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Parakh S, Bhatt V, Das S, Chaturvedi A, Luthra G, Katoch D, Barman P, Jindal AK, Luthra S. Pediatric Lupus Retinopathy: A Rare Manifestation of a Grave Systemic Disorder. Cureus 2023; 15:e46616. [PMID: 37937017 PMCID: PMC10626398 DOI: 10.7759/cureus.46616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/09/2023] Open
Abstract
We describe a rare case of pediatric systemic lupus erythematosus (pSLE) and its successful management. A nine-year-old female presented with bilateral diminution of vision, fever, and rash in the malar region, chest, abdomen, back, and arms for three months. Clinical examination and multimodal imaging revealed bilateral extensive retinal vasculitis with macular edema. Laboratory investigations revealed anemia, leucopenia, positive serum antinuclear antibody (ANA), and anti-extractable nuclear antigen (ENA) antibodies. A diagnosis of pediatric lupus retinopathy was made. Ocular and systemic manifestations responded well to intense systemic immunosuppression (pulse intravenous {IV} methylprednisolone, oral prednisolone and hydroxychloroquine {HCQ}, six cycles of IV cyclophosphamide, and oral azathioprine) along with topical steroids and laser photocoagulation, over the next 10 months. Though ocular manifestations are not a part of the diagnostic criteria for SLE, they may be markers of active systemic disease. Ophthalmologists and rheumatologists must treat this complex disease in tandem in order to provide optimum patient care.
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Affiliation(s)
| | | | | | | | | | - Deeksha Katoch
- Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Prabal Barman
- Pediatric Rheumatology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ankur K Jindal
- Pediatric Rheumatology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Desurmont MG, Sales de Gauzy T, Toutée A, Lam D, Fardeau C, Bodaghi B. [Systemic lupus erythematosus and ischemic macular retinopathy: A case report]. J Fr Ophtalmol 2022; 45:e419-e422. [PMID: 35659459 DOI: 10.1016/j.jfo.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 10/18/2022]
Affiliation(s)
- M-G Desurmont
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP-Sorbonne université, 47-83, boulevard de l'hôpital, 75013 Paris, France.
| | - T Sales de Gauzy
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP-Sorbonne université, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - A Toutée
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP-Sorbonne université, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - D Lam
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP-Sorbonne université, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - C Fardeau
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP-Sorbonne université, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - B Bodaghi
- Service d'ophtalmologie, hôpital Pitié-Salpêtrière, IHU FOReSIGHT, AP-HP-Sorbonne université, 47-83, boulevard de l'hôpital, 75013 Paris, France
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Gupta L, Soliman MK, Ahmad R, Kurup S. Ischemic Proliferative Retinopathy as the Presenting Feature of Systemic Sarcoidosis. JOURNAL OF VITREORETINAL DISEASES 2021; 5:542-545. [PMID: 37007168 PMCID: PMC9976150 DOI: 10.1177/2474126421996261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work reports a case of systemic sarcoidosis presenting with ischemic ocular manifestations without uveitis. Methods: This case report describes a 28-year-old White male who presented with pain, redness, and blurry vision of his left eye for 1 month who was found to have proliferative retinopathy and neovascular glaucoma. Results: Normal fasting blood glucose and glycated hemoglobin A1c levels warranted further investigation. Abnormal findings from chest x-ray of hilar lymphadenopathy as well as an elevated angiotensin-converting enzyme level were suggestive of sarcoidosis, and they were further confirmed by histopathology derived through bronchoscopy. Conclusions: Systemic sarcoidosis may present with rapidly progressing ischemic retinopathy without signs of inflammation, which may obscure the diagnosis. Such presentation may be misdiagnosed, which may result in delayed treatment and poor outcome.
