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Magesan K, Ahmed A, George AE, Ganesh SK, Biswas J, Dutta Majumder P. An Analysis of the clinical and investigative profile of uveitis in the elderly: First case series from India. Indian J Ophthalmol 2024; 72:S596-S600. [PMID: 38454869 PMCID: PMC11338401 DOI: 10.4103/ijo.ijo_2788_23] [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: 10/18/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To evaluate the spectrum of uveitis occurring after 60 years of age in elderly patients who presented to a tertiary care eye center in India. METHODS Retrospective study of patients who visited a tertiary eye care institute between January 2010 and July 2020. RESULT Eighty-seven patients developed uveitis after 60 years, with only 44.8% having sufficient follow-up documentation and were included in the final analysis. The median age of these patients was 64 (IQR: 62-70) years, and 69% of them were male. Among the identifiable causes of uveitis, infectious uveitis (36%) was the most common and noninfectious uveitis was noted in 23% of patients. The most common subtype of uveitis was anterior uveitis (52%), followed by intermediate uveitis (32%), panuveitis (11%), and posterior uveitis (7%). Tuberculosis (28%) was the most common cause in our cohort, followed by HLA B27 (10%), sarcoid (8%), and Vogt-Koyanagi-Harada disease (5%). In 41% of patients, a definitive diagnosis of uveitis could not be achieved, and the anterior uveitis group had the highest number of undifferentiated uveitis cases. There were no undifferentiated cases of uveitis in the posterior and panuveitis category. The median follow-up period of these patients was 52 (15-91) months and 66% of eyes had recurrence. A statistically significant improvement in vision was seen in anterior uveitis and panuveitis groups, whereas the median visual acuity of the intermediate uveitis group remained stable throughout the follow-up period. CONCLUSION Uveitis in the elderly can have a higher recurrence rate; however, the lack of follow-up in these groups of patients is a major challenge.
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Affiliation(s)
- Kowsigan Magesan
- Department of Optometry, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Arshee Ahmed
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Amala E George
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Sudha K Ganesh
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
- Department of Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
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Barraquer-López D, Cifuentes-González C, Peña-Pulgar LF, Rojas-Carabali W, Villa-Piñeros J, de-la-Torre A. De Novo Uveitis in the Colombian Elderly Population: Characteristics and Comparison with Patients Under 60 Years of Age. Ocul Immunol Inflamm 2024; 32:71-78. [PMID: 36624966 DOI: 10.1080/09273948.2022.2155841] [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: 07/02/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe the differences between de novo uveitis in elderly patients (≥60 years of age) and younger patients (< 60 years of age) in Colombia. METHODS Observational, analytic, cross-sectional study. RESULTS In the elderly group, idiopathic was the most common type of uveitis, followed by immune-mediated and infectious uveitis.No masquerade syndromes were diagnosed. Elderly patients had worse average visual acuities than young. Significant differences between both groups were observed in corneal edema, macular edema, cataract, glaucoma, and epiretinal membrane. Additionally, there were differences in the drugs used, such as topical hypotensive drugs, ocular lubricants, topical steroids, methotrexate, hydroxychloroquine, and adalimumab. CONCLUSION The present study demonstrated significant differences between elderly and young Colombian patients with de novo uveitis. The ophthalmologists should be aware of these patterns of presentation, which would help reach an adequate diagnosis and prevent complications based on the characteristics of each group.
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Affiliation(s)
- Doménico Barraquer-López
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Luisa Fernanda Peña-Pulgar
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Jerónimo Villa-Piñeros
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
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Hébert M, You E, Touma S, Bourgault S, Hammamji K, Dirani A. Indications and pathologic diagnoses of diagnostic chorioretinal biopsies in the province of Quebec, Canada. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:491-497. [PMID: 35716703 DOI: 10.1016/j.jcjo.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/10/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review the clinical usefulness of chorioretinal biopsies in diagnostically undefined cases of intraocular inflammation or chorioretinal lesions. DESIGN Retrospective case series. PARTICIPANTS Seven patients who underwent chorioretinal biopsies. METHODS This case series included all consecutive patients who underwent chorioretinal biopsies in 2 academic tertiary care centres in the province of Quebec between 2014 and 2020. RESULTS A total of 7 patients were included in the study. Five patients with intraocular inflammation underwent chorioretinal biopsies to rule out an infectious or neoplastic etiology, whereas 2 patients underwent biopsies for suspicion of neoplastic chorioretinal masses. Final diagnoses included primary chorioretinal lymphoma (n = 2), toxoplasmosis (n = 1), benign choroidal mass (n = 1), nonnecrotizing granuloma (n = 1), and peripheral exudative hemorrhagic chorioretinopathy (n = 1). No specific diagnosis was defined in 1 case of panuveitis with scleritis. No postoperative complications were reported. CONCLUSIONS Chorioretinal biopsies clarified the diagnosis in 6 of 7 patients, including a definitive diagnosis of lymphoma in 2 patients. This is a high rate of diagnosis that also represents clinically meaningful results that influence management. Future directions include identifying patients in whom adjuvant chorioretinal biopsy would yield a high rate of diagnosis.
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Affiliation(s)
- Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada
| | - Eunice You
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada
| | - Samir Touma
- Department of Ophthalmology, Centre hospitalier universitaire de Montréal, Montreal, Qc, Canada
| | - Serge Bourgault
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada
| | - Karim Hammamji
- Department of Ophthalmology, Centre hospitalier universitaire de Montréal, Montreal, Qc, Canada
| | - Ali Dirani
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada.
