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Saifaldein AA, AlBloushi AF, Altariqi SM, Aljarallah S, Abu El-Asrar AM. Occlusive Retinal Vasculitis in Patients with Multiple Sclerosis. Ocul Immunol Inflamm 2023; 31:1750-1757. [PMID: 35914306 DOI: 10.1080/09273948.2022.2103717] [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: 03/29/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the frequency, clinical findings and outcomes of occlusive retinal vasculitis in patients with multiple sclerosis (MS). METHODS A retrospective case series. RESULTS During the period between January 2000 and December 2021, we identified 24 patients who were diagnosed to have uveitis associated with MS. Among them, four (16.6%) patients presented with bilateral occlusive retinal vasculitis who were diagnosed to have MS prior to presentation. All patients were treated successfully with a combination of systemic corticosteroids combined with mycophenolate mofetil. In addition, scatter laser photocoagulation was applied to the ischemic retina in all eyes. CONCLUSIONS Early recognition and prompt treatment with systemic immunosuppressive agents and scatter laser photocoagulation prevent complications and improve outcomes in MS patients with occlusive retinal vasculitis.
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Affiliation(s)
- Amjad Ameen Saifaldein
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman M Altariqi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salman Aljarallah
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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2
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Glover K, Mishra D, Singh TRR. Epidemiology of Ocular Manifestations in Autoimmune Disease. Front Immunol 2021; 12:744396. [PMID: 34795665 PMCID: PMC8593335 DOI: 10.3389/fimmu.2021.744396] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 01/19/2023] Open
Abstract
The global prevalence of autoimmune diseases is increasing. As a result, ocular complications, ranging from minor symptoms to sight-threatening scenarios, associated with autoimmune diseases have also risen. These ocular manifestations can result from the disease itself or treatments used to combat the primary autoimmune disease. This review provides detailed insights into the epidemiological factors affecting the increasing prevalence of ocular complications associated with several autoimmune disorders.
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Affiliation(s)
| | | | - Thakur Raghu Raj Singh
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, Belfast, United Kingdom
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3
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Neuro-ophthalmologic manifestations of multiple sclerosis other than acute optic neuritis. Mult Scler Relat Disord 2020; 48:102730. [PMID: 33412489 DOI: 10.1016/j.msard.2020.102730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 11/21/2022]
Abstract
Acute optic neuritis is the most common neuro-opthalmologic manifestation of multiple sclerosis (MS). Treatment with high-dose intravenous corticosteroids accelerates visual recovery, although it has no long-term visual benefit. MS has several others, less common, neuro-ophthalmological manifestations, where corticotherapy may not be the best treatment option. Neuro-ophthalmologic manifestations of MS other than optic neuritis can be divided in afferent and efferent visual pathways, acute and chronic and may be associated with drugs that are employed in MS. The authors propose is to review the neuro-ophthalmologic manifestations of multiple sclerosis other than optic neuritis. Recognition of these leads to a more targeted treatment and may prevent visual deterioration.
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4
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Coric D, Ometto G, Montesano G, Keane PA, Balk LJ, Uitdehaag BMJ, Petzold A, Crabb DP, Denniston AK. Objective quantification of vitreous haze on optical coherence tomography scans: no evidence for relationship between uveitis and inflammation in multiple sclerosis. Eur J Neurol 2019; 27:144-e3. [PMID: 31342606 PMCID: PMC6916624 DOI: 10.1111/ene.14048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE The occurrence of intermediate uveitis, which is characterized by the presence of vitreous haze (VH), in patients with multiple sclerosis (MS) may be a sign of coexistent inflammatory central nervous system (CNS) disease activity. Using an automated algorithm to quantify VH on optical coherence tomography (OCT) scans, the aim was to investigate whether VH in MS patients is associated with signs of inflammatory CNS disease activity. METHODS Vitreous haze was quantified on OCT macular volume scans of 290 MS patients and 85 healthy controls (HCs). The relationship between VH and clinical, retinal OCT and magnetic resonance imaging parameters of inflammatory disease activity was investigated using generalized estimating equations. RESULTS Mean VH scores did not differ between patients and HCs (P = 0.629). Six patients (2.1%) showed values higher than the highest of the controls by HCs. VH scores did not differ between the different disease types or between eyes with and without a history of optic neuritis (P = 0.132). VH was not associated with inner nuclear layer volume on OCT (P = 0.233), cerebral T2 lesion load on magnetic resonance imaging (P = 0.416) or the development of new relapses (P = 0.205). CONCLUSION In this study, OCT-based automated VH estimation did not detect increased vitreous inflammation in MS patients compared to HCs and did not find an association with CNS inflammatory burden.