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Affiliation(s)
- Lalita Gupta
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, OH, USA
| | | | - Riaz Ahmad
- Department of Rheumatology, University Hospitals, Cleveland, OH, USA
| | - Shree Kurup
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, OH, USA
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Paladino RA, Miller SN, Kleiber KF, Byers DM. Resveratrol reverses the effect of TNF-α on inflammatory markers in a model of autoimmune uveitis. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Grzybowski A, Kanclerz P. The Role of Steroids and NSAIDs in Prevention and Treatment of Postsurgical Cystoid Macular Edema. Curr Pharm Des 2019; 24:4896-4902. [PMID: 30727876 DOI: 10.2174/1381612825666190206104524] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pseudophakic cystoid macular edema (PCME) remains one of the most common visionthreatening complication of phacoemulsification cataract surgery (PCS). Pharmacological therapy is the current mainstay of both prophylaxis, and treatment of PCME in patients undergoing PCS. We aimed to review pharmacological treatment options for PCME, which primarily include topical steroids, topical nonsteroidal antiinflammatory drugs (NSAIDS), periocular and intravitreal steroids, as well as anti-vascular endothelial growth factor therapy. METHODS The PubMed and Web Of Science web platforms were used to find relevant studies using the following keywords: cataract surgery, phacoemulsification, cystoid macular edema, and pseudophakic cystoid macular edema. Of articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Other studies were also considered as a potential source of information when referenced in relevant articles. The search revealed 193 publications. Finally 82 articles dated from 1974 to 2018 were assessed as significant and analyzed. RESULTS Based on the current literature, we found that corticosteroids remain the mainstay of PCME prophylaxis in uncomplicated cataract surgery, while it is still unclear if NSAID can offer additional benefits. In patients at risk for PCME development, periocular subconjunctival injection of triamcinolone acetonide may prevent PCME development. For PCME treatment the authors recommend a stepwise therapy: initial topical steroids and adjuvant NSAIDs, followed by additional posterior sub-Tenon or retrobulbar corticosteroids in moderate PCME, and intravitreal corticosteroids in recalcitrant PCME. Intravitreal anti-vascular endothelial growth factor agents may be considered in patients unresponsive to steroid therapy at risk of elevated intraocular pressure, and with comorbid macular disease. CONCLUSION Therapy with topical corticosteroids and NSAIDs is the mainstay of PCME prophylaxis and treatment, however, periocular and intravitreal steroids should be considered in refractory cases.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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Intravitreal aflibercept for choroidal neovascularization in ocular sarcoidosis. Eur J Ophthalmol 2016; 26:e124-7. [PMID: 26868005 DOI: 10.5301/ejo.5000759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To report a case of choroidal neovascularization (CNV) in a patient with ocular sarcoidosis treated by intravitreal aflibercept. METHODS A 27-year old man was referred to our department because of sudden visual acuity decrease (best-corrected visual acuity (BCVA) was 20/80 LE). Fundus examination showed bilateral optic disk swelling, retinal pigment epithelium changes at the posterior pole, yellowish chorioretinal lesions in the periphery, and the presence of a prominent peripapillary neovascular complex. RESULTS The clinical diagnosis was most compatible with ocular sarcoidosis, later confirmed by mediastinal lymph node biopsy. Fluorescein and indocyanine green angiography confirmed the presence of active peripapillary type 2 (classic) CNV in both eyes. Given that the exudation of the peripapillary CNV harmed the fovea, the patient underwent a single intravitreal aflibercept injection LE. One month after the treatment, LE BCVA decreased to 20/125. Spectral-domain optical coherence tomography (SD-OCT) showed complete resolution of subretinal fluid but revealed outer retinal atrophy with complete loss of the ellipsoid zone (EZ) in the macula (possibly responsible for visual acuity worsening). Six months later, LE BCVA slightly increased to 20/100, and SD-OCT showed partial recovery of the EZ in the macula. No adverse events related to the treatment were recorded during follow-up. CONCLUSIONS We report a case of CNV in a patient with ocular sarcoidosis treated with intravitreal aflibercept. In our experience, intravitreal aflibercept injection achieved morphologic resolution for sarcoid-related peripapillary CNV.