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Okazawa R, Iwai S, Nagura K, Sora D, Sato T, Takayama K, Harimoto K, Kanda T, Takeuchi M. Epidemiology and characteristics of common forms of anterior uveitis at initial presentation in a tertiary facility in Japan. Jpn J Ophthalmol 2023; 67:22-31. [PMID: 36346554 DOI: 10.1007/s10384-022-00961-w] [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: 06/16/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To elucidate detailed epidemiological profile of common types of anterior uveitis (AU) in real-world clinical setting of a tertiary facility in Japan, and to evaluate the characteristic clinical findings at initial presentation. STUDY DESIGN Retrospective cohort study. METHODS Clinical charts of 275 patients (335 eyes) aged 52.5 ± 19.1 years were reviewed retrospectively. Herpetic AU was diagnosed by multiplex polymerase chain reaction tests using aqueous humor. Time of uveitis onset, gender, laterality, disease course since the initial onset of AU, visual acuity (VA) and intraocular pressure (IOP) at first visit, and definitive diagnosis were collected from clinical charts. RESULTS Acute AU (AAU) was the most common (21.8%) form of AU; followed by herpetic AU (20.7%) comprising Herpes Simplex Virus (HSV) (8.0%), Varicella Zoster Virus (VZV) (9.1%) and cytomegalo virus (CMV) (3.6%); scleritis (13.5%); diabetic iritis (7.6%), and Posner-Schlossman syndrome (5.5%). Unilateral AU constituted 78.2%, and VA less than 20/30 accounted for 31.2%. Of all the eyes, 16.1% had an IOP higher than 20 mmHg, out of which 37.0% had herpetic AU, followed by scleritis in 25.9%, and Posner-Schlossman syndrome (PSS) in 11.1%. AU patients over 60 years of age were 40.4%, in which 34.2% had herpetic AU, followed by scleritis in 14.4% and AAU in 13.5%. Herpetic AU patients were significantly older and had higher IOP compared with AAU patients. CONCLUSION The most frequent AU was AAU, followed by herpetic AU. Herpetic AU patients were older and had higher intraocular pressure than AAU patients, although VA was equally impaired in both groups.
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Affiliation(s)
- Rina Okazawa
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Seima Iwai
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Koichi Nagura
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Daisuke Sora
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Kei Takayama
- Sakura street Takayama Eye Clinic, 4-262-1 Sakuragaoka, Higashiyamato, Japan
| | - Kozo Harimoto
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan.
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Zhao XY, Cheng TT, Meng LH, Zhang WF, Chen YX. Clinical Features, Diagnosis, Management and Prognosis of Primary Intraocular Lymphoma. Front Oncol 2022; 12:808511. [PMID: 35186744 PMCID: PMC8851327 DOI: 10.3389/fonc.2022.808511] [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: 11/04/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the clinical features, diagnostic techniques, various treatment strategies and prognosis of primary intraocular lymphoma (PIOL).MethodsThe databases PubMed, EMBASE, and Ovid were searched from inception to March 2021 to identify relevant studies. Statistical analyses were performed with R version 3.3.1.Results87 studies involving 1484 patients (aged from 14 to 90 years old) were finally included. The pooling results indicated PIOL patients were female, elderly, binocular and B cell type dominated. About 19% have central nervous system (CNS) involvement at the first visit. During follow-up, the incidence of CNS involvement, death rate, 2-year and 5-year survival rate, 1-year and 2-year progression-free survival, and recurrence rate were 58%, 33%, 82%, 70%, 88%, 70%, 44%, respectively. The most common recurrent site was CNS. The delayed diagnosis rate was 85%, the misdiagnosed rate was 64%. The diagnostic technique with the highest positive rate was IL10:IL6>1 of aqueous (98%). The most common symptoms, signs, FFA and OCT features were blurring of vision (72%), vitreous inflammatory opacity (92%), FA/FAF reversal (91%) and hyper-reflective foci in posterior vitreous (53%), respectively. The prognosis of PIOL patients without CNS involvement was obviously better than those with CNS involvement. Overall, intravitreal injection of chemotherapy drug plus systemic chemotherapy (IV+CT) could achieve satisfactory prognosis, the combination of local radiotherapy (RT) could further decrease the recurrent and death rate.ConclusionPIOL patients with CNS involvement had significantly worse prognosis. The aqueous humor examination should be regarded as first-line and routine diagnostic technique. IV+CT could achieve satisfactory prognosis, the combination of RT was also beneficial.
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Affiliation(s)
- Xin-yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian-tian Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - You-xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: You-xin Chen, ;
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Classification Criteria for Intermediate Uveitis, Non-Pars Planitis Type. Am J Ophthalmol 2021; 228:159-164. [PMID: 33839089 PMCID: PMC8501159 DOI: 10.1016/j.ajo.2021.03.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine classification criteria for intermediate uveitis, non-pars planitis type (IU-NPP, also known as undifferentiated intermediate uveitis). DESIGN Machine learning of cases with IU-NPP and 4 other intermediate uveitides. METHODS Cases of intermediate uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the intermediate uveitides. The resulting criteria were evaluated on the validation set. RESULTS Five hundred eighty-nine of cases of intermediate uveitides, including 114 cases of IU-NPP, were evaluated by machine learning. The overall accuracy for intermediate uveitides was 99.8% in the training set and 99.3% in the validation set (95% confidence interval 96.1, 99.9). Key criteria for IU-NPP included unilateral or bilateral intermediate uveitis with neither snowballs in the vitreous humor nor snowbanks on the pars plana. Other key exclusions included multiple sclerosis, sarcoidosis, and syphilis. The misclassification rates for IU-NPP were 0% in the training set and 0% in the validation set. CONCLUSIONS The criteria for IU-NPP had a low misclassification rate and seemed to perform well enough for use in clinical and translational research.
