based analysis of retinal vasculitis cases in a tertiary care center in Eastern India from January 2007 to December 2009. Results: One hundred and thirteen eyes of 70 patients of retinal vasculitis were included in this study. Sixty (85.7%) patients were male (mean age 33± 11.1 years) and 10 (14.3%) were female (mean age 32.4 ± 13.6 years). Vasculitis was bilateral in 43 (61.4%) and unilateral in 27 (38.6%) patients. Commonest symptoms were dimness of vision (73; 64.6%) and floaters (36; 31.9%). Vascular sheathing (82; 72.6%) and vitritis (51; 45.1%) were commonest signs. Mantoux test was positive in 21 (30%) patients but tuberculosis was confirmed in only four (5.71%) patients. Raised serum angiotensin-converting enzyme level and positive antinuclear antibody level were reported in four (5.71%) patients each. Human leukocyte antigen B5 (HLA B5) marker was present in one (1.4%) patient. However, none of the total 70 patients were found to have a conclusively proven systemic disease attributable as the cause of retinal vasculitis. Oral corticosteroid (60; 85.7%) was the mainstay of treatment. Forty-eight (42.5%) eyes maintained their initial visual acuity and 43 (38%) gained one or more line at mean follow-up of 16.6± 6.3 months. Conclusion: Retinal vasculitis cases had similar clinical presentations and common treatment plan. There was no systemic disease association with vasculitis warranting a careful approach in prescribing investigations.
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Affiliation(s)
- Kumar Saurabh
- Department of Vitreoretina, Sankara Nethralaya, Kolkata, West Bengal, India.
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Forooghian F, Cukras C, Meyerle CB, Nussenblatt RB, Gottlieb CC, Chew EY, Wong WT. Gallium scintigraphy in the investigation of retinal inflammatory vasculopathy. Acta Ophthalmol 2010; 88:e291-2. [PMID: 19878127 DOI: 10.1111/j.1755-3768.2009.01725.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mahyudin M, Choo MM, Ramli NM, Omar SS. Ocular Tuberculosis Initially Presenting as Central Retinal Vein Occlusion. Case Rep Ophthalmol 2010; 1:30-35. [PMID: 21116342 PMCID: PMC2992647 DOI: 10.1159/000317605] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 23-year-old man presented with central retinal vein occlusion. The retinal haemorrhages worsened and signs of retinal vasculitis appeared later as vision dropped from 6/60 to Counting Fingers. No signs of systemic disease were observed. Routine Mantoux test and chest radiograph were negative for tuberculosis. Fundus flourescein angiogram confirmed presence of retinal vasculitis. Both systemic and topical corticosteroid therapy were ineffective. Polymerase chain reaction analysis of vitreous fluid showed presence of Mycobacterium tuberculosis. A full 6-month course of antituberculosis therapy was given and inflammation subsided. Vision improved to 3/60. This is a rare case of ocular tuberculosis without evidence of systemic infection, presenting first as a central retinal vein occlusion.
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Affiliation(s)
- Muiz Mahyudin
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Neri P, Salvolini S, Giovannini A, Mariotti C. Retinal vasculitis associated with asymptomatic Gardnerella vaginalis infection: a new clinical entity. Ocul Immunol Inflamm 2009; 17:36-40. [PMID: 19294572 DOI: 10.1080/09273940802491876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report on 3 cases of retinal vasculitis associated with asymptomatic Gardnerella vaginalis (GV) infection. METHODS Review of 3 consecutive patients who presented with central retinal vasculitis without signs or symptoms of systemic disease. The vasculitis involved the central branches of the retinal vessels bilaterally and was steroid-dependent. RESULTS During treatment, patients developed clinically significant vaginitis, which the gynecologist considered to be exacerbated by the steroid treatment, leading to its withdrawal. All 3 vaginal specimens were positive for GV. Antibiotic susceptibility testing led to administration of oral ampicillin (2 g/day for 10 days), which resolved both the vaginal infection and the retinal vasculitis. CONCLUSIONS Idiopathic retinal vasculitis can be triggered by several agents. In this case series, GV was associated with retinal vasculitis, which was resolved by oral ampicillin. GV infection may be one of a number of triggers of retinal vasculitis. Appropriate treatment and full resolution of ocular inflammation requires exclusion of possible underlying infections.