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Kim IG, Lee JE, Park JM. Combination Therapy with Photodynamic Therapy and Intravitreal Bevacizumab in Idiopathic Macular Telangiectasia Type I. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.12.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- In Geun Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jung Min Park
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
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Risk of Retinal Neovascularization in Cases of Uveitis. Ophthalmology 2015; 123:646-54. [PMID: 26686964 DOI: 10.1016/j.ophtha.2015.10.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/24/2015] [Accepted: 10/28/2015] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate the risk of and risk factors for retinal neovascularization (NV) in cases of uveitis. DESIGN Retrospective cohort study. PARTICIPANTS Patients with uveitis at 4 US academic ocular inflammation subspecialty practices. METHODS Data were ascertained by standardized chart review. Prevalence data analysis used logistic regression. Incidence data analysis used survival analysis with time-updated covariates where appropriate. MAIN OUTCOME MEASURES Prevalence and incidence of NV. RESULTS Among uveitic eyes of 8931 patients presenting for initial evaluation, 106 of 13,810 eyes had NV (prevalence = 0.77%, 95% confidence interval [CI], 0.60-0.90). Eighty-eight more eyes developed NV over 26,465 eye-years (incidence, 0.33%/eye-year; 95% CI, 0.27-0.41). Factors associated with incident NV include age <35 years compared with >35 years (adjusted hazard ratio [aHR], 2.4; 95% CI, 1.5-3.9), current cigarette smoking (aHR, 1.9; 95% CI, 1.1-3.4), and systemic lupus erythematosus (aHR, 3.5, 95% CI, 1.1-11). Recent diagnosis of uveitis was associated with an increased incidence of NV (compared with patients diagnosed >5 years ago, aHR, 2.4 [95% CI, 1.1-5.0] and aHR, 2.6 [95% CI, 1.2-6.0] for diagnosis within <1 year vs. 1-5 years, respectively). Compared with anterior uveitis, intermediate uveitis (aHR, 3.1; 95% CI, 1.5-6.6), posterior uveitis (aHR, 5.2; 95% CI, 2.5-11), and panuveitis (aHR, 4.3; 95% CI, 2.0-9.3) were associated with a similar degree of increased NV incidence. Active (aHR, 2.1, 95% CI, 1.2-3.7) and slightly active (aHR, 2.4, 95% CI, 1.3-4.4) inflammation were associated with an increased incidence of NV compared with inactive inflammation. Neovascularization incidence also was increased with retinal vascular occlusions (aHR, 10, 95% CI, 3.0-33), retinal vascular sheathing (aHR, 2.6, 95% CI, 1.4-4.9), and exudative retinal detachment (aHR, 4.1, 95% CI, 1.3-13). Diabetes mellitus was associated with a somewhat increased incidence of retinal NV (aHR, 2.3, 95% CI, 1.1-4.9), and systemic hypertension (aHR 1.5, 95% CI, 0.89-2.4) was associated with nonsignificantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus. CONCLUSIONS Retinal NV is a rare complication of uveitis, which occurs more frequently in younger patients, smokers, and those with intermediate/posterior/panuveitis, systemic vasculopathy, retinal vascular disease, or active inflammation. Inflammation and retinal NV likely are linked; additional studies are needed to further elucidate this connection.
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Mérida S, Palacios E, Navea A, Bosch-Morell F. New Immunosuppressive Therapies in Uveitis Treatment. Int J Mol Sci 2015; 16:18778-95. [PMID: 26270662 PMCID: PMC4581271 DOI: 10.3390/ijms160818778] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 12/14/2022] Open
Abstract
Uveitis is an inflammatory process that initially starts in the uvea, but can also affect other adjacent eye structures, and is currently the fourth cause of blindness in developed countries. Corticoids are probably the most widespread treatment, but resorting to other immunosuppressive treatments is a frequent practice. Since the implication of different cytokines in uveitis has been well demonstrated, the majority of recent treatments for this disease include inhibitors or antibodies against these. Nevertheless, adequate treatment for each uveitis type entails a difficult therapeutic decision as no clear recommendations are found in the literature, despite the few protocolized clinical assays and many case-control studies done. This review aims to present, in order, the mechanisms and main indications of the most modern immunosuppressive drugs against cytokines.