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Classification Criteria for Birdshot Chorioretinitis. Am J Ophthalmol 2021; 228:65-71. [PMID: 33845003 PMCID: PMC8517033 DOI: 10.1016/j.ajo.2021.03.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine classification criteria for birdshot chorioretinitis. DESIGN Machine learning of cases with birdshot chorioretinitis and 8 other posterior uveitides. METHODS Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set. RESULTS One thousand sixty-eight cases of posterior uveitides, including 207 cases of birdshot chorioretinitis, were evaluated by machine learning. Key criteria for birdshot chorioretinitis included a multifocal choroiditis with (1) the characteristic appearance of a bilateral multifocal choroiditis with cream-colored or yellow-orange, oval or round choroidal spots ("birdshot" spots); (2) absent to mild anterior chamber inflammation; and (3) absent to moderate vitreous inflammation; or multifocal choroiditis with positive HLA-A29 testing and either classic "birdshot spots" or characteristic imaging on indocyanine green angiography. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for birdshot chorioretinitis were 10% in the training set and 0% in the validation set. CONCLUSIONS The criteria for birdshot chorioretinitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
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Radosavljevic A, Agarwal M, Chee SP, Zierhut M. Epidemiology of Viral Induced Anterior Uveitis. Ocul Immunol Inflamm 2021; 30:297-309. [PMID: 33617392 DOI: 10.1080/09273948.2020.1853177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Viral agents are the most common cause of infectious anterior uveitis worldwide. The purpose of this review is to analyze the frequency, gender and racial differences of viral anterior uveitis (VAU) in various populations.Methods: Systematized literature review of epidemiological reports of VAU cited in PubMed, EMBASE and the Cochrane Library database published until June 30th, 2020.Results: A total of 12 clinical studies on epidemiology of definite VAU and 36 clinical studies of presumed VAU were identified. Members of Herpesviridae family represent the most common causes of VAU. Other less frequently reported causes, such as rubella and endemic viruses (HTLV-1, Chikungunya, Dengue, Ebola, Zika virus) were also analyzed.Conclusion: HSV, VZV are prevalent worldwide. CMV is more frequent in Asia, and rubella in the West. However, due to globalization and air travel, HTLV-1, Chikungunya, Dengue and Ebola may become important causes of VAU across the world.
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Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Duke-NUS Medical School, Singapore
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tubingen, Tubingen, Germany
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Samalia P, Hawley LJ, Niederer RL, Sims J. Review of de novo uveitis in older adults presenting to a large tertiary centre. Br J Ophthalmol 2021; 106:941-946. [PMID: 33597198 DOI: 10.1136/bjophthalmol-2020-318657] [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: 12/16/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The primary aim of this study was to describe the causes of de novo uveitis in individuals 60 years and older. Secondary objectives were to determine the incidence of intraocular lymphoma and the clinical predictors of lymphoma. METHODS Retrospective chart review of all subjects presenting to the uveitis service at Auckland District Health Board (Auckland, New Zealand) between January 2006 and October 2020 RESULTS: 686 subjects (900 eyes) were aged ≥60 years at first presentation with uveitis, representing 23.4% of all subjects with uveitis during the study period. Non-infectious aetiology occurred in 631 (70.1%) eyes and infectious etiologies occurred in 269 (29.9%) eyes. The most frequent causes were idiopathic (36.3%), herpes zoster (14.8%), HLAB27 (8.7%) and sarcoidosis (4.8%). Twenty (2.2%) eyes of 13 (1.9%) subjects had a diagnosis of lymphoma. Lymphoma represented 11.2% of all intermediate uveitis. Subjects diagnosed with lymphoma did not develop posterior synechiae, epiretinal membrane, cystoid macular oedema or ocular hypertension. CONCLUSIONS Intraocular lymphoma was uncommon in the overall cohort, but an important cause of intermediate uveitis. A diagnosis of lymphoma needs to be considered in any older subject with de novo intermediate uveitis. The lack of posterior synechiae, cystoid macular oedema, epiretinal membrane and ocular hypertension further increases the suspicion for lymphoma.
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Affiliation(s)
- Priya Samalia
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand .,Ophthalmology, The University of Auckland Department of Ophthalmology, Auckland, New Zealand
| | | | | | - Joanne Sims
- Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
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Grumet P, Kerever S, Gilbert T, Kodjikian L, Gerfaud-Valentin M, De Parisot A, Jamilloux Y, Sève P. Clinical and etiologic characteristics of de novo uveitis in patients aged 60 years and above: experience of a French tertiary center. Graefes Arch Clin Exp Ophthalmol 2019; 257:1971-1979. [PMID: 31312906 DOI: 10.1007/s00417-019-04411-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/05/2019] [Accepted: 07/02/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To describe the characteristics of de novo uveitis in patients ≥ 60 years old. METHODS Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared. RESULTS A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group. CONCLUSION In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.
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Affiliation(s)
- P Grumet
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - S Kerever
- Service d'Anesthésie-Réanimation, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Gilbert
- Service de Gériatrie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - L Kodjikian
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - M Gerfaud-Valentin
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - A De Parisot
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - Y Jamilloux
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France
| | - P Sève
- Servicede Médecine Interne, Hôpital de la Croix-Rousse, Hospic es Civils de Lyon, Université Claude Bernard-Lyon 1, 103 grande rue de la Croix-Rousse, 69318, Lyon Cedex 04, France. .,Hospices Civils de Lyon, Pôle IMER, F-69003, Lyon, France. .,Univ. Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
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Accorinti M, Okada AA, Smith JR, Gilardi M. Epidemiology of Macular Edema in Uveitis. Ocul Immunol Inflamm 2019; 27:169-180. [DOI: 10.1080/09273948.2019.1576910] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Annabelle A. Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Justine R. Smith
- Flinders University College of Medicine & Public Health, Adelaide, Australia
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Abstract
Uveitis can affect individuals of all ages, genders, and races and accounts for 10-15% of all cases of blindness. Uveitis represents a diverse array of intraocular inflammatory conditions that can be associated with complications from autoimmune diseases, bacterial infections, viral infections, chemical injuries, and metabolic issues. In rodents, endotoxin-induced uveitis (EIU) is an efficient experimental model to study pathological mechanisms associated with the disease and evaluate the pharmacological efficacy of potential new drug agents. In the EIU model, uveitis is characterized by clinically relevant inflammation, including inflammatory exudates and cells infiltrated into the anterior and vitreous eye chambers. EIU in small animal models, including rats, mice, and rabbits, is characterized by a short-lived uveal inflammation. This inflammation can be facilitated using bacterial endotoxins, such as lipopolysaccharide (LPS). In this chapter, we present a reliable, reproducible, and simplified protocol to induce EIU in mice. This method is flexible and can be applied for EIU induction in other small animals and rodents.
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Affiliation(s)
- Umesh C S Yadav
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kota V Ramana
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to determine the prevalence of uveitis in the diabetic population, the clinical features of the uveitis and diabetes when coexisting and pathophysiology of a possible correlation. We also aim to review the cases of diabetes and uveitis in the literature. RECENT FINDINGS The basis of an association between uveitis and diabetes mellitus (DM) is the common pathophysiology of inflammation. There are several reports on a DM-related uveitis, defined as idiopathic anterior uveitis in the presence of poorly controlled DM, but causation has not been established. There are conflicting results in the literature regarding an association between uveitis and DM. More studies are needed to determine if an association truly exists.