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Affiliation(s)
- D Coric
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - G Ometto
- Optometry and Visual Sciences, City, University of London, London, UK
| | - G Montesano
- Optometry and Visual Sciences, City, University of London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - L J Balk
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - B M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Petzold
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands.,Moorfields Eye Hospital, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK
| | - D P Crabb
- Optometry and Visual Sciences, City, University of London, London, UK
| | - A K Denniston
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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5
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Olsen TG, Frederiksen J. The association between multiple sclerosis and uveitis. Surv Ophthalmol 2017; 62:89-95. [DOI: 10.1016/j.survophthal.2016.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 11/16/2022]
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6
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Affiliation(s)
- Julie Vadboncoeur
- Resident in Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Katarzyna Biernacki
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Alexandre Prat
- Department of Neurology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Laurence Jaworski
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
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7
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Hickman SJ, Raoof N, McLean RJ, Gottlob I. Vision and multiple sclerosis. Mult Scler Relat Disord 2014; 3:3-16. [DOI: 10.1016/j.msard.2013.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
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9
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Abstract
Background/Aim. Multiple sclerosis (MS) is an immunemediated disorder of the
central nervous system (CNS), characterized by inflammation, demyelination
and axonal loss. Retinal periphlebitis (RP) is often present in MS patients
with similar evolution and histopathological changes as MS lesions. The aim
of this study was to analyze the presence of RP in MS patients during
different clinical phases, and its connection with impairment of blood-brain
barrier. Methods. The study included 45 patients (26 females and 19 males)
with MS. Their average age was 33.2 ? 8.1 years. There were 28 patients with
relapsing-remitting (RR) form, 7 with primary progresive (PP) and 10 with
secondary progressive (SP) form of MS. There were 27 patients in the relapse
and 18 patients in the remission phase. The average MS duration was 7.48 ?
1.3 years. Ophthalmological, neurological and MRI examination were performed
in all the patients, as well as cerebrospinal fluid sampling. Albumin ratio
and IgG index were calculated in all the patients. Results. There were 9
patients with RP, and 36 without it. MS duration was significantly longer in
the RP group. RP was much more common in the progressive form and was not
present in the remission phase of MS. Albumin ratio values were increased in
the group with RP. IgG index and IgG synthesis according to Tourtellotte
formula, were statistically higher in the group of patients with RP. The
values of visual evoked potentials (VEP's) latency were significantly higher
in the group of patients with RP. Conclusion. The presence of RP is a
reliable indicator of MS activity and might be considered as a parameter for
monitoring the disease activity and effects of the treatment.
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10
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Graves J, Balcer LJ. Eye disorders in patients with multiple sclerosis: natural history and management. Clin Ophthalmol 2010; 4:1409-22. [PMID: 21188152 PMCID: PMC3000766 DOI: 10.2147/opth.s6383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system and leading cause of disability in young adults. Vision impairment is a common component of disability for this population of patients. Injury to the optic nerve, brainstem, and cerebellum leads to characteristic syndromes affecting both the afferent and efferent visual pathways. The objective of this review is to summarize the spectrum of eye disorders in patients with MS, their natural history, and current strategies for diagnosis and management. We emphasize the most common disorders including optic neuritis and internuclear ophthalmoparesis and include new techniques, such as optical coherence tomography, which promise to better our understanding of MS and its effects on the visual system.