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Affiliation(s)
- Salvador Mérida
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
| | - Elena Palacios
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
| | - Amparo Navea
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
| | - Francisco Bosch-Morell
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
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Silpa-archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol 2015; 100:135-41. [PMID: 25904124 DOI: 10.1136/bjophthalmol-2015-306629] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022]
Abstract
Systemic lupus erythematosus (SLE) can involve many parts of the eye, including the eyelid, ocular adnexa, sclera, cornea, uvea, retina and optic nerve. Ocular manifestations of SLE are common and may lead to permanent blindness from the underlying disease or therapeutic side effects. Keratoconjunctivitis sicca is the most common manifestation. However, vision loss may result from involvement of the retina, choroid and optic nerve. Ocular symptoms are correlated to systemic disease activity and can present as an initial manifestation of SLE. The established treatment includes prompt systemic corticosteroids, steroid-sparing immunosuppressive drugs and biological agents. Local ocular therapies are options with promising efficacy. The early recognition of disease and treatment provides reduction of visual morbidity and mortality.
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Affiliation(s)
- Sukhum Silpa-archa
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA Faculty of Medicine, Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Joan J Lee
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
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12
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Ischemic retinal vasculitis and its management. J Ophthalmol 2014; 2014:197675. [PMID: 24839552 PMCID: PMC4009272 DOI: 10.1155/2014/197675] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/21/2014] [Accepted: 03/25/2014] [Indexed: 12/14/2022] Open
Abstract
Ischemic retinal vasculitis is an inflammation of retinal blood vessels associated with vascular occlusion and subsequent retinal hypoperfusion. It can cause visual loss secondary to macular ischemia, macular edema, and neovascularization leading to vitreous hemorrhage, fibrovascular proliferation, and tractional retinal detachment. Ischemic retinal vasculitis can be idiopathic or secondary to systemic disease such as in Behçet's disease, sarcoidosis, tuberculosis, multiple sclerosis, and systemic lupus erythematosus. Corticosteroids with or without immunosuppressive medication are the mainstay treatment in retinal vasculitis together with laser photocoagulation of retinal ischemic areas. Intravitreal injections of bevacizumab are used to treat neovascularization secondary to systemic lupus erythematosus but should be timed with retinal laser photocoagulation to prevent further progression of retinal ischemia. Antitumor necrosis factor agents have shown promising results in controlling refractory retinal vasculitis excluding multiple sclerosis. Interferon has been useful to control inflammation and induce neovascular regression in retinal vasculitis secondary to Behçet's disease and multiple sclerosis. The long term effect of these management strategies in preventing the progression of retinal ischemia and preserving vision is not well understood and needs to be further studied.
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Kim SB, Cho WH, Chang MH. A Case of Severe Vaso-Occlusive Retinopathy as the First Manifestation Associated with Systemic Lupus Erythematosus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.3.518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Si Bum Kim
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
| | - Woo Hyung Cho
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
| | - Moo Hwan Chang
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
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Riveros Frutos A, Romera Romero P, Holgado Pérez S, Anglada Escalona JR, Martínez-Morillo M, Tejera Segura B. Enfermedad de Vogt-Koyanagi-Harada. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.semreu.2012.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Androudi S, Dastiridou A, Symeonidis C, Kump L, Praidou A, Brazitikos P, Kurup SK. Retinal vasculitis in rheumatic diseases: an unseen burden. Clin Rheumatol 2012; 32:7-13. [PMID: 22955636 DOI: 10.1007/s10067-012-2078-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/20/2012] [Indexed: 12/14/2022]
Abstract
Retinal vascular inflammation, a potentially blinding condition (herein: retinal vasculitis (RV)) is commonly associated with a heterogeneous group of diseases characterized by systemic inflammatory cell infiltration and/or necrosis of blood vessel walls. RV may arise as an isolated ocular disorder, as part of systemic vasculitis (Wegener's granulomatosis and Adamantiadis-Behcet Disease), or it can be secondary to an underlying connective tissue disease (systemic lupus erythematosus, sarcoidosis, and rheumatoid arthritis), systemic infection, or malignancy. Depending on the type of RV, it can be a potentially disabling condition, in the short or long term. Early diagnosis is the key to successful treatment and better prognosis. However, early diagnosis can be difficult, because these conditions usually present with nonspecific visual symptoms for a long period before diagnostic manifestations occur. The retina should be examined in warranted patients with verified rheumatic disease, since retinal vasculitis may be asymptomatic at the beginning (peripheral retinal disease). RV can be detected clinically (often accompanied by uveitis, scleritis, or macular edema) or revealed on fluorescein fundus angiography, even if minimal signs of retinal vessel inflammation are present. RV may also represent one of the possible extra-articular manifestations of the rheumatic disease. Rheumatologists should be familiar with the ocular manifestations of these disorders, since they may not only be sight-threatening, but more importantly, could be the presenting or even the very first manifestations of active, potentially lethal systemic disease in a patient with nonspecific rheumatologic presentation.