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Affiliation(s)
- Wajiha J Kheir
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Huda A Sheheitli
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Rola N Hamam
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon.
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14
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Wakefield D, McCluskey P, Wildner G, Thurau S, Carr G, Chee SP, Forrester J, Dick A, Hudson B, Lightman S, Smith J, Tugal-Tutkun I. Inflammatory eye disease: Pre-treatment assessment of patients prior to commencing immunosuppressive and biologic therapy: Recommendations from an expert committee. Autoimmun Rev 2017; 16:213-222. [PMID: 28137477 DOI: 10.1016/j.autrev.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022]
Abstract
AIM To outline recommendations from an expert committee on the assessment and investigation of patients with severe inflammatory eye disease commencing immunosuppressive and/or biologic therapy. METHOD The approach to assessment is based on the clinical experience of an expert committee and a review of the literature with regard to corticosteroids, immunosuppressive drug and biologic therapy and other adjunct therapy in the management of patients with severe sight-threatening inflammatory eye disease. CONCLUSION We recommend a careful assessment and consultative approach by ophthalmologists or physicians experienced in the use of immunosuppressive agents for all patients commencing immunosuppressive and/or biologic therapy for sight threatening inflammatory eye disease with the aim of preventing infection, cardiovascular, metabolic and bone disease and reducing iatrogenic side effects.
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Affiliation(s)
- Denis Wakefield
- University of New South Wales, Faculty of Medicine, Kensington, Australia.
| | - Peter McCluskey
- Save Sight Institute, Sydney Eye Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gerhild Wildner
- Section of Immunobiology, Department of Ophthalmology, Clinic of the University of Munich, Munich, Germany
| | - Stephan Thurau
- Section of Immunobiology, Department of Ophthalmology, Clinic of the University of Munich, Munich, Germany
| | - Gregory Carr
- Manly Hospital, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Soon-Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Department of Ophthalmology, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore National Eye Centre, Ocular Inflammation and Immunology Department, Singapore
| | - John Forrester
- The Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Andrew Dick
- UCL-Institute of Ophthalmology, London, UK; School of Clinical Science, University of Bristol, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | - Bernard Hudson
- Department of Microbiology & Infectious Diseases, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia
| | - Susan Lightman
- UCL/Institute of Ophthalmology, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Justine Smith
- Eye & Vision Health, Flinders University School of Medicine, Adelaide, Australia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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15
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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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16
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Sabhapandit S, Murthy SI, Singh VM, Gaitonde K, Gopal M, Marsonia K, Sajid S, Babu K. Epidemiology and Clinical Features of Uveitis from Urban Populations in South India. Ocul Immunol Inflamm 2016; 25:S39-S45. [PMID: 27782762 DOI: 10.1080/09273948.2016.1236971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the epidemiology of uveitis in two urban centers in South India. METHODS Case records seen between January 2014 and December 2014 at two tertiary eye centers in South India were retrospectively reviewed. RESULTS A total of 1123 patients in the study population had uveitis. Anterior uveitis was seen in 48.9%, posterior in 20.5%, intermediate in 17.3%, and panuveitis in 13.3%. Of these cases, 68.4% were acute uveitis. Pediatric uveitis constituted 6.9% patients. Tuberculosis was the commonest infectious etiology. CONCLUSIONS Idiopathic uveitis was highest in non-infectious and tuberculosis in infectious etiology. Toxoplasmosis was seen in the pediatric age group.
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Affiliation(s)
- Swapnali Sabhapandit
- a Tej Kohli Cornea Institute, LV Prasad Eye Institute , Kallam Anji Reddy Campus , Hyderabad , Telangana , India
| | - Somasheila I Murthy
- a Tej Kohli Cornea Institute, LV Prasad Eye Institute , Kallam Anji Reddy Campus , Hyderabad , Telangana , India
| | - Vivek M Singh
- a Tej Kohli Cornea Institute, LV Prasad Eye Institute , Kallam Anji Reddy Campus , Hyderabad , Telangana , India
| | - Ketaki Gaitonde
- a Tej Kohli Cornea Institute, LV Prasad Eye Institute , Kallam Anji Reddy Campus , Hyderabad , Telangana , India
| | - Madhumita Gopal
- a Tej Kohli Cornea Institute, LV Prasad Eye Institute , Kallam Anji Reddy Campus , Hyderabad , Telangana , India
| | - Kerul Marsonia
- a Tej Kohli Cornea Institute, LV Prasad Eye Institute , Kallam Anji Reddy Campus , Hyderabad , Telangana , India
| | - Shajeera Sajid
- b Prabha Eye Clinic & Research Centre , Bangalore , Karnataka , India
| | - Kalpana Babu
- b Prabha Eye Clinic & Research Centre , Bangalore , Karnataka , India
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17
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Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C, Androudi S. A Focus on the Epidemiology of Uveitis. Ocul Immunol Inflamm 2016; 26:2-16. [PMID: 27467180 DOI: 10.1080/09273948.2016.1196713] [Citation(s) in RCA: 320] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Uveitis is a common, sight-threatening inflammatory ocular disease and includes multiple heterogeneous clinical entities. The prevalence of various types of uveitis depends upon multiple factors, such as age, sex, race, geographic distribution, environmental influence, genetics, and social habits. Epidemiologic research of uveitis is necessary to understand the etiology and immunopathogenesis of this group of diseases. The present study attempts to concentrate on the most recent information on the epidemiology of uveitis and compare it with previous knowledge. METHODS An extensive literature search was performed in the Medline database (PubMed) and included surveys completed until 2015. Articles that reported prevalence and incidence were studied. References cited in the articles were also studied. RESULTS The incidence and prevalence of uveitis differs based on age, anatomic location of the inflammatory process (anterior, intermediate, posterior uveitis, panuveitis), gender, histopathology (granulomatous, non-granulomatous), type of inflammatory process (acute, chronic, recurrent), and etiology (infectious, non-infectious). Prevalence differs by geographic location. Idiopathic anterior uveitis is the most common form of uveitis in the community. Infectious causes are common (30-60%) in the developing countries. Herpes and toxoplasmosis are the leading infectious causes of uveitis. Non-infectious uveitic conditions are generally more common in the developed world. An increase in the prevalence of infectious etiologies, including tuberculosis and syphilis, has been seen in developed countries. Introduction of new treatment options has also changed patterns of disease. CONCLUSIONS Introduction of new uveitis entities, changes in the incidence of already known disease and increased availability of diagnostic testing have all altered the epidemiology of uveitis in recent years. Knowledge of regional patterns of disease is essential. A more detailed classification of uveitis with the establishment of uniform diagnostic criteria and prospective population based studies would certainly benefit epidemiologic research and clinical practice.