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Affiliation(s)
- Piergiorgio Neri
- Eye Clinic, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy. doctor
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Majji AB, Vemuganti GK, Shah VA, Singh S, Das T, Jalali S. A comparative study of epiretinal membranes associated with Eales' disease: a clinicopathologic evaluation. Eye (Lond) 2005; 20:46-54. [PMID: 15877102 DOI: 10.1038/sj.eye.6701788] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To study the histopathologic features and clinical correlation of epiretinal membranes (ERM) obtained from patients of Eales' disease and compare with other vasoproliferative disorders. METHODS Retrospective analysis of epiretinal membranes submitted for histological evaluation between January 1995 and June 2001, from the patients of diabetic retinopathy and vascular occlusions (Group 1; vaso-occlusive disorders) and of Eales' disease (Group 2; vasoinflammatory disorders). Demographics, pre and postoperative visual acuity, and anatomic and histologic characteristics of membranes were studied. Histopathologic features and clinical outcomes were correlated between the groups. The results were analysed statistically by Student's t-test, Fisher's exact test and Kruskal-Wallis test. RESULTS This study consisted of 42 patients, 24 in Group 1 and 18 in Group 2. Patients in Group 2 (33.0+/-9.2 years) were significantly younger than the patients in Group 1 (49.9+/-7.6 years) (P< or =0.0001). Final visual acuity of >20/400 was attained in 79.2% (19/24) patients in Group 1 and 83.3% (15/18) in Group 2 (P=1.0). Inflammatory membranes were significantly associated with presumed Eales' disease (94.4 vs 0%) (P< or =0.0001) and fibrovascular membranes with Group 1 (70.8% vs 33.3%) (P=0.028). Mast cells and eosinophils were observed as special features in epiretinal membranes of patients with Eales' disease. CONCLUSIONS Histological features of ERM in Eales' disease are comparable to other vasoproliferative disorders except for features of inflammation. Presence of mast cells and eosinophils in epiretinal membranes of Eales' disease needs further investigation.
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Affiliation(s)
- A B Majji
- Smt Kanuri Santhamma Retina-Vitreous Centre, LV Prasad Eye Institute, Hyderabad, India.
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Affiliation(s)
- Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg. 10 Room 10S219C, Bethesda, MD 20892, USA
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Ozdek S, Gürelik G, Hasanreisoglu B, Fu AD, Harrison S, Godley B. Diagnostic and therapeutic challenges. Retina 2004; 24:602-9. [PMID: 15300082 DOI: 10.1097/00006982-200408000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sengül Ozdek
- Opthalmology Department, Gazi University School of Medicine, Ankara, Turkey
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Abstract
Retinal vasculitis represents a group of diseases characterized by inflammation affecting the retinal vasculature. It is an uncommon disorder that may occur as an isolated disease or more commonly in association with other ocular diseases or a variety of systemic diseases. With a wide variety of disease associations, a search for an underlying etiology should be undertaken based on a meticulous history, review of systems, and physical examination. The laboratory evaluation of patients with retinal vasculitis is an essential component of the work-up to facilitate detection of any underlying disease or to establish a limited differential diagnosis. The management of infectious causes of retinal vasculitis consists of antimicrobial therapy while noninfectious retinal vasculitis is managed with corticosteroids and/or immunosuppressive agents. Because retinal vasculitis is an uncommon disease, there are only a limited number of publications over the past year related to this topic.
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Affiliation(s)
- R Christopher Walton
- Department of Ophthalmology, University of Tennessee College of Medicine, Memphis, 38163, USA.
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Abstract
The retinal arteries and veins may be involved in isolation or as the result of a systemic vasculitis. This article emphasizes neurologic diseases in which the ocular vasculature is affected.
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Affiliation(s)
- Judith E A Warner
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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Abstract
Retinal vasculitis is a rare, but potentially blinding intraocular inflammatory condition with diverse aetiology. Although commonly idiopathic, it has a strong association with systemic inflammatory diseases known to involve other areas of the central nervous system, most notably Behcet's disease, sarcoidosis, systemic lupus erythematosis and multiple sclerosis. This article describes the clinicopathologic features of retinal vasculitis and its visually damaging sequelae, reviewing available human histopathologic studies and work with experimental models to discuss the pathogenesis and immunopathology. Evidence indicates that noninfective retinal vasculitis is an autoimmune condition that may be induced by antecedent infection with microbes cross-reacting with putative autoantigens, influenced by genetic susceptibility of both HLA associations and cytokine polymorphisms. The growing understanding of the cellular mechanisms involved in the effector immune response is already providing a rationale for more specific therapeutic approaches.