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Affiliation(s)
- Sofia Androudi
- Department of Ophthalmology, University of Thessalia, Larissa, Greece.
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Mansour AM, Arevalo JF, Fardeau C, Hrisomalos EN, Chan WM, Lai TYY, Ziemssen F, Ness T, Sibai AM, Mackensen F, Wolf A, Hrisomalos N, Heiligenhaus A, Spital G, Jo Y, Gomi F, Ikuno Y, Akesbi J, LeHoang P, Adan A, Mahendradas P, Khairallah M, Guthoff R, Ghandour B, Küçükerdönmez C, Kurup SK. Three-year visual and anatomic results of administrating intravitreal bevacizumab in inflammatory ocular neovascularization. Can J Ophthalmol 2012; 47:269-74. [PMID: 22687305 DOI: 10.1016/j.jcjo.2012.03.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 01/15/2012] [Accepted: 01/25/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the 3-year visual outcome of intravitreal bevacizumab in inflammatory ocular neovascularization. DESIGN Experimental study. METHODS Retrospective multicenter consecutive case series in 81 patients with inflammatory ocular neovascularization refractory to standard therapy and treated with intravitreal bevacizumab. The outcome measures included improvement of best corrected visual acuity expressed as logarithm of minimum angle of resolution (logMAR) and paired comparison decrease in central foveal thickness by optical coherence tomography. RESULTS Mean best corrected visual acuity improved from baseline 0.699 (6/30 or 20/101) (SD 0.434) to 0.426 (6/16 or 20/53) (SD 0.428) (n = 81; p < 0.001), a gain of 2.7 lines (median 3 injections; 81 eyes; 81 patients). Paired comparisons revealed significant central foveal flattening at 3 years of 97.9 μm (n = 51; p < 0.001). In a subgroup analysis, visual improvement was significant for ocular histoplasmosis (p = 0.026); multifocal choroiditis (p = 0.05); serpiginous choroiditis (p = 0.028); ocular toxoplasmosis (p = 0.042); and punctate inner choroidopathy (p = 0.015). In a subgroup analysis, foveal flattening was significant for ocular histoplasmosis (p = 0.004); multifocal choroiditis (p = 0.007); serpiginous choroiditis (p = 0.011); and punctate inner choroidopathy (p = 0.001). Of the group, 5 eyes developed submacular fibrosis, 1 eye retinal pigment epithelial tear, and 1 eye macular ischemia in the context of vasculitis. CONCLUSION At 3 years, intravitreal bevacizumab sustained significant visual improvement of 2.7 lines and significant foveal flattening of 98 μm in a wide variety of inflammatory ocular diseases without major complications after a median of 3 injections.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
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Effects of intravitreal bevacizumab on inflammatory choroidal neovascular membrane. Eur J Ophthalmol 2012; 23:114 - 118. [PMID: 22890601 DOI: 10.5301/ejo.5000192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 12/31/2022]
Abstract
purpose. To test the efficacy of intravitreal bevacizumab (IB) in the treatment of inflammatory choroidal neovascularization (CNV).
Methods. A prospective interventional study on patients with subfoveal CNV secondary to posterior/diffuse uveitis treated with 1.5 mg/0.05 mL of IB. Eight eyes of 8 patients, with mean follow-up of 19.25±6 months, were included. The measurements adopted were 1) changes in best-corrected visual acuity (BCVA), 2) reduction in CNV size, and 3) changes in central foveolar thickness (CFT) measured by optical coherence tomography.
Results. The mean number of intravitreal injections was 3.75±1.38. After IB treatment, the mean BCVA improved significantly, from 0.27±0.10 before treatment to 0.5±0.29 after treatment (p<0.05). The CFT also responded well to IB, with 402.75±114.11 µm preoperatively, and after treatment 300.5±90.98 µm (p<0.01). Notably, all patients showed a reduction in the size of the CNV and BCVA remained stable or improved in 7 eyes (87.5%). No episode of active intraocular inflammation was observed and patients continued to receive their systemic steroid or immunosuppressive therapy.