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Affiliation(s)
- Theodora Tsirouki
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | - Anna Dastiridou
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | | | - Ourania Tounakaki
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | - Irini Brazitikou
- b 2nd Department of Ophthalmology , Papageorgiou Hospital , Thessaloniki , Greece
| | | | - Sofia Androudi
- a Department of Ophthalmology , University of Thessaly , Larissa , Greece
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18
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Abdulaal MR, Abiad BH, Hamam RN. Uveitis in the Aging Eye: Incidence, Patterns, and Differential Diagnosis. J Ophthalmol 2015; 2015:509456. [PMID: 26090218 PMCID: PMC4452188 DOI: 10.1155/2015/509456] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/27/2015] [Indexed: 11/17/2022] Open
Abstract
Uveitis is a vision threatening inflammation of the eye that carries considerable morbidity. It is responsible for 10% of legal blindness in the United States and up to 25% in the developing world. Uveitis in patients more than 60 years of age is less common. The aging body has a changing response of the immune system, which might reflect a different pattern of uveitis in the elderly population. In this paper we review the incidence and patterns of uveitis in the elderly as reported in the literature and discuss changes with time. We also delineate a thorough differential diagnosis of de novo uveitis in the elderly.
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Affiliation(s)
- Marwan R. Abdulaal
- Department of Ophthalmology, American University of Beirut Medical Center, P.O. Box 11-0236/D41, Riad El Solh, Beirut 11072020, Lebanon
| | - Bachir H. Abiad
- Department of Ophthalmology, American University of Beirut Medical Center, P.O. Box 11-0236/D41, Riad El Solh, Beirut 11072020, Lebanon
| | - Rola N. Hamam
- Department of Ophthalmology, American University of Beirut Medical Center, P.O. Box 11-0236/D41, Riad El Solh, Beirut 11072020, Lebanon
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19
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Vitale AT. Birdshot retinochoroidopathy. J Ophthalmic Vis Res 2015; 9:350-61. [PMID: 25667738 PMCID: PMC4307660 DOI: 10.4103/2008-322x.143376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 12/25/2013] [Indexed: 01/14/2023] Open
Abstract
Birdshot retinochoroidopathy (BSRC) is an uncommon, but well-characterized chronic, bilateral posterior uveitis, which is uniquely associated with the human leukocyte antigen-A29 phenotype. The disease presents predominantly in middle-aged Caucasian females who complain of blurred vision, floaters, photopsias, paracentral scotomas and nyctalopia. While autoimmune mechanisms are thought to play an important role in the pathogenesis of BSRC, its etiology remains unknown. Important questions remain in our understanding of BSRC with respect to its pathogenesis, epidemiology, optimal treatment, and prognosis, including the determinants of remission and relapse, as well as the best strategy for monitoring disease activity, progression and response to therapy with electroretinographic and psychophysical testing, established and emerging imaging modalities, and peripheral cytokines profiles.
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Affiliation(s)
- Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Salt Lake City, UT, USA
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20
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Nalcacioglu-Yuksekkaya P, Ozdal PC, Yazici A, Tirhis H. Clinical and Demographic Characteristics of Patients with Uveitis Starting Later in Life. Ocul Immunol Inflamm 2014; 23:304-310. [DOI: 10.3109/09273948.2014.938761] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Grange LK, Kouchouk A, Dalal MD, Vitale S, Nussenblatt RB, Chan CC, Sen HN. Neoplastic masquerade syndromes in patients with uveitis. Am J Ophthalmol 2014; 157:526-31. [PMID: 24211361 DOI: 10.1016/j.ajo.2013.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE To identify the demographic and clinical characteristics, along with the frequency, of neoplastic masquerade syndromes in a tertiary uveitis clinic. DESIGN A retrospective observational cohort. METHODS Demographic and clinical data on all patients presenting to the National Eye Institute (NEI) with uveitis between 2004 and 2012 were used to compare neoplastic masquerade syndromes and uveitis. RESULTS A total of 853 patients presenting with uveitis were identified. Of these, 21 (2.5%) were diagnosed with neoplastic masquerade syndromes. The average age at presentation of masquerade syndrome patients was 57 years (median, 55; range, 38-78); for uveitis, 42 years (median, 43; range, 3-98) (P = 0.0003). There were 48% females in the masquerade syndromes group, compared with 59% females in the uveitis group. African American patients represented 9% of the masquerade syndrome patients and 36% of uveitis patients (P = 0.01). Mean worse eye visual acuity was 0.89 (20/160) in neoplastic masquerade syndromes, and 0.66 (20/100) in the uveitis group (P = 0.21). Of masquerade syndrome patients, 90% had posterior inflammation, compared with 63% of uveitis patients (P = 0.006). Of those with masquerade syndromes, 48% of patients had unilateral disease, compared with 27% of the uveitis patients (P = 0.04). CONCLUSIONS Patients with neoplastic masquerade syndromes were more likely to be older, male, or non-African American and to have posterior segment inflammation and unilateral disease. Patients with masquerade syndromes also had worse visual acuity than did uveitis patients. These differences in clinical characteristics may help to raise the suspicion for neoplastic masquerade syndromes.