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Affiliation(s)
- Jennifer Graves
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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11
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Abstract
PURPOSE To describe choroiditis in multiple sclerosis (MS). DESIGN Case report. METHODS Clinical findings, fluorescein angiography, optical coherence tomography, and treatment are presented. A 50-year-old man with MS presented with vitritis and multiple choroidal lesions in the fovea and periphery in both eyes. Fluorescein angiography (FA) revealed early hyperfluorescence and late leakage of the lesions. Optical coherence tomography showed subretinal fluid in the right eye. One month post-treatment, visual acuity returned to the baseline with complete resolution of subretinal fluid and decreased leakage on FA. CONCLUSIONS Choroiditis might be related to MS, but may also be a chance occurrence.
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12
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Forooghian F, Adamus G, Sproule M, Westall C, O'Connor P. Enolase autoantibodies and retinal function in multiple sclerosis patients. Graefes Arch Clin Exp Ophthalmol 2007; 245:1077-84. [PMID: 17219105 DOI: 10.1007/s00417-006-0527-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2006] [Revised: 12/13/2006] [Accepted: 12/14/2006] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Electroretinographic (ERG) abnormalities have been reported in multiple sclerosis (MS), as well as the presence of circulating antiretinal antibodies. We and others have reported cases of impaired vision and diminished ERGs in MS patients with alpha-enolase autoantibodies. Anti-enolase antibodies have been implicated in autoimmune retinopathy. We performed this study to further explore the relationship between antiretinal antibodies and ERG changes in patients with MS. METHODS Patients with clinically definite MS and normal visual acuity were recruited for this study, along with healthy controls. All patients and controls had ERG testing done according to ISCEV standards. Patient and control sera were analyzed for the presence of antiretinal antibodies using Western blot and ELISA techniques, and HLA class II typing was performed using polymerase chain reaction. RESULTS We found a statistically significant difference between MS patients and controls in the rod-cone b-wave implicit time (p < 0.005). We found autoantibodies against alpha-enolase in 38% of MS patients and 11% of controls (p < 0.02). There was no statistically significant difference between ERG parameters of MS patients with alpha-enolase autoantibodies compared to those without alpha-enolase antibodies. Furthermore, the presence of alpha-enolase did not associate with a particular HLA haplotype. CONCLUSIONS Factors affecting the retina other than alpha-enolase antibodies may account for the delayed rod-cone b-wave implicit times observed in MS patients in this study. Anti-enolase antibodies are likely an epiphenomenon of autoimmune disease, and are not causing retinopathy in MS patients with normal visual acuity. However, the possibility of rare cases of patients with pathogenic alpha-enolase autoantibodies can not be excluded. The pathogenic contribution of these antibodies in MS patients with visual impairment deserves further investigation.
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Affiliation(s)
- Farzin Forooghian
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
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13
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Kaur P, Bennett JL. Optic neuritis and the neuro-ophthalmology of multiple sclerosis. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2007; 79:633-63. [PMID: 17531862 DOI: 10.1016/s0074-7742(07)79028-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Multiple sclerosis (MS) is the most common cause of neurological disability in young adults. Since approximately 40% of the brain is devoted to vision, demyelination commonly affects visual function, resulting in a myriad of neuro-ophthalmic symptoms. In this chapter, we examine the seminal afferent and efferent neuro-ophthalmological manifestations of MS, highlighting those history and examination findings critical for the diagnosis and treatment of various visual and ocular motor disorders. Among the topics, a special emphasis will be placed on optic neuritis, the most common clinically isolated demyelinating syndrome. This chapter focuses on the evaluation and treatment of visual sensory and oculomotor disorders in MS. The objective is to provide the reader with a working model for enhancing their care of patients with demyelinating disease.