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Affiliation(s)
- E H Hughes
- University of Bristol, Bristol Eye Hospital, Bristol, UK
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Abstract
Eales disease, first described by Henry Eales in 1880, remains an enigma. The disease, observed more commonly in the Indian subcontinent than in the rest of the world, occurs in young healthy adult males, initially presenting as retinal periphlebitis and later as retinal ischemia that may lead to vascular alterations and neovascularization. Recurrent vitreous hemorrhage with or without retinal detachment is the common sequelae. In recent years, immunological, molecular biological, and biochemical studies have indicated the role of human leukocyte antigen, retinal autoimmunity, mycobacterium tuberculosis genome, and free radical mediated damage in the etiopathogenesis of this disease. However, its etiology appears to be multifactorial. The management depends on the stage of the disease and consists of medical treatment with oral corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages. The results of vitreoretinal surgery have been found to be satisfactory in case of vitreous hemorrhage with or without retinal detachment.
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Rosenbaum JT, Smith JR. Ocular features associated with anticardiolipin antibodies: a descriptive study. Am J Ophthalmol 2002; 133:293-4. [PMID: 11812452 DOI: 10.1016/s0002-9394(01)01289-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stanford MR, Verity DH. Diagnostic and therapeutic approach to patients with retinal vasculitis. Int Ophthalmol Clin 2000; 40:69-83. [PMID: 10791258 DOI: 10.1097/00004397-200004000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M R Stanford
- Department of Ophthalmology, Rayne Institute, St. Thomas' Hospital, London, UK
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Abstract
PURPOSE The authors present clinical features of 18 juvenile patients with a new type of uveitis termed bilateral iridocyclitis with retinal capillaritis (BIRC). METHODS The authors reviewed medical records of 18 consecutive patients who showed bilateral iridocyclitis with retinal capillary leakage but no systemic manifestations during an 11-year period from January 1985 to December 1995. RESULTS Twelve of the 18 patients were female and the age at onset ranged from 9 to 17 years old. All patients had many cells in the anterior chamber and anterior vitreous, together with mutton fat keratic precipitates. Fluorescein angiography showed leakage from the optic disc and retinal capillaries, mainly in the midperiphery, which corresponded to retinal cloudiness. Macular edema was minimal, and all patients maintained good vision. The inflammation responded well topical, oral, and intravenous administration of corticosteroids, the choice of which was based on the extent of retinal inflammation. Human leukocyte antigen (HLA)-DR6 and HLA-Cw7 were associated significantly with the presence of BIRC (chi square test, P < 0.0001). CONCLUSIONS Bilateral retinal capillaritis affecting capillaries in various areas of the retina and overlying retinal cloudiness with no distinct lesions are unique to these patients. Fluorescein angiography is essential for diagnosis of BIRC.
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Affiliation(s)
- T Matsuo
- Department of Ophthalmology, Okayama University Medical School, Japan
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Dunn JP, Noorily SW, Petri M, Finkelstein D, Rosenbaum JT, Jabs DA. Antiphospholipid antibodies and retinal vascular disease. Lupus 1996; 5:313-22. [PMID: 8869905 DOI: 10.1177/096120339600500413] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Antiphospholipid antibody retinopathy is a rare and poorly defined clinical entity in which the proper diagnosis has important ocular and systemic implications. The clinical course of five patients with antiphospholipid antibody retinopathy is described and the role of such antibodies in idiopathic retinal venous occlusive disease is investigated. METHODS Five case reports are presented highlighting the presentation, course, therapy, associations and outcomes of patients with antiphospholipid antibody retinopathy. In addition, twenty additional patients presenting with idiopathic retinal venous occlusive disease were tested for the presence of antiphospholipid antibodies. RESULTS All five patients with antiphospholipid antibody retinopathy had diffuse retinal vascular occlusion. All five patients presented with associated rheumatologic disease, including three with lupus or lupus-like disease. Antibodies to antiphospholipid were not detected in any of the twenty patients with idiopathic retinal venous occlusive disease. Prompt panretinal photocoagulation together with varying regimens of corticosteroids, immunosuppressives, or warfarin was partially successful in stabilizing the ocular and systemic disease. CONCLUSION The diagnosis of antiphospholipid antibody retinopathy should be suspected in patients with diffuse retinal vaso-occlusion, particularly when characterized by involvement of both arteries and veins, neovascularization at presentation, and symptoms of symptoms of systemic rheumatologic disease. Antiphospholipid antibodies do not appear to play an important role in idiopathic retinal vein occlusions.
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Affiliation(s)
- J P Dunn
- Wilmer Ophthlmological Institute, Department of Ophthalmology, Jhons Hopkins University School of Medicine, Baltimore, MD 21205, USA
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