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22
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Sagoo MS, Mehta H, Swampillai AJ, Cohen VML, Amin SZ, Plowman PN, Lightman S. Primary intraocular lymphoma. Surv Ophthalmol 2013; 59:503-16. [PMID: 24560125 DOI: 10.1016/j.survophthal.2013.12.001] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 01/25/2023]
Abstract
Primary intraocular lymphoma (PIOL) is an ocular malignancy that is a subset of primary central system lymphoma (PCNSL). Approximately one-third of PIOL patients will have concurrent PCNSL at presentation, and 42-92% will develop PCNSL within a mean of 8-29 months. Although rare, the incidence has been rising in both immunocompromised and immunocompetent populations. The majority of PIOL is diffuse large B-cell lymphoma, though rare T-cell variants are described. Recently, PIOL has been classified by main site of involvement in the eye, with vitreoretinal lymphoma as the most common type of ocular lymphoma related to PCNSL. Diagnosis remains challenging for ophthalmologists and pathologists. PIOL can masquerade as noninfectious or infectious uveitis, white dot syndromes, or occasionally as other neoplasms such as metastatic cancers. Laboratory diagnosis by cytology has been much aided by the use of immunocytochemistry, flow cytometry, biochemical finding of interleukin changes (IL10:IL6 ratio > 1), and cellular microdissection with polymerase chain reaction amplification for clonality. Use of several tests improves the diagnostic yield. Approaches to treatment have centered on systemic methotrexate-based chemotherapy, often with cytarabine (Ara-C) and radiotherapy. Use of intravitreal chemotherapy with methotrexate (0.4 mg/0.1 mL) is promising in controlling ocular disease, and intravitreal rituximab (anti-CD20 monoclonal antibody) has also been tried. Despite these advances, prognosis remains poor.
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Affiliation(s)
- Mandeep S Sagoo
- UCL Institute of Ophthalmology, London, UK; Moorfields Eye Hospital, London, UK; Department of Ophthalmology, St Bartholomew's Hospital, London, UK.
| | | | | | - Victoria M L Cohen
- Moorfields Eye Hospital, London, UK; Department of Ophthalmology, St Bartholomew's Hospital, London, UK
| | | | | | - Sue Lightman
- UCL Institute of Ophthalmology, London, UK; Moorfields Eye Hospital, London, UK
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23
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Review on the worldwide epidemiology of uveitis. Eur J Ophthalmol 2013; 23:705-17. [PMID: 23661536 DOI: 10.5301/ejo.5000278] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE We describe the worldwide epidemiology of uveitis through a systematic literature review.
METHODS Data obtained from the most relevant studies published until November 2012 were reported.
RESULTS Results of our research were structured in sections about the epidemiology of uveitis by anatomical location of inflammation (anterior, intermediate, posterior, and panuveitis), type of inflammation (infectious and noninfectious), and by age (children and elderly). Difficulties encountered analyzing the different epidemiologic studies were discussed in a dedicated section.
CONCLUSIONS Limited information is available regarding the epidemiology of uveitis. Worldwide epidemiologic studies may help the clinician in the management of patients with inflammatory ocular diseases, enabling the comparison of different uveitis entities.
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Abstract
Uveitis is a common cause of vision loss, accounting for 10-15 % of all cases of blindness worldwide and affects individuals of all ages, genders, and races. Uveitis represents a broad range of intraocular inflammatory conditions due to complications of autoimmune diseases, bacterial infections, viral infections, and chemical and metabolic injuries. Endotoxin-induced uveitis (EIU) in rodents is an efficient experimental model to investigate the pathological mechanism and pharmacological efficacy of potential drug agents. EIU is characterized by clinically relevant classical signs of inflammation, including inflammatory exudates and cells in the anterior and vitreous chambers. EIU in small animal models such as rats, mice, and rabbits is a short-lived uveal inflammation that can be developed subsequent to administration of bacterial endotoxin, such as lipopolysaccharide. Here, we present a reproducible, reliable, and simplified protocol to induce EIU in mice. This method could be used with similar efficacy for EIU induction in other small animals as well.
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Affiliation(s)
- Umesh C S Yadav
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
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25
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Understanding uveitis: The impact of research on visual outcomes. Prog Retin Eye Res 2011; 30:452-70. [DOI: 10.1016/j.preteyeres.2011.06.005] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 01/01/2023]
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26
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Grégoire MA, Kodjikian L, Varron L, Grange JD, Broussolle C, Seve P. Characteristics of Uveitis Presenting for the First Time in the Elderly: Analysis of 91 Patients in a Tertiary Center. Ocul Immunol Inflamm 2011; 19:219-26. [DOI: 10.3109/09273948.2011.580071] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE The purpose of this study was to describe patients initially carrying a diagnosis of primary intraocular lymphoma who were ultimately diagnosed with ocular sarcoidosis. METHODS The medical records of patients evaluated between 1995 and 2007 fitting the criteria described earlier were identified, and pertinent clinical findings allowing for the diagnosis of sarcoidosis are described. RESULTS Nine patients between the ages of 52 and 83 were referred with a diagnosis of primary intraocular lymphoma but were ultimately diagnosed with sarcoidosis. The most common clinical signs found in these patients that are atypical for primary intraocular lymphoma but common in sarcoidosis were multifocal choroiditis (n = 7) and cystoid macular edema (n = 6). Additional findings included keratic precipitates, posterior synechiae, and Koeppe nodules. Chest computerized tomography was consistent with sarcoidosis in seven of eight tested patients, and five of these patients had normal chest x-rays. Other findings included elevated angiotensin-converting enzyme and/or lysozyme, and biopsy revealing noncaseating granulomas. CONCLUSION Although primary intraocular lymphoma should always be in the differential diagnosis of older patients who present with signs of ocular inflammation, ophthalmologists must also consider other etiologies, including sarcoidosis. A chest computerized tomography may be helpful in the diagnosis, particularly when laboratory findings are supportive of sarcoidosis.