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Affiliation(s)
- Paramjit Kaur
- Department of Neurology, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80262, USA
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14
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Forooghian F, Sproule M, Westall C, Gordon L, Jirawuthiworavong G, Shimazaki K, O'Connor P. Electroretinographic abnormalities in multiple sclerosis: possible role for retinal autoantibodies. Doc Ophthalmol 2006; 113:123-32. [PMID: 16972082 DOI: 10.1007/s10633-006-9022-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) has been associated with inflammation of the uveal tract, suggesting an immunological link between the uvea and central nervous system (CNS) in this disease. The retina is embryologically derived from the CNS, and it is conceivable that retinal antigens may also be recognized by the immune system in MS. Electroretinographic abnormalities, as well as retinal autoantibodies, have previously been described in MS. We performed this study to further explore the possibility of retinal autoimmunity in MS. METHODS Thirty-four patients with clinically definite MS and thirty-seven healthy controls were recruited. All patients and controls had standard electroretinographic (ERG) testing done, as well as a brightflash ERG protocol to isolate rod photoreceptor function. Patient and control sera were analyzed for the presence of antiretinal antibodies using Western blot techniques. RESULTS We found statistically significant differences between MS patients and controls in four ERG parameters. In the MS group, implicit times of the rod-cone b-wave response, cone b-wave response, and rod photoreceptor response were increased. The amplitudes of the photopic oscillatory potentials were reduced in the MS group. Patients with the highest titres of retinal autoantibodies had delayed rod-cone b-wave implicit times and diminished photopic oscillatory potential amplitudes. CONCLUSIONS We report ERG evidence of retinal dysfunction in patients with MS. We also report the first use of the brightflash ERG protocol in MS, which demonstrated rod photoreceptor dysfunction. Patients with the highest antiretinal antibody titres had abnormal ERG recordings. Retinal autoimmunity is a possible explanation for these observed ERG abnormalities in MS patients.
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Affiliation(s)
- Farzin Forooghian
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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15
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Abstract
PURPOSE OF REVIEW Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system that is commonly manifested by visual system involvement and that may initially present with ophthalmologic symptoms. This paper reviews recent findings regarding the ocular manifestations in multiple sclerosis. RECENT FINDINGS Manifestations of multiple sclerosis in the eye include both the afferent and efferent visual pathways. Optic neuritis, the most common ocular manifestation of multiple sclerosis, may be the initial clinical disease manifestation. Recent long-term follow-up data show that most patients with demyelinating optic neuritis have an excellent prognosis for recovery of central visual acuity. Evidence is emerging, however, for significant and broad reduction in both contrast sensitivity and color perception in multiple sclerosis patients despite near-normal visual acuities. Ocular motor deficits in multiple sclerosis include internuclear ophthalmoplegia and nystagmus, resulting in diplopia, oscillopsia, blurred visual, loss of stereopsis, and reading fatigue. Multiple sclerosis also may be associated with ocular inflammatory diseases, in particular pars planitis and retinal periphlebitis. SUMMARY Ocular findings may be initial manifestations of multiple sclerosis and may predict additional demyelinating events. Recognizing these syndromes and signs will help clinicians to properly evaluate the patient, formulate an appropriate differential diagnosis, be able to discuss the prognosis with the patient, and help develop an effective therapeutic plan.
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Affiliation(s)
- Ling Chen
- Jules Stein Eye Institute, Ocular Inflammatory Disease Center, University of California, Los Angeles, and Greater Los Angeles VA Healthcare System, Los Angeles, California 90095, USA
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16
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Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S. The neuro-ophthalmology of multiple sclerosis. Lancet Neurol 2005; 4:111-21. [PMID: 15664543 DOI: 10.1016/s1474-4422(05)00992-0] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Abstract
Neurological disease can involve the eye in many ways. Every structure--the conjunctiva, cornea, anterior chamber, iris, lens, vitreous humour, retina, choroid, and optic nerve--can be affected. In many cases, ocular involvement is the first manifestation of the underlying disease. In such cases, the ability of the physician to recognise the nature and significance of the ocular abnormality can lead to early diagnosis and successful treatment of the underlying condition. In other cases, recognition of the ocular abnormality can prevent permanent visual dysfunction.