Conclusions. Intravitreal bevacizumab may be an additional strategy in inflammatory CNV of eyes with controlled uveitis.
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Mansour AM, Mackensen F, Mahendradas P, Khairallah M, Lai TY, Bashshur Z. Five-year visual results of intravitreal bevacizumab in refractory inflammatory ocular neovascularization. Clin Ophthalmol 2012; 6:1233-7. [PMID: 22927733 PMCID: PMC3422149 DOI: 10.2147/opth.s34294] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the 5-year visual outcome of intravitreal bevacizumab in inflammatory ocular neovascularization. Methods Retrospective, multicenter, consecutive case series of eight patients with inflammatory ocular neovascularization refractory to standard therapy who were treated with intravitreal bevacizumab and followed for 5 years after first injection. The outcome measures included improvement of best-corrected visual acuity expressed as logarithm of minimum angle of resolution. Results Mean best-corrected visual acuity significantly improved from 0.58 at baseline (6/23 or 20/76; standard deviation = 0.32) to 0.20 at final assessment (6/10 or 20/32; standard deviation = 0.25) (n = 8; P = 0.02), a gain of 3.8 lines (median: three injections; eight eyes; eight patients). No ocular or systemic complications from intravitreal bevacizumab were noted. Conclusion At 5 years, intravitreal bevacizumab sustained significant visual improvement in ocular neovascularization due to a variety of inflammatory ocular diseases without major complications after a median of three injections.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
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Abstract
Autoimmune uveitis (AIU) is among the leading causes of preventable blindness. It can be isolated, precede, or appear in the course of a systemic autoimmune inflammatory disease. When suspected, AIU should be promptly referred to an ophthalmologist for proper anatomic classification and local treatment. In recurrent and chronic forms, systemic treatment should be started, usually with corticosteroids and immunesuppressors. In cases of lack of efficacy or intolerance, biologic agents such as monoclonal antibodies anti-TNF (infliximab and adalimumab) and others (abatacept and tocilizumab) are being used. The clinical diseases associated to AIU and the experimental models have helped in the understanding of the pathogenic mechanism. The treatment schemes have improved, and recent advances in basic knowledge are leading to even more effective targeted therapies.
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Intravitreal bevacizumab for severe vaso-occlusive retinopathy in systemic lupus erythematosus. Rheumatol Int 2011; 33:247-51. [DOI: 10.1007/s00296-011-2139-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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Julián K, Terrada C, Fardeau C, Cassoux N, Français C, LeHoang P, Bodaghi B. Intravitreal bevacizumab as first local treatment for uveitis-related choroidal neovascularization: long-term results. Acta Ophthalmol 2011; 89:179-84. [PMID: 21348964 DOI: 10.1111/j.1755-3768.2010.02046.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To report long-term results of intravitreal (IVT) bevacizumab as first local treatment for choroidal neovascularization (CNV) secondary to uveitis. METHODS Files of patients receiving 1.25 mg/0.05 ml bevacizumab as primary local treatment for CNV were retrospectively reviewed. Main outcomes were change in best-corrected visual acuity (BCVA) and central foveolar thickness (CFT), treatment-related adverse events, and number and frequency of injections. RESULTS Fifteen eyes from fifteen patients were included. Multifocal choroiditis and panuveitis were the diagnosis in seven, ampiginous choroiditis in two, and for six remaining, serpiginous choroiditis, sympathetic ophthalmia, Vogt-Koyanagi-Harada syndrome, punctuate inner choroidopathy, tuberculosis and idiopathic inflammation. In 13 eyes, neovascularization was subfoveal, and peripapillary in two. Intraocular inflammation was strictly controlled in all cases by the time of injections. BCVA improved from logMar 0.53 to logMar 0.29 in 12 eyes (80%), while CFT decreased from 239.06 to 195.2 μm in 13 (87%). Twelve eyes received more than one injection; mean number in this group was 4.25 (2-8), and frequency 1 every 12.97 weeks. There were no adverse events related to bevacizumab or the procedure. Median follow-up was 17.6 months (8-25). CONCLUSIONS First-intention IVT bevacizumab for inflammatory CNV showed transient improvement in BCVA and CFT, in eyes under controlled inflammation. Reinjection was needed in most cases. Further work should conclude about safety related to repeated injections.