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28
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Infectious Uveitis in Children. Ophthalmology 2009; 116:1588, 1588.e1-2. [DOI: 10.1016/j.ophtha.2008.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 12/04/2008] [Indexed: 11/30/2022] Open
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29
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Baatz H, Scharioth GB, de Ortueta D, Pavlidis M. Age distribution of patients presenting with uveitis. Open Ophthalmol J 2007; 1:23-4. [PMID: 19478860 PMCID: PMC2605695 DOI: 10.2174/1874364100701010023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 11/26/2007] [Accepted: 12/03/2007] [Indexed: 12/02/2022] Open
Abstract
Background: Endogenous uveitis has long been considered to be uncommon in elderly patients. Recently, population-based studies have shown an increase in the incidence of uveitis with inreasing age. It was the aim of this study to analyse the age distribution of patients presenting with endogenous uveitis in the setting of an eye centre. Methods: Retrospective cohort analysis. Results: 278 patients with endogenous uveitis showed the following age distribution: 0 - 15: 9, 15 - 30: 28, 30 - 45: 73, 45 - 60: 78, >60: 90 (age group: number of patients). Localization of uveitis was 82,4% anterior, 9,4% intermedia, 12,9% posterior. Two patients >60y were diagnosed with a masquerade syndrome. Conclusions: A large number of patients presenting with endogenous uveitis is in the elderly age group. An early and appropriate diagnostic work-up for uveitis is recommended for the elderly.
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Affiliation(s)
- Holger Baatz
- Eye Centre Recklinghausen, Erlbruch 34-36, D-45657 Recklinghausen, Germany
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30
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Shah KH, Levinson RD, Yu F, Goldhardt R, Gordon LK, Gonzales CR, Heckenlively JR, Kappel PJ, Holland GN. Birdshot Chorioretinopathy. Surv Ophthalmol 2005; 50:519-41. [PMID: 16263368 DOI: 10.1016/j.survophthal.2005.08.004] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Birdshot chorioretinopathy is a well-known, yet poorly understood, form of posterior uveitis, characterized by multiple, distinctive, hypopigmented choroidal lesions, and strongly associated with human leukocyte antigen (HLA)-A29. We reviewed all English language publications regarding birdshot chorioretinopathy and performed analyses of combined patient data taken from these articles. The mean age at presentation was 53 years, with a slight female predominance (54.1%). At least 95.7% of reported patients have been HLA-A29-positive. Blurring of vision and floaters are the most prevalent presenting complaints, even in patients with visual acuity of 20/20 or better in both eyes. Birdshot chorioretinopathy is a slowly progressive disease with profound dysfunction of vision that may not be reflected in Snellen visual acuity. Two or more lines of Snellen visual acuity were lost in approximately 20% of eyes over a median follow-up of 3.5 years; macular edema was the most common cause of reduced visual acuity. Overall, patients had a slow decline in visual acuity, despite the fact that nearly all were treated with anti-inflammatory therapies. Final visual acuity in the better eye was 20/40 or better in 75.1% of patients and 20/200 or worse in 9.8% of patients. Oral corticosteroids and cyclosporine were the most commonly used medications. Using a regression model, patients in the literature that have been treated with cyclosporine alone had better final visual acuity than patients treated with oral corticosteroids alone. Further study is needed to determine the optimal methods for treating and monitoring patients with birdshot chorioretinopathy.
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Affiliation(s)
- Kayur H Shah
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7000, USA
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Ikeda N, Hayasaka S, Hayasaka Y. Uveitis and Pseudouveitis Presenting for the First Time in Japanese Elderly Patients. Ophthalmologica 2005; 219:263-6. [PMID: 16123550 DOI: 10.1159/000086108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 08/19/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the clinical characteristics of uveitis or pseudouveitis presenting de novo in Japanese elderly patients. METHODS We retrospectively examined 296 patients with uveitis or pseudouveitis who were treated at Toyama Medical and Pharmaceutical University Hospital. Patients were followed up for 1 week to 5 years (mean, 11 months). RESULTS Of 296 patients, 82 (38 men and 44 women, 120 eyes) presented with their first episode of uveitis or pseudouveitis at the age of > or = 60 years. Forty patients had anterior uveitis, 2 had intermediate uveitis and the other 40 had posterior and/or pan-uveitis. Of 82 patients, 53 (64.6%) had idiopathic uveitis. The prevalence of Vogt-Koyanagi-Harada syndrome and Behçet disease in elderly patients was lower than that in younger patients. Complicated cataract was frequently seen in the eyes with uveitis. Most eyes with uveitis had poor visual acuity. CONCLUSIONS The prevalence of Vogt-Koyanagi-Harada syndrome and Behçet disease in elderly patients was lower than that in younger patients.
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Affiliation(s)
- Nariko Ikeda
- Division of Ophthalmology, Itoigawa General Hospital, Niigata, Japan.
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Chevalet P, Clément R, Rodat O, Moreau A, Brisseau JM, Clarke JP. Sarcoidosis diagnosed in elderly subjects: retrospective study of 30 cases. Chest 2005; 126:1423-30. [PMID: 15539708 DOI: 10.1378/chest.126.5.1423] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE This study investigated the clinical features and disease course of sarcoidosis diagnosed in patients > 70 years of age. METHODS A retrospective analysis was made of cases treated at the University Hospital in Nantes, France, between 1986 and 2000. The diagnosis of sarcoidosis was confirmed histopathologically. Cases involving progressive cancer and active tuberculosis were excluded. RESULTS Thirty white patients with sarcoidosis diagnosed after age 70 years (mean, 74 years) were included. An alteration of general health (asthenia and/or anorexia and/or weight loss) was frequent (53%) and characteristic of the systemic form of the disease. Dyspnea was a fairly common sign (23%). The intrathoracic form of sarcoidosis was most frequent (43.3%). Diagnosis was difficult and lengthy, and symptomatology was atypical. Accessory salivary gland biopsy was an important contributing factor to diagnosis (70.6% were positive). Oral corticosteroid therapy was often required (60.7%). The disease course was satisfactory overall (81.8% of cases), but only for 50% of patients in intrathoracic stage IV. CONCLUSIONS The clinical presentation of sarcoidosis in elderly subjects is mainly characterized by an alteration of general health. Diagnosis is difficult and should include accessory salivary gland biopsy. Therapy frequently involves corticosteroids. Overall prognosis is similar to that for young subjects.
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Affiliation(s)
- Pascal Chevalet
- Department of Geriatric Medecine, Hôpital Léon Bellier, 41 rue Curie, BP 84607, 44046 Nantes Cedex 1, France.
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Maini R, O'Sullivan J, Reddy A, Watson S, Edelsten C. The risk of complications of uveitis in a district hospital cohort. Br J Ophthalmol 2004; 88:512-7. [PMID: 15031168 PMCID: PMC1772087 DOI: 10.1136/bjo.2002.013334] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2003] [Indexed: 11/04/2022]
Abstract
AIMS To establish the frequency and risk factors for visual loss in a primary referral cohort of hospital patients with uveitis. METHODS 561 consecutive uveitis patients attending three district hospitals were recruited and the acuity at the end of the study period recorded. A retrospective case-control study of risk factors for visual loss (permanent loss of acuity <6/9) was performed. Risk factors examined included type of uveitis, age at onset of uveitis, race, type of systemic inflammatory disease, length of follow up, and treatment variables. RESULTS Visual loss of at least 6/12 in one eye was found in 111 patients (19.9%). Only four patients (0.7%) suffered severe bilateral visual loss (6/36 or less). Visual loss was associated with age at onset >60 years (odds ratio 3.9, 95% confidence interval (CI) 2.2 to 7.0, long follow up 2.0 (1.2 to 3.3) and a history of cataract surgery 3.9 (2.1 to 7.2). It was less likely in patients with acute anterior uveitis 0.2 (0.1 to 0.3). CONCLUSION The frequency of visual loss associated with uveitis in a district hospital cohort is less than that found in referral centres and levels of legal blindness are low. Although acute anterior uveitis has a low frequency of visual loss it contributes significantly to the total burden. The ocular co-morbidity of the elderly may contribute to the increased visual loss of late onset uveitis.
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Affiliation(s)
- R Maini
- Ipswich Hospital, Suffolk, UK
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Labalette P, Delhaes L, Margaron F, Fortier B, Rouland JF. Ocular toxoplasmosis after the fifth decade. Am J Ophthalmol 2002; 133:506-15. [PMID: 11931784 DOI: 10.1016/s0002-9394(02)01324-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the clinical features in patients presenting with ocular toxoplasmosis after the fifth decade and to analyze laboratory findings in comparison to uveitis history and clinical data. DESIGN Prospective consecutive observational case series. METHODS A prospective clinical analysis of 27 consecutive patients older than 50 years of age with primary or recurrent ocular toxoplasmosis was performed during a period of 8 years. These cases account for 12% of all ocular toxoplasmosis cases irrespective of age indexed in our institution during the same period. Paired serum and aqueous humor samples were tested for anti-Toxoplasma gondii IgG, IgM, and IgA antibodies. The presence of T. gondii DNA in aqueous humor was determined by polymerase chain reaction followed by DNA hydridization method. RESULTS Although similar in age, two groups were distinguished clinically: 12 patients (44%) presented with usual forms of retinochoroiditis (mean +/- SD, 1.6 +/- 0.5 disk areas [DA] in size); 15 patients (56%) presented with atypical lesions, greater than 3 DA in size (mean +/- SD, 5.0 +/- 2.0 DA). The second group showed a higher rate of complications (P =.028) and a poorer visual outcome (P =.015). Twenty-four patients (89%) had intraocular IgG production, 17 (63%) had intraocular IgA production, 3 (11%) had intraocular IgM production, and 12 (44%) had a positive T. gondii DNA detection. CONCLUSIONS After the fifth decade, ocular toxoplasmosis remains an important cause of posterior uveitis. The combination of antibody detection by immunocapture tests with T. gondii DNA detection, both in aqueous humor, allowed the diagnosis of toxoplasmic infection in the atypical cases with large ocular lesions.
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Affiliation(s)
- Pierre Labalette
- Department of Ophthalmology, Lille University Hospital, Lille, France.
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Kaiser PK, Lowder CY, Sullivan P, Sanislo SR, Kosmorsky GS, Meziane MA, Rice TW, Smith SD, Meisler DM. Chest computerized tomography in the evaluation of uveitis in elderly women. Am J Ophthalmol 2002; 133:499-505. [PMID: 11931783 DOI: 10.1016/s0002-9394(02)01333-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the usefulness of chest computerized tomography (CT) in the evaluation of uveitis in elderly women and the clinical characteristics of patients with an abnormal chest CT scan. DESIGN Prospective noncomparative case series. METHODS We evaluated 30 elderly women, aged 61-83 years, with chronic iritis, vitritis, or choroiditis and with no definitive cause for their uveitis. All patients underwent a battery of diagnostic laboratory studies and chest CT. RESULTS The diagnostic examination in most patients included serum angiotensin converting enzyme level, serum lysozyme, rapid plasma reagin level, fluorescent treponemal antibody-absorption test, purified protein derivative skin test, and chest x-rays. Chest CT performed on all patients showed parenchymal, mediastinal, and/or hilar adenopathy in 17 patients (57%). Histopathologic confirmation of sarcoidosis with noncaseating granulomas in the biopsy specimens was obtained in 14 patients: eight by mediastinoscopy, two by bronchoscopy, two by conjunctival biopsy, one by nasal biopsy, and one by vitreous biopsy. CONCLUSIONS Chest CT can be useful in elderly female patients with chronic uveitis for identifying mediastinal lymphadenopathy and other lesions suggestive of sarcoidosis, as well as to help guide tissue confirmation and to rule out other diagnoses including lymphoma.
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Affiliation(s)
- Peter K Kaiser
- Division of Ophthalmology, Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Bouillet L, Sarrot Reynauld F, Gonzalvez B, Mouillon M, Romanet JP, Massot C. [Uveitis after the age of 60]. Rev Med Interne 2000; 21:1131-2. [PMID: 11191683 DOI: 10.1016/s0248-8663(00)00276-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Herpetic eye disease is common and is frequently associated with intraocular inflammation or uveitis. Despite recent advances in measuring anti-herpes virus antibodies and viral DNA in ocular fluids, diagnosis remains largely clinical. The two more common syndromes include anterior uveitis, often associated with keratitis, and the acute retinal necrosis (ARN) syndrome. Treatment is complex and requires careful monitoring to provide the appropriate balance of antiviral medication and corticosteroids. Long-term prophylaxis with oral antiviral agents may be required in selected patients to help prevent the vision-compromising complications associated with recurrences.
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Affiliation(s)
- B D Gaynor
- Francis I. Proctor Foundation, UCSF, Medical Center 94143, USA
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