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Affiliation(s)
- Neil R Miller
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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18
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Abstract
Retinal vasculitis is a rare, but potentially blinding intraocular inflammatory condition with diverse aetiology. Although commonly idiopathic, it has a strong association with systemic inflammatory diseases known to involve other areas of the central nervous system, most notably Behcet's disease, sarcoidosis, systemic lupus erythematosis and multiple sclerosis. This article describes the clinicopathologic features of retinal vasculitis and its visually damaging sequelae, reviewing available human histopathologic studies and work with experimental models to discuss the pathogenesis and immunopathology. Evidence indicates that noninfective retinal vasculitis is an autoimmune condition that may be induced by antecedent infection with microbes cross-reacting with putative autoantigens, influenced by genetic susceptibility of both HLA associations and cytokine polymorphisms. The growing understanding of the cellular mechanisms involved in the effector immune response is already providing a rationale for more specific therapeutic approaches.
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Affiliation(s)
- E H Hughes
- University of Bristol, Bristol Eye Hospital, Bristol, UK
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19
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Schmidt S, Wessels L, Augustin A, Klockgether T. Patients with Multiple Sclerosis and concomitant uveitis/periphlebitis retinae are not distinct from those without intraocular inflammation. J Neurol Sci 2001; 187:49-53. [PMID: 11440744 DOI: 10.1016/s0022-510x(01)00520-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent models of experimental autoimmune encephalomyelitis (EAE) have indicated that antigens co-expressed in the retina and uvea might be of pathogenetic relevance in Multiple Sclerosis (MS). We investigated the clinical spectrum and magnetic resonance imaging of 11 MS patients with concomitant uveitis, and determined the frequency of clinically silent intraocular inflammation in a prospective series of 50 patients. Two of the 11 patients had panuveitis, seven had anterior, and the remaining two had intermediate uveitis. The onset of uveitis preceded that of neurological symptoms by a mean of 8.5 years (range 1-20). None of the 50 MS patients studied prospectively by using slit lamp examinations and dilated funduscopy showed any evidence of uveitis but six patients had signs of retinal inflammation ("periphlebitis retinae"). Cranial MRI did not reveal "atypical" lesional distribution in MS patients with uveitis or periphlebitis retinae. No correlation between the type of MS and uveitis, or between the degree of neurological disability and the type of uveitis was found.
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Affiliation(s)
- S Schmidt
- Department of Neurology, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany.
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20
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Walsh MJ, Murray JM. Dual implication of 2',3'-cyclic nucleotide 3' phosphodiesterase as major autoantigen and C3 complement-binding protein in the pathogenesis of multiple sclerosis. J Clin Invest 1998; 101:1923-31. [PMID: 9576757 PMCID: PMC508779 DOI: 10.1172/jci1983] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Multiple sclerosis (MS) is characterized by intra-blood-brain barrier immunoglobulin synthesis that persists lifelong. Subcellular fractionation and two-dimensional electrophoresis were used in conjunction with immune precipitation and immunoblotting to identify antigenic determinants for this immunoglobulin. We report that 2', 3'-cyclic nucleotide 3'-phosphodiesterase (CNP), a protein associated with oligodendrocyte/myelin membranes, also present in lymphocytes and retina, is one major target for the humoral response. Antibodies to CNP are detected in sera of 74% of MS patients. The antibodies are IgM and are present in serum in high titer as well as in cerebrospinal fluid. The antibody response is temporally persistent, consistent with systemic immune activation and persistent antigenic stimulation. Moreover, CNP is isolated as an immune complex from MS brain. CNP is expressed as two isoforms, with CNPII identical to CNPI but with a 20-amino acid extension at the amino terminus of CNPII; however, the antibody response is exclusively restricted to CNPI. In contrast, both isoforms bind the C3 complement, providing a plausible mechanism in MS central nervous system (CNS) for opsonization of myelin membrane CNP, mediated via the C3 receptor, and phagocytosis of CNP-Ig immune complexes, mediated by membrane Ig Fc receptors of macrophages and CNS microglia.
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Affiliation(s)
- M J Walsh
- Department of Neurology, Mount Sinai School of Medicine, New York 10029, USA.
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