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Affiliation(s)
- Karina Julián
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
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Wolf A, Thurau S, Kook D, Hoeing A, Priglinger S, Kampik A, Haritoglou C. Intravitreal bevacizumab for choroidal neovascularization secondary to inflammation. Acta Ophthalmol 2010; 88:e295-6. [PMID: 19860782 DOI: 10.1111/j.1755-3768.2009.01681.x] [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: 12/20/2022]
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Shah SP, Hubschman JP, Bourges JL, Hu AYH, Schwartz SD. Limited long-term efficacy of intravitreous anti-VEGF pharmacotherapy in sarcoidosis complicated by peripapillary choroidal neovascular membrane. Acta Ophthalmol 2010; 88:e243-4. [PMID: 19740129 DOI: 10.1111/j.1755-3768.2009.01590.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sudharshan S, Ganesh SK, Biswas J. Current approach in the diagnosis and management of posterior uveitis. Indian J Ophthalmol 2010; 58:29-43. [PMID: 20029144 PMCID: PMC2841371 DOI: 10.4103/0301-4738.58470] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous, optic nerve head and retinal blood vessels. Thorough clinical evaluation gives a clue to the diagnosis while ancillary investigations and laboratory tests assist in confirming the diagnosis. Newer evolving techniques in the investigations and management have increased the diagnostic yield. In case of diagnostic dilemma, intraocular fluid evaluation for polymerase chain testing for the genome and antibody testing against the causative agent provide greater diagnostic ability.
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Akesbi J, Brousseaud FX, Adam R, Rodallec T, Nordmann JP. Intravitreal bevacizumab (Avastin) in idiopathic retinitis, vasculitis, aneurysms and neuroretinitis. Acta Ophthalmol 2010; 88:e40-1. [PMID: 19508455 DOI: 10.1111/j.1755-3768.2009.01540.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lott MN, Schiffman JC, Davis JL. Bevacizumab in inflammatory eye disease. Am J Ophthalmol 2009; 148:711-717.e2. [PMID: 19660732 DOI: 10.1016/j.ajo.2009.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 06/01/2009] [Accepted: 06/02/2009] [Indexed: 01/19/2023]
Abstract
PURPOSE To report the effect of intravitreal bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) on visual acuity and macular thickness in patients with inflammatory choroidal neovascularization (CNV) or cystoid macular edema (CME). DESIGN Retrospective, noncomparative, interventional case series. METHODS Each eye received 1.25 mg of intravitreal bevacizumab at baseline. Follow-up examinations were scheduled at 1- to 2-month intervals, with additional injections at the discretion of the physician. Comprehensive evaluations, including Snellen best-corrected visual acuity (BVCA) and optical coherence tomography measurements, were performed at each visit. Main outcome measures were BCVA and central subfield thickness (CST), as measured by optical coherence tomography. RESULTS Thirty-four eyes of 30 patients with inflammatory CNV (n = 21 eyes of 19 patients; 9 male, 10 female) or CME (n = 13 eyes of 11 patients; 4 male, 7 female) were identified. Median ages were 52 years (range, 7 to 83) and 67 years (range, 17 to 83) for the CNV and CME groups, respectively. The median length of follow-up for CNV eyes was 7 months (range, 1 to 28) while the median follow-up for CME eyes was 13 months (range, 1 to 20). Both groups received a median of two injections (range, 1 to 9 for CNV and 1 to 4 for CME). For eyes with CNV, BCVA improved significantly at follow-up month 1, but was not different from baseline thereafter; CST remained unchanged throughout follow-up. For eyes with CME, neither BCVA nor CST changed significantly over the course of follow-up. CONCLUSIONS Bevacizumab appears to stabilize BCVA and CST for eyes with inflammatory CNV or CME.
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Moon SW, Song Y, Cho HY, Lee BR, Sohn JH, Park YS. The Effect of Intravitreal Bevacizumab Injection in Eales' Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.10.1595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Won Moon
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Yumi Song
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Hee Yoon Cho
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Byung Ro Lee
